This page is part of the CCDA: Consolidated CDA Release (v3.0.0-ballot: CCDA 3.0 Ballot 1) based on FHIR (HL7® FHIR® Standard) v5.0.0. . For a full list of available versions, see the Directory of published versions
Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/ContinuityofCareDocumentCCD | Version: 3.0.0-ballot | |||
Active as of 2023-12-21 | Computable Name: ContinuityofCareDocumentCCD | |||
Other Identifiers: id: urn:hl7ii:2.16.840.1.113883.10.20.22.1.2:2024-05-01 |
This document type was originally based on the Continuity of Care Document (CCD) Release 1.1 which itself was derived from HITSP C32 and CCD Release 1.0.
The Continuity of Care Document (CCD) represents a core data set of the most relevant administrative, demographic, and clinical information facts about a patient’s healthcare, covering one or more healthcare encounters. It provides a means for one healthcare practitioner, system, or setting to aggregate all of the pertinent data about a patient and forward it to another to support the continuity of care.
The primary use case for the CCD is to provide a snapshot in time containing the germane clinical, demographic, and administrative data for a specific patient. The key characteristic of a CCD is that the ServiceEvent is constrained to “PCPR”. This means it does not function to report new ServiceEvents associated with performing care. It reports on care that has already been provided. The CCD provides a historical tally of the care over a range of time and is not a record of new services delivered.
More specific use cases, such as a Discharge Summary, Transfer Summary, Referral Note, Consultation Note, or Progress Note, are available as alternative documents in this guide.
Usage:
Description of Profiles, Differentials, Snapshots and how the different presentations work.
This structure is derived from USRealmHeader
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ClinicalDocument | 1..1 | USRealmHeader | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, @classCode, @moodCode, realmCode, typeId, templateId, id, code, title, sdtcStatusCode, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, copyTime, recordTarget, author, dataEnterer, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, relatedDocument, authorization, componentOf, component, realmCode, typeId, templateId, templateId, id, code, title, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, recordTarget, author, dataEnterer, informant, informant, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, authorization, componentOf Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) | |
templateId | 2..* | II | ||
templateId:CCD | 1..1 | II | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.2 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
code | 1..1 | CE | Summarization of Episode Note | |
@code | 1..1 | cs | Required Pattern: 34133-9 | |
@codeSystem | 1..1 | oid, uuid, ruid | LOINC Required Pattern: 2.16.840.1.113883.6.1 | |
author | 1..* | Author | The author element represents the creator of the clinical document. The author may be a device or a person. | |
assignedAuthor | C | 1..1 | AssignedAuthor | 1198-8456: Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). |
documentationOf | 1..1 | DocumentationOf | The documentationOf relationship in a Continuity Care Document contains the representation of providers who are wholly or partially responsible for the safety and well-being of a subject of care. | |
serviceEvent | C | 1..1 | ServiceEvent | The main activity being described by a CCD is the provision of healthcare over a period of time. This is shown by setting the value of serviceEvent/@classCode to 'PCPR' (care provision) and indicating the duration over which care was provided in serviceEvent/effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g., reviewed during the stated time range).
NOTE: Implementations originating a CCD should take care to discover what the episode of care being summarized is. For example, when a patient fills out a form providing relevant health history, the episode of care being documented might be from birth to the present. should-performer: SHOULD contain performer |
@classCode | 1..1 | cs | Fixed Value: PCPR | |
effectiveTime | 1..1 | USRealmDateTimeInterval | Base for all types and resources | |
low | 1..1 | IVXB_TS | **MAY** be precise to at least the second | |
high | 1..1 | IVXB_TS | **MAY** be precise to at least the second | |
performer | 0..* | Performer1 | The serviceEvent/performer represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patient's key healthcare providers would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors. | |
@typeCode | 1..1 | cs | Fixed Value: PRF | |
assignedEntity | C | 1..1 | AssignedEntity | SG 20230709: Illegal constraint - base has min = 1 (deleted min=0) 1198-32466: If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). |
id | 1..* | II | ||
assignedPerson | 0..1 | Person | ||
component | 1..1 | Component | ||
structuredBody | C | 1..1 | StructuredBody | should-section-procedures: SHOULD contain a Procedures Section should-section-plan-of-treatment: SHOULD contain a Plan of Treatment Section |
Slices for component | 6..* | InfrastructureRoot | Slice: Unordered, Open by profile:section | |
component:allergies | 1..1 | InfrastructureRoot | ||
section | 1..1 | AllergiesAndIntolerancesSection | Base for all types and resources | |
component:medications | 1..1 | InfrastructureRoot | ||
section | 1..1 | MedicationsSection | Base for all types and resources | |
component:problems | 1..1 | InfrastructureRoot | ||
section | 1..1 | ProblemSection | Base for all types and resources | |
component:procedures | 0..1 | InfrastructureRoot | ||
section | 1..1 | ProceduresSection | Base for all types and resources | |
component:results | 1..1 | InfrastructureRoot | ||
section | 1..1 | ResultsSection | Base for all types and resources | |
component:advDirectives | 0..1 | InfrastructureRoot | ||
section | 1..1 | AdvanceDirectivesSection | Base for all types and resources | |
component:encounters | 0..1 | InfrastructureRoot | ||
section | 1..1 | EncountersSection | Base for all types and resources | |
component:famHistory | 0..1 | InfrastructureRoot | ||
section | 1..1 | FamilyHistorySection | Base for all types and resources | |
component:functionalStatus | 0..1 | InfrastructureRoot | ||
section | 1..1 | FunctionalStatusSection | Base for all types and resources | |
component:immunizations | 0..1 | InfrastructureRoot | ||
section | 1..1 | ImmunizationsSection | Base for all types and resources | |
component:medEquipment | 0..1 | InfrastructureRoot | ||
section | 1..1 | MedicalEquipmentSection | Base for all types and resources | |
component:payers | 0..1 | InfrastructureRoot | ||
section | 1..1 | PayersSection | Base for all types and resources | |
component:planOfTreatment | 0..1 | InfrastructureRoot | ||
section | 1..1 | PlanofTreatmentSection | Base for all types and resources | |
component:socialHist | 1..1 | InfrastructureRoot | ||
section | 1..1 | SocialHistorySection | Base for all types and resources | |
component:vitalSigns | 1..1 | InfrastructureRoot | ||
section | 1..1 | VitalSignsSection | Base for all types and resources | |
component:mentalStatus | 0..1 | InfrastructureRoot | ||
section | 1..1 | MentalStatusSection | Base for all types and resources | |
component:nutrition | 0..1 | InfrastructureRoot | ||
section | 1..1 | NutritionSection | Base for all types and resources | |
Documentation for this format |
Id | Grade | Path(s) | Details | Requirements |
1198-8456 | error | ClinicalDocument.author.assignedAuthor | Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). : assignedPerson.exists() or (assignedAuthoringDevice.exists() and representedOrganization.exists()) | |
1198-32466 | warning | ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). : assignedPerson.exists() implies id.where(root = '2.16.840.1.113883.4.6') | |
should-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-section-plan-of-treatment | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Plan of Treatment Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/PlanofTreatmentSection')) | |
should-section-procedures | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Procedures Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProceduresSection')) |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ClinicalDocument | C | 1..1 | USRealmHeader | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, @classCode, @moodCode, realmCode, typeId, templateId, id, code, title, sdtcStatusCode, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, copyTime, recordTarget, author, dataEnterer, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, relatedDocument, authorization, componentOf, component, realmCode, typeId, templateId, templateId, id, code, title, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, recordTarget, author, dataEnterer, informant, informant, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, authorization, componentOf Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) |
realmCode | 1..1 | CS | ||
@code | 1..1 | cs | Required Pattern: US | |
typeId | 1..1 | II | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | Fixed Value: POCD_HD000040 | |
Slices for templateId | 2..* | II | Slice: Unordered, Open by value:root, value:extension | |
templateId:us-realm | 1..1 | II | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.1 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
templateId:CCD | 1..1 | II | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.2 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
id | 1..1 | II | **SHALL** be a globally unique identifier for the document (CONF:4537-9991). | |
code | C | 1..1 | CE | Summarization of Episode Note Binding: FHIRDocumentTypeCodes (example) |
@code | 1..1 | cs | Required Pattern: 34133-9 | |
@codeSystem | 1..1 | oid, uuid, ruid | LOINC Required Pattern: 2.16.840.1.113883.6.1 | |
title | 1..1 | ST | The title can either be a locally defined name or the displayName corresponding to clinicalDocument/code | |
effectiveTime | C | 1..1 | USRealmDateTime | Base for all types and resources |
confidentialityCode | 1..1 | CE | Binding: HL7 BasicConfidentialityKind (preferred) | |
@code | 1..1 | cs | ||
languageCode | 1..1 | CS | Binding: AllLanguages (required) | |
recordTarget | 1..* | RecordTarget | The recordTarget records the administrative and demographic data of the patient whose health information is described by the clinical document; each recordTarget must contain at least one patientRole element | |
patientRole | 1..1 | PatientRole | ||
id | 1..* | II | ||
addr | C | 1..* | USRealmAddress | (USCDI) Address |
telecom | C | 1..* | TEL | (USCDI) Phone Number / Email |
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
patient | C | 1..1 | Patient | |
name | C | 1..* | USRealmPatientNamePTNUSFIELDED | Base for all types and resources |
administrativeGenderCode | 1..1 | CE | Binding: Administrative Gender (HL7 V3) (required) | |
birthTime | C | 1..1 | TS | (USCDI) Date of Birth - **MAY** be precise to the minute (CONF:4537-32418) (For cases where information about newborn's time of birth needs to be captured) |
raceCode | 1..1 | CE | (USCDI) Race Binding: Race Category Excluding Nulls (required) | |
ethnicGroupCode | 1..1 | CE | (USCDI) Ethnicity Binding: Ethnicity (required) | |
author | 1..* | Author | The author element represents the creator of the clinical document. The author may be a device or a person. | |
time | C | 1..1 | USRealmDateTime | Base for all types and resources |
assignedAuthor | C | 1..1 | AssignedAuthor | 1198-8456: Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). |
Slices for id | 1..* | II | Slice: Unordered, Open by value:root | |
id:npi | C | 0..1 | II | |
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.4.6 | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
Slices for informant | 0..* | Informant | Slice: Unordered, Open by exists:relatedEntity, exists:assignedEntity | |
informant:provider | 0..* | Informant | The informant element describes an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient. | |
assignedEntity | 1..1 | AssignedEntity | ||
id | 1..* | II | If assignedEntity/id is a provider then this id, **SHOULD** include zero or one [0..1] id where id/@root ="2.16.840.1.113883.4.6" National Provider Identifier (CONF:4537-9946). | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
assignedPerson | 1..1 | Person | ||
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
informant:non-provider | 0..* | Informant | The informant element describes an information source (who is not a provider) for any content within the clinical document. This informant would be used when the source of information has a personal relationship with the patient or is the patient. | |
relatedEntity | 1..1 | RelatedEntity | ||
custodian | 1..1 | Custodian | The custodian element represents the organization that is in charge of maintaining and is entrusted with the care of the document. There is only one custodian per CDA document. Allowing that a CDA document may not represent the original form of the authenticated document, the custodian represents the steward of the original source document. The custodian may be the document originator, a health information exchange, or other responsible party. | |
assignedCustodian | 1..1 | AssignedCustodian | ||
representedCustodianOrganization | 1..1 | CustodianOrganization | ||
id | 1..* | II | ||
name | 1..1 | ON | ||
telecom | C | 1..1 | TEL | |
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
addr | C | 1..1 | USRealmAddress | Base for all types and resources |
documentationOf | 1..1 | DocumentationOf | The documentationOf relationship in a Continuity Care Document contains the representation of providers who are wholly or partially responsible for the safety and well-being of a subject of care. | |
serviceEvent | C | 1..1 | ServiceEvent | The main activity being described by a CCD is the provision of healthcare over a period of time. This is shown by setting the value of serviceEvent/@classCode to 'PCPR' (care provision) and indicating the duration over which care was provided in serviceEvent/effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g., reviewed during the stated time range).
NOTE: Implementations originating a CCD should take care to discover what the episode of care being summarized is. For example, when a patient fills out a form providing relevant health history, the episode of care being documented might be from birth to the present. should-performer: SHOULD contain performer |
@classCode | 1..1 | cs | Binding: ActClass (required) Fixed Value: PCPR | |
effectiveTime | C | 1..1 | USRealmDateTimeInterval | Base for all types and resources |
low | C | 1..1 | IVXB_TS | **MAY** be precise to at least the second |
high | C | 1..1 | IVXB_TS | **MAY** be precise to at least the second |
performer | 0..* | Performer1 | The serviceEvent/performer represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patient's key healthcare providers would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors. | |
@typeCode | 1..1 | cs | Binding: x_ServiceEventPerformer (required) Fixed Value: PRF | |
assignedEntity | C | 1..1 | AssignedEntity | SG 20230709: Illegal constraint - base has min = 1 (deleted min=0) 1198-32466: If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). |
id | 1..* | II | ||
assignedPerson | 0..1 | Person | ||
component | 1..1 | Component | ||
structuredBody | C | 1..1 | StructuredBody | should-section-procedures: SHOULD contain a Procedures Section should-section-plan-of-treatment: SHOULD contain a Plan of Treatment Section |
Slices for component | 6..* | InfrastructureRoot | Slice: Unordered, Open by profile:section | |
component:All Slices | Content/Rules for all slices | |||
section | 1..1 | Section | ||
component:allergies | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | AllergiesAndIntolerancesSection | Base for all types and resources |
component:medications | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | MedicationsSection | Base for all types and resources |
component:problems | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | ProblemSection | Base for all types and resources |
component:procedures | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | ProceduresSection | Base for all types and resources |
component:results | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | ResultsSection | Base for all types and resources |
component:advDirectives | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | AdvanceDirectivesSection | Base for all types and resources |
component:encounters | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | EncountersSection | Base for all types and resources |
component:famHistory | 0..1 | InfrastructureRoot | ||
section | 1..1 | FamilyHistorySection | Base for all types and resources | |
component:functionalStatus | 0..1 | InfrastructureRoot | ||
section | 1..1 | FunctionalStatusSection | Base for all types and resources | |
component:immunizations | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | ImmunizationsSection | Base for all types and resources |
component:medEquipment | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | MedicalEquipmentSection | Base for all types and resources |
component:payers | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | PayersSection | Base for all types and resources |
component:planOfTreatment | 0..1 | InfrastructureRoot | ||
section | 1..1 | PlanofTreatmentSection | Base for all types and resources | |
component:socialHist | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | SocialHistorySection | Base for all types and resources |
component:vitalSigns | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | VitalSignsSection | Base for all types and resources |
component:mentalStatus | 0..1 | InfrastructureRoot | ||
section | 1..1 | MentalStatusSection | Base for all types and resources | |
component:nutrition | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | NutritionSection | Base for all types and resources |
Documentation for this format |
Path | Conformance | ValueSet / Code |
ClinicalDocument.code | example | FHIRDocumentTypeCodes |
ClinicalDocument.confidentialityCode | preferred | HL7BasicConfidentialityKind |
ClinicalDocument.languageCode | required | AllLanguages |
ClinicalDocument.recordTarget.patientRole.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.recordTarget.patientRole.patient.administrativeGenderCode | required | AdministrativeGenderHL7V3 |
ClinicalDocument.recordTarget.patientRole.patient.raceCode | required | RaceCategoryExcludingNulls |
ClinicalDocument.recordTarget.patientRole.patient.ethnicGroupCode | required | Ethnicity |
ClinicalDocument.author.assignedAuthor.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.documentationOf.serviceEvent.classCode | required | Fixed Value: PCPR |
ClinicalDocument.documentationOf.serviceEvent.performer.typeCode | required | Fixed Value: PRF |
Id | Grade | Path(s) | Details | Requirements |
1198-8456 | error | ClinicalDocument.author.assignedAuthor | Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). : assignedPerson.exists() or (assignedAuthoringDevice.exists() and representedOrganization.exists()) | |
1198-32466 | warning | ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). : assignedPerson.exists() implies id.where(root = '2.16.840.1.113883.4.6') | |
4537-6380 | error | ClinicalDocument | If setId is present versionNumber **SHALL** be present (CONF:4537-6380). : setId.exists() implies versionNumber.exists() | |
4537-6387 | error | ClinicalDocument | If versionNumber is present setId **SHALL** be present (CONF:4537-6387). : versionNumber.exists() implies setId.exists() | |
4537-16790 | error | ClinicalDocument.author.assignedAuthor | There **SHALL** be exactly one assignedAuthor/assignedPerson or exactly one assignedAuthor/assignedAuthoringDevice (CONF:4537-16790). : (assignedPerson | assignedAuthoringDevice).count() = 1 | |
4537-21000 | error | ClinicalDocument.recordTarget.patientRole.patient | If sdtc:deceasedTime/@value is present, then sdtc:deceasedInd SHALL be present with value=true : sdtcDeceasedTime.value.exists() implies sdtcDeceasedInd.exists(value='true') | |
4537-32948 | error | ClinicalDocument.code | This code **SHALL** be drawn from the LOINC document type ontology (LOINC codes where SCALE = DOC) (CONF:4537-32948). : codeSystem = '2.16.840.1.113883.6.1' | |
4537-32993 | error | ClinicalDocument.recordTarget.patientRole.patient | If sdtc:deceasedInd="true", then sdtc:deceasedTime **SHALL** be present with either a @value or @nullFlavor=UNK (CONF:4537-32993). : sdtcDeceasedInd.exists(value='true') implies sdtcDeceasedTime.exists() | |
81-7278 | error | ClinicalDocument.recordTarget.patientRole.patient.name | **SHALL NOT** have mixed content except for white space (CONF:81-7278). : item.xmlText.empty() | |
81-7296 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | **SHALL NOT** have mixed content except for white space (CONF:81-7296) : item.xmlText.empty() | |
81-9371 | error | ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name | The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists() | |
81-9372 | error | ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name | The string **SHALL NOT** contain name parts (CONF:81-9372). : item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty() | |
81-10024 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')) | |
81-10025 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')) | |
ivl-ts-center | error | ClinicalDocument.documentationOf.serviceEvent.effectiveTime | Center cannot co-exist with low or high : center.empty() or (low.empty() and high.empty()) | |
ivl-value-shall | error | ClinicalDocument.documentationOf.serviceEvent.effectiveTime | If a time interval contains @value, then it shall be precise to at least the day. : value.exists() implies value.toString().length() >= 10 | |
ivl-value-should | warning | ClinicalDocument.documentationOf.serviceEvent.effectiveTime | If a time interval contains @value, then it SHOULD contain a time component. : value.exists() implies value.toString().length() > 10 | |
pn-no-ls | error | ClinicalDocument.recordTarget.patientRole.patient.name, ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name | No PN name part may have a qualifier of LS. : (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty() | |
shall-adv-directive-organizer | error | ClinicalDocument.component.structuredBody.component:advDirectives.section | SHALL contain at least one Advance Directive Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveOrganizer')) | |
shall-allergy-concern | error | ClinicalDocument.component.structuredBody.component:allergies.section | SHALL contain at least one Allergy Concern Act : nullFlavor.exists() or entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/AllergyConcernAct')) | |
shall-city | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHALL contain exactly one [1..1] city (CONF:81-7292). : nullFlavor.exists() or item.city.count() = 1 | |
shall-encounter-activity | error | ClinicalDocument.component.structuredBody.component:encounters.section | SHALL contain at least one Encounter Activity : nullFlavor.exists() or entry.where(encounter.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/EncounterActivity')) | |
shall-family | error | ClinicalDocument.recordTarget.patientRole.patient.name | SHALL contain exactly one [1..1] family (CONF:81-7159). : nullFlavor.exists() or item.family.count() = 1 | |
shall-given | error | ClinicalDocument.recordTarget.patientRole.patient.name | SHALL contain at least one [1..*] given (CONF:81-7157). : nullFlavor.exists() or item.given.exists() | |
shall-immunization-activity | error | ClinicalDocument.component.structuredBody.component:immunizations.section | SHALL contain at least one Immunization Activity : nullFlavor.exists() or entry.where(substanceAdministration.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity')) | |
shall-max-ad-parts | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHALL have at most one of each: state, city, postalCode, and country : (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1) | |
shall-max-suffix | error | ClinicalDocument.recordTarget.patientRole.patient.name | There may be at most one suffix : (item.suffix.empty() or item.suffix.count() = 1) | |
shall-med-activity | error | ClinicalDocument.component.structuredBody.component:medications.section | SHALL contain at least one Medication Activity : nullFlavor.exists() or entry.where(substanceAdministration.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/MedicationActivity')) | |
shall-problem-concern-act | error | ClinicalDocument.component.structuredBody.component:problems.section | SHALL contain at least one Problem Concern Act : nullFlavor.exists() or entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProblemConcernAct')) | |
shall-procedure-act-procedure | error | ClinicalDocument.component.structuredBody.component:procedures.section | SHALL contain at least one Procedure Activity Procedure : nullFlavor.exists() or entry.where(procedure.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure')) | |
shall-result-org | error | ClinicalDocument.component.structuredBody.component:results.section | SHALL contain at least one Result Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ResultOrganizer')) | |
shall-streetAddressLine | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291). : nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4) | |
shall-vital-signs-org | error | ClinicalDocument.component.structuredBody.component:vitalSigns.section | SHALL contain at least one Vital Signs Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/VitalSignsOrganizer')) | |
should-country | warning | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHOULD contain country : nullFlavor.exists() or item.country.exists() | |
should-coverage-activity | warning | ClinicalDocument.component.structuredBody.component:payers.section | SHOULD contain Coverage Activity : entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/CoverageActivity')) | |
should-extension | warning | ClinicalDocument.author.assignedAuthor.id:npi | SHOULD contain extension : extension.exists() | |
should-id-npi | warning | ClinicalDocument.author.assignedAuthor | SHOULD contain an id with root='2.16.840.1.113883.4.6' (NPI) : id.where(root = '2.16.840.1.113883.4.6') | |
should-legalAuthenticator | warning | ClinicalDocument | SHOULD contain legalAuthenticator : legalAuthenticator.exists() | |
should-maritalStatusCode | warning | ClinicalDocument.recordTarget.patientRole.patient | SHOULD contain maritalStatusCode : maritalStatusCode.exists() | |
should-non-med-supply | warning | ClinicalDocument.component.structuredBody.component:medEquipment.section | SHOULD contain Non-Medicinal Supply Activity : entry.where(supply.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/NonMedicinalSupplyActivity')) | |
should-nutritional-status-obs | warning | ClinicalDocument.component.structuredBody.component:nutrition.section | SHOULD contain Nutritional Status Observation : entry.where(observation.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/NutritionalStatusObservation')) | |
should-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-procedure-act-procedure | warning | ClinicalDocument.component.structuredBody.component:medEquipment.section | SHOULD contain Procedure Activity Procedure : entry.where(procedure.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure')) | |
should-relatedParticipant | warning | ClinicalDocument | Documents SHOULD contain a RelatedPerson participant : participant.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/RelatedPersonRelationshipAndNameParticipant').exists() | |
should-section-plan-of-treatment | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Plan of Treatment Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/PlanofTreatmentSection')) | |
should-section-procedures | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Procedures Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProceduresSection')) | |
should-smoking-status | warning | ClinicalDocument.component.structuredBody.component:socialHist.section | SHOULD contain Smoking Status - Meaningful Use : entry.where(observation.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/SmokingStatusMeaningfulUse')) | |
should-us-code | warning | ClinicalDocument.author.assignedAuthor, ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | SHOULD contain code : code.exists() | |
should-us-languageCommunication | warning | ClinicalDocument.recordTarget.patientRole.patient | SHOULD contain languageCommunication : languageCommunication.exists() | |
should-us-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-use | warning | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.telecom, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.author.assignedAuthor.telecom, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHOULD contain @use : nullFlavor.exists() or use.exists() | |
ts-shall-day | error | ClinicalDocument.effectiveTime, ClinicalDocument.author.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high | **SHALL** be precise to at least the day : nullFlavor.exists() or value.toString().length() >= 10 | |
ts-shall-year | error | ClinicalDocument.recordTarget.patientRole.patient.birthTime | **SHALL** be precise to at least the year : nullFlavor.exists() or value.toString().length() >= 4 | |
ts-should-day | warning | ClinicalDocument.recordTarget.patientRole.patient.birthTime | **SHOULD** be precise to at least the day : nullFlavor.exists() or value.toString().length() >= 10 | |
ts-should-minute | warning | ClinicalDocument.effectiveTime, ClinicalDocument.author.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high | **SHOULD** be precise to at least the minute : nullFlavor.exists() or value.toString().length() > 10 |
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ClinicalDocument | C | 1..1 | USRealmHeader | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, @classCode, @moodCode, realmCode, typeId, templateId, id, code, title, sdtcStatusCode, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, copyTime, recordTarget, author, dataEnterer, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, relatedDocument, authorization, componentOf, component, realmCode, typeId, templateId, templateId, id, code, title, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, recordTarget, author, dataEnterer, informant, informant, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, authorization, componentOf Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@classCode | 0..1 | cs | Binding: ActClass (example) Fixed Value: DOCCLIN | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
realmCode | 1..1 | CS | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Required Pattern: US | |
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
typeId | 1..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | Fixed Value: POCD_HD000040 | |
Slices for templateId | 2..* | II | Slice: Unordered, Open by value:root, value:extension | |
templateId:us-realm | 1..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.1 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
templateId:CCD | 1..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.2 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
id | 1..1 | II | **SHALL** be a globally unique identifier for the document (CONF:4537-9991). | |
code | C | 1..1 | CE | Summarization of Episode Note Binding: FHIRDocumentTypeCodes (example) |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Required Pattern: 34133-9 | |
@codeSystem | 1..1 | oid, uuid, ruid | LOINC Required Pattern: 2.16.840.1.113883.6.1 | |
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
title | 1..1 | ST | The title can either be a locally defined name or the displayName corresponding to clinicalDocument/code | |
sdtcStatusCode | 0..1 | CS | XML Namespace: urn:hl7-org:sdtc XML: statusCode (urn:hl7-org:sdtc) Binding: ActStatus (required) | |
effectiveTime | C | 1..1 | USRealmDateTime | Base for all types and resources |
confidentialityCode | 1..1 | CE | Binding: HL7 BasicConfidentialityKind (preferred) | |
@code | 1..1 | cs | ||
@codeSystem | 0..1 | oid, uuid, ruid | ||
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
languageCode | 1..1 | CS | Binding: AllLanguages (required) | |
setId | 0..1 | II | ||
versionNumber | 0..1 | INT | ||
copyTime | 0..1 | TS | ||
recordTarget | 1..* | RecordTarget | The recordTarget records the administrative and demographic data of the patient whose health information is described by the clinical document; each recordTarget must contain at least one patientRole element | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: RCT | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
patientRole | 1..1 | PatientRole | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassRelationshipFormal (required) Fixed Value: PAT | |
id | 1..* | II | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
addr | C | 1..* | USRealmAddress | (USCDI) Address |
telecom | C | 1..* | TEL | (USCDI) Phone Number / Email |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
patient | C | 1..1 | Patient | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
id | 0..1 | II | ||
name | C | 1..* | USRealmPatientNamePTNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
administrativeGenderCode | 1..1 | CE | Binding: Administrative Gender (HL7 V3) (required) | |
birthTime | C | 1..1 | TS | (USCDI) Date of Birth - **MAY** be precise to the minute (CONF:4537-32418) (For cases where information about newborn's time of birth needs to be captured) |
sdtcDeceasedInd | 0..1 | BL | XML Namespace: urn:hl7-org:sdtc sdtc:deceasedInd XML: deceasedInd (urn:hl7-org:sdtc) | |
sdtcDeceasedTime | C | 0..1 | TS | XML Namespace: urn:hl7-org:sdtc (USCDI) Date of Death XML: deceasedTime (urn:hl7-org:sdtc) |
sdtcMultipleBirthInd | 0..1 | BL | XML Namespace: urn:hl7-org:sdtc XML: multipleBirthInd (urn:hl7-org:sdtc) | |
sdtcMultipleBirthOrderNumber | 0..1 | INT_POS | XML Namespace: urn:hl7-org:sdtc XML: multipleBirthOrderNumber (urn:hl7-org:sdtc) | |
maritalStatusCode | 0..1 | CE | Binding: Marital Status (required) | |
religiousAffiliationCode | 0..1 | CE | Binding: Religious Affiliation (required) | |
raceCode | 1..1 | CE | (USCDI) Race Binding: Race Category Excluding Nulls (required) | |
sdtcRaceCode | 0..* | CE | XML Namespace: urn:hl7-org:sdtc (USCDI) Race - The sdtc:raceCode is only used to record additional values when the patient has indicated multiple races or additional race detail beyond the five categories required for Meaningful Use Stage 2. The prefix sdtc: SHALL be bound to the namespace “urn:hl7-org:sdtc”. The use of the namespace provides a necessary extension to CDA R2 for the use of the additional raceCode elements. XML: raceCode (urn:hl7-org:sdtc) Binding: Race Value Set (required) | |
ethnicGroupCode | 1..1 | CE | (USCDI) Ethnicity Binding: Ethnicity (required) | |
sdtcEthnicGroupCode | 0..* | CE | XML Namespace: urn:hl7-org:sdtc (USCDI) Ethnicity XML: ethnicGroupCode (urn:hl7-org:sdtc) Binding: Detailed Ethnicity (required) | |
guardian | C | 0..* | Guardian | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAgent (required) Fixed Value: GUARD | |
id | 0..* | II | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Personal And Legal Relationship Role Type (required) | |
addr | C | 0..* | USRealmAddress | Base for all types and resources |
telecom | C | 0..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
guardianPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
guardianOrganization | 0..1 | Organization | ||
birthplace | 0..1 | Birthplace | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassPassive (required) Fixed Value: BIRTHPL | |
place | 1..1 | Place | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassPlace (required) Fixed Value: PLC | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | 0..1 | EN | ||
addr | C | 1..1 | AD | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@isNotOrdered | 0..1 | bl | ||
@use | 0..* | cs | Binding: CDAPostalAddressUse (required) | |
item | C | 0..* | Base | Choice Group: This is a repeating choice group that does not appear directly in the instance |
(Choice of one) | 1..1 | |||
delimiter | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DEL | |
country | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CNT | |
state | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: STA | |
county | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CPA | |
city | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CTY | |
postalCode | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: ZIP | |
streetAddressLine | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: SAL | |
houseNumber | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: BNR | |
houseNumberNumeric | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: BNN | |
direction | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DIR | |
streetName | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: STR | |
streetNameBase | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: STB | |
streetNameType | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: STTYP | |
additionalLocator | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: ADL | |
unitID | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: UNID | |
unitType | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: UNIT | |
careOf | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CAR | |
censusTract | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CEN | |
deliveryAddressLine | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DAL | |
deliveryInstallationType | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DINST | |
deliveryInstallationArea | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DINSTA | |
deliveryInstallationQualifier | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DINSTQ | |
deliveryMode | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DMOD | |
deliveryModeIdentifier | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DMODID | |
buildingNumberSuffix | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: BNS | |
postBox | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: POB | |
precinct | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: PRE | |
xmlText | 0..1 | st | Allows for mixed text content | |
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
languageCommunication | C | 0..* | LanguageCommunication | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
languageCode | 1..1 | CS | Binding: AllLanguages (required) | |
modeCode | 0..1 | CE | Binding: LanguageAbilityMode (required) | |
proficiencyLevelCode | 0..1 | CE | Binding: LanguageAbilityProficiency (required) | |
preferenceInd | 0..1 | BL | ||
providerOrganization | 0..1 | Organization | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassOrganization (required) Fixed Value: ORG | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
name | 1..* | ON | ||
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
standardIndustryClassCode | 0..1 | CE | Binding: OrganizationIndustryClassNAICS (example) | |
asOrganizationPartOf | 0..1 | OrganizationPartOf | ||
author | 1..* | Author | The author element represents the creator of the clinical document. The author may be a device or a person. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: AUT | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
functionCode | 0..1 | CE | ||
time | C | 1..1 | USRealmDateTime | Base for all types and resources |
assignedAuthor | C | 1..1 | AssignedAuthor | 1198-8456: Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
Slices for id | 1..* | II | Slice: Unordered, Open by value:root | |
id:npi | C | 0..1 | II | |
@nullFlavor | 0..1 | cs | If NPI is unknown, set @nullFlavor to UNK Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.4.6 | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Only if this assignedAuthor is an assignedPerson should the assignedAuthor contain a code. Binding: v3 Code System RoleCode (example) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Binding: Healthcare Provider Taxonomy (preferred) | |
@codeSystem | 0..1 | oid, uuid, ruid | ||
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
(Choice of one) | 1..1 | |||
assignedPerson | 0..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
assignedAuthoringDevice | 0..1 | AuthoringDevice | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassDevice (required) Fixed Value: DEV | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
code | 0..1 | CE | Binding: EntityCode (example) | |
manufacturerModelName | 1..1 | SC | Binding: Manufacturer Model Name Example (example) | |
softwareName | 1..1 | SC | Binding: Software Name Example (example) | |
asMaintainedEntity | 0..* | MaintainedEntity | ||
representedOrganization | 0..1 | Organization | ||
dataEnterer | 0..1 | DataEnterer | The dataEnterer element represents the person who transferred the content, written or dictated, into the clinical document. To clarify, an author provides the content found within the header or body of a document, subject to their own interpretation; a dataEnterer adds an author's information to the electronic system. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: ENT | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
time | C | 0..1 | USRealmDateTime | Base for all types and resources |
assignedEntity | 1..1 | AssignedEntity | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred) | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
assignedPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
Slices for informant | 0..* | Informant | Slice: Unordered, Open by exists:relatedEntity, exists:assignedEntity | |
informant:provider | 0..* | Informant | The informant element describes an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: INF | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
assignedEntity | 1..1 | AssignedEntity | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | If assignedEntity/id is a provider then this id, **SHOULD** include zero or one [0..1] id where id/@root ="2.16.840.1.113883.4.6" National Provider Identifier (CONF:4537-9946). | |
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred) | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | 0..* | TEL | ||
assignedPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
informant:non-provider | 0..* | Informant | The informant element describes an information source (who is not a provider) for any content within the clinical document. This informant would be used when the source of information has a personal relationship with the patient or is the patient. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: INF | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
relatedEntity | 1..1 | RelatedEntity | ||
custodian | 1..1 | Custodian | The custodian element represents the organization that is in charge of maintaining and is entrusted with the care of the document. There is only one custodian per CDA document. Allowing that a CDA document may not represent the original form of the authenticated document, the custodian represents the steward of the original source document. The custodian may be the document originator, a health information exchange, or other responsible party. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: CST | |
assignedCustodian | 1..1 | AssignedCustodian | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
representedCustodianOrganization | 1..1 | CustodianOrganization | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassOrganization (required) Fixed Value: ORG | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
name | 1..1 | ON | ||
telecom | C | 1..1 | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
addr | C | 1..1 | USRealmAddress | Base for all types and resources |
informationRecipient | 0..* | InformationRecipient | The informationRecipient element records the intended recipient of the information at the time the document was created. In cases where the intended recipient of the document is the patient's health chart, set the receivedOrganization to the scoping organization for that chart. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: XInformationRecipient (2.0.0) (required) | |
intendedRecipient | 1..1 | IntendedRecipient | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | ||
id | 0..* | II | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
addr | 0..* | AD | ||
telecom | 0..* | TEL | ||
informationRecipient | 0..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
receivedOrganization | 0..1 | Organization | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassOrganization (required) Fixed Value: ORG | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
id | 0..* | II | ||
name | 1..1 | ON | ||
telecom | 0..* | TEL | ||
addr | 0..* | AD | ||
standardIndustryClassCode | 0..1 | CE | Binding: OrganizationIndustryClassNAICS (example) | |
asOrganizationPartOf | 0..1 | OrganizationPartOf | ||
legalAuthenticator | 0..1 | LegalAuthenticator | The legalAuthenticator identifies the single person legally responsible for the document and must be present if the document has been legally authenticated. A clinical document that does not contain this element has not been legally authenticated. The act of legal authentication requires a certain privilege be granted to the legal authenticator depending upon local policy. Based on local practice, clinical documents may be released before legal authentication. All clinical documents have the potential for legal authentication, given the appropriate credentials. Local policies MAY choose to delegate the function of legal authentication to a device or system that generates the clinical document. In these cases, the legal authenticator is a person accepting responsibility for the document, not the generating device or system. Note that the legal authenticator, if present, must be a person. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: LA | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
time | C | 1..1 | USRealmDateTime | Base for all types and resources |
signatureCode | C | 1..1 | CS | Binding: CDASignatureCode (required) |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Required Pattern: S | |
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
sdtcSignatureText | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc The signature can be represented either inline or by reference according to the ED data type. Typical cases for CDA are: 1) Electronic signature: this attribute can represent virtually any electronic signature scheme. 2) Digital signature: this attribute can represent digital signatures by reference to a signature data block that is constructed in accordance to a digital signature standard, such as XML-DSIG, PKCS#7, PGP, etc. The sdtc:signatureText extension provides a location in CDA for a textual or multimedia depiction of the signature by which the participant endorses and accepts responsibility for his or her participation in the Act as specified in the Participation.typeCode. Details of what goes in the field are described in the HL7 CDA Digital Signature Standard balloted in Fall 2013. XML: signatureText (urn:hl7-org:sdtc) | |
assignedEntity | 1..1 | AssignedEntity | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 0..1 | oid, uuid, ruid | MAY contain '2.16.840.1.113883.4.6' (NPI) | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred) | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
assignedPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
authenticator | 0..* | Authenticator | The authenticator identifies a participant or participants who attest to the accuracy of the information in the document. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: AUTHEN | |
time | C | 1..1 | USRealmDateTime | Base for all types and resources |
signatureCode | C | 1..1 | CS | Binding: CDASignatureCode (required) |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Required Pattern: S | |
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
sdtcSignatureText | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc The signature can be represented either inline or by reference according to the ED data type. Typical cases for CDA are: 1) Electronic signature: this attribute can represent virtually any electronic signature scheme. 2) Digital signature: this attribute can represent digital signatures by reference to a signature data block that is constructed in accordance to a digital signature standard, such as XML-DSIG, PKCS#7, PGP, etc. The sdtc:signatureText extension provides a location in CDA for a textual or multimedia depiction of the signature by which the participant endorses and accepts responsibility for his or her participation in the Act as specified in the Participation.typeCode. Details of what goes in the field are described in the HL7 CDA Digital Signature Standard balloted in Fall of 2013. XML: signatureText (urn:hl7-org:sdtc) | |
assignedEntity | 1..1 | AssignedEntity | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: v3 Code System RoleCode (example) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 0..1 | cs | Binding: Healthcare Provider Taxonomy (preferred) | |
@codeSystem | 0..1 | oid, uuid, ruid | ||
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
assignedPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
participant | C | 0..* | Participant1 | The participant element identifies supporting entities, including parents, relatives, caregivers, insurance policyholders, guarantors, and others related in some way to the patient. A supporting person or organization is an individual or an organization with a relationship to the patient. A supporting person who is playing multiple roles would be recorded in multiple participants (e.g., emergency contact and next-of-kin). |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 1..1 | cs | Binding: ParticipationType (required) | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
functionCode | 0..1 | CE | ||
time | C | 0..1 | USRealmDateTimeInterval | Base for all types and resources |
associatedEntity | 1..1 | AssociatedEntity | ||
inFulfillmentOf | 0..* | InFulfillmentOf | The inFulfillmentOf element represents orders that are fulfilled by this document such as a radiologists' report of an x-ray. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ActRelationshipFulfills (2.0.0) (required) Fixed Value: FLFS | |
order | 1..1 | Order | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Binding: ActClass (required) | |
@moodCode | 0..1 | cs | Binding: ActMoodIntent (required) Fixed Value: RQO | |
id | 1..* | II | ||
code | 0..1 | CE | Binding: v3 Code System ActCode (example) | |
priorityCode | 0..1 | CE | Binding: ActPriority (example) | |
documentationOf | 1..1 | DocumentationOf | The documentationOf relationship in a Continuity Care Document contains the representation of providers who are wholly or partially responsible for the safety and well-being of a subject of care. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: DOC | |
serviceEvent | C | 1..1 | ServiceEvent | The main activity being described by a CCD is the provision of healthcare over a period of time. This is shown by setting the value of serviceEvent/@classCode to 'PCPR' (care provision) and indicating the duration over which care was provided in serviceEvent/effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g., reviewed during the stated time range).
NOTE: Implementations originating a CCD should take care to discover what the episode of care being summarized is. For example, when a patient fills out a form providing relevant health history, the episode of care being documented might be from birth to the present. should-performer: SHOULD contain performer |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Binding: ActClass (required) Fixed Value: PCPR | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
id | 0..* | II | ||
code | 0..1 | CE | ||
effectiveTime | C | 1..1 | USRealmDateTimeInterval | Base for all types and resources |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | ts | Either @value or low/high should be present, but not both Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz] | |
@operator | 0..1 | cs | Binding: SetOperator (required) | |
low | C | 1..1 | IVXB_TS | **MAY** be precise to at least the second |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | ts | Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz] | |
@inclusive | 0..1 | bl | ||
center | 0..1 | TS | ||
width | 0..1 | PQ | ||
high | C | 1..1 | IVXB_TS | **MAY** be precise to at least the second |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | ts | Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz] | |
@inclusive | 0..1 | bl | ||
performer | 0..* | Performer1 | The serviceEvent/performer represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patient's key healthcare providers would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 1..1 | cs | Binding: x_ServiceEventPerformer (required) Fixed Value: PRF | |
functionCode | C | 0..1 | CE | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 0..1 | cs | Binding: Care Team Member Function (preferred) | |
@codeSystem | 0..1 | oid, uuid, ruid | ||
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
time | C | 0..1 | USRealmDateTimeInterval | Base for all types and resources |
assignedEntity | C | 1..1 | AssignedEntity | SG 20230709: Illegal constraint - base has min = 1 (deleted min=0) 1198-32466: If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred) | |
addr | 0..* | AD | ||
telecom | 0..* | TEL | ||
assignedPerson | 0..1 | Person | ||
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
relatedDocument | 0..* | RelatedDocument | ||
authorization | 0..* | Authorization | The authorization element represents information about the patient's consent. The type of consent is conveyed in consent/code. Consents in the header have been finalized (consent/statusCode must equal Completed) and should be on file. This specification does not address how 'Privacy Consent' is represented, but does not preclude the inclusion of 'Privacy Consent'. The authorization consent is used for referring to consents that are documented elsewhere in the EHR or medical record for a health condition and/or treatment that is described in the CDA document. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: AUTH | |
consent | 1..1 | Consent | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: ActClass (required) Fixed Value: CONS | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
id | 0..* | II | ||
code | 0..1 | CE | The type of consent (e.g., a consent to perform the related serviceEvent) is conveyed in consent/code. Binding: v3 Code System ActCode (example) | |
statusCode | 1..1 | CS | Binding: ActStatus (required) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Fixed Value: completed | |
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
componentOf | 0..1 | ComponentOf | The encompassing encounter represents the setting of the clinical encounter during which the document act(s) or ServiceEvent(s) occurred. In order to represent providers associated with a specific encounter, they are recorded within the encompassingEncounter as participants. In a CCD, the encompassingEncounter may be used when documenting a specific encounter and its participants. All relevant encounters in a CCD may be listed in the encounters section. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ActRelationshipHasComponent (required) Fixed Value: COMP | |
encompassingEncounter | C | 1..1 | EncompassingEncounter | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: ActClass (required) Fixed Value: ENC | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
id | 1..* | II | ||
code | 0..1 | CE | Binding: Act Encounter Codes (preferred) | |
effectiveTime | C | 1..1 | USRealmDateTimeInterval | Base for all types and resources |
sdtcAdmissionReferralSourceCode | 0..1 | CE | XML Namespace: urn:hl7-org:sdtc XML: admissionReferralSourceCode (urn:hl7-org:sdtc) | |
dischargeDispositionCode | 0..1 | CE | Binding: USEncounterDischargeDisposition (example) | |
responsibleParty | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: RESP | |
assignedEntity | C | 1..1 | AssignedEntity | |
encounterParticipant | 0..* | EncounterParticipant | ||
location | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationTargetLocation (required) Fixed Value: LOC | |
healthCareFacility | 1..1 | HealthCareFacility | ||
component | 1..1 | Component | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ActRelationshipHasComponent (required) Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
nonXMLBody | 0..1 | NonXMLBody | ||
structuredBody | C | 1..1 | StructuredBody | should-section-procedures: SHOULD contain a Procedures Section should-section-plan-of-treatment: SHOULD contain a Plan of Treatment Section |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: ActClassRecordOrganizer (required) Fixed Value: DOCBODY | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
confidentialityCode | 0..1 | CE | ||
languageCode | 0..1 | CS | Binding: AllLanguages (required) | |
Slices for component | 6..* | InfrastructureRoot | Slice: Unordered, Open by profile:section | |
component:All Slices | Content/Rules for all slices | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | Section | ||
component:allergies | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | AllergiesAndIntolerancesSection | Base for all types and resources |
component:medications | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | MedicationsSection | Base for all types and resources |
component:problems | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | ProblemSection | Base for all types and resources |
component:procedures | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | ProceduresSection | Base for all types and resources |
component:results | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | ResultsSection | Base for all types and resources |
component:advDirectives | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | AdvanceDirectivesSection | Base for all types and resources |
component:encounters | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | EncountersSection | Base for all types and resources |
component:famHistory | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | FamilyHistorySection | Base for all types and resources | |
component:functionalStatus | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | FunctionalStatusSection | Base for all types and resources | |
component:immunizations | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | ImmunizationsSection | Base for all types and resources |
component:medEquipment | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | MedicalEquipmentSection | Base for all types and resources |
component:payers | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | PayersSection | Base for all types and resources |
component:planOfTreatment | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | PlanofTreatmentSection | Base for all types and resources | |
component:socialHist | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | SocialHistorySection | Base for all types and resources |
component:vitalSigns | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | VitalSignsSection | Base for all types and resources |
component:mentalStatus | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | MentalStatusSection | Base for all types and resources | |
component:nutrition | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | NutritionSection | Base for all types and resources |
Documentation for this format |
Path | Conformance | ValueSet / Code |
ClinicalDocument.nullFlavor | required | CDANullFlavor |
ClinicalDocument.classCode | example | Fixed Value: DOCCLIN |
ClinicalDocument.moodCode | required | Fixed Value: EVN |
ClinicalDocument.realmCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.templateId:us-realm.nullFlavor | required | CDANullFlavor |
ClinicalDocument.templateId:CCD.nullFlavor | required | CDANullFlavor |
ClinicalDocument.code | example | FHIRDocumentTypeCodes |
ClinicalDocument.code.nullFlavor | required | CDANullFlavor |
ClinicalDocument.sdtcStatusCode | required | ActStatus |
ClinicalDocument.confidentialityCode | preferred | HL7BasicConfidentialityKind |
ClinicalDocument.languageCode | required | AllLanguages |
ClinicalDocument.recordTarget.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.typeCode | required | Fixed Value: RCT |
ClinicalDocument.recordTarget.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.recordTarget.patientRole.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.classCode | required | Fixed Value: PAT |
ClinicalDocument.recordTarget.patientRole.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.recordTarget.patientRole.patient.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.classCode | required | Fixed Value: PSN |
ClinicalDocument.recordTarget.patientRole.patient.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.recordTarget.patientRole.patient.administrativeGenderCode | required | AdministrativeGenderHL7V3 |
ClinicalDocument.recordTarget.patientRole.patient.maritalStatusCode | required | MaritalStatus |
ClinicalDocument.recordTarget.patientRole.patient.religiousAffiliationCode | required | ReligiousAffiliation |
ClinicalDocument.recordTarget.patientRole.patient.raceCode | required | RaceCategoryExcludingNulls |
ClinicalDocument.recordTarget.patientRole.patient.sdtcRaceCode | required | RaceValueSet |
ClinicalDocument.recordTarget.patientRole.patient.ethnicGroupCode | required | Ethnicity |
ClinicalDocument.recordTarget.patientRole.patient.sdtcEthnicGroupCode | required | DetailedEthnicity |
ClinicalDocument.recordTarget.patientRole.patient.guardian.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.classCode | required | Fixed Value: GUARD |
ClinicalDocument.recordTarget.patientRole.patient.guardian.code | required | PersonalAndLegalRelationshipRoleType |
ClinicalDocument.recordTarget.patientRole.patient.guardian.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.classCode | required | Fixed Value: BIRTHPL |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.classCode | required | Fixed Value: PLC |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.use | required | CDAPostalAddressUse |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.delimiter.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.country.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.state.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.county.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.city.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.postalCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetAddressLine.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.houseNumber.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.houseNumberNumeric.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.direction.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetName.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetNameBase.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetNameType.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.additionalLocator.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.unitID.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.unitType.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.careOf.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.censusTract.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryAddressLine.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationType.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationArea.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationQualifier.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryMode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryModeIdentifier.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.buildingNumberSuffix.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.postBox.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.precinct.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.languageCode | required | AllLanguages |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.modeCode | required | LanguageAbilityMode |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.proficiencyLevelCode | required | LanguageAbilityProficiency |
ClinicalDocument.recordTarget.patientRole.providerOrganization.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.providerOrganization.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.providerOrganization.classCode | required | Fixed Value: ORG |
ClinicalDocument.recordTarget.patientRole.providerOrganization.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.recordTarget.patientRole.providerOrganization.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.providerOrganization.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.providerOrganization.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.recordTarget.patientRole.providerOrganization.standardIndustryClassCode | example | OrganizationIndustryClassNAICS |
ClinicalDocument.author.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.typeCode | required | Fixed Value: AUT |
ClinicalDocument.author.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.author.assignedAuthor.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.author.assignedAuthor.id:npi.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.code | example | RoleCode |
ClinicalDocument.author.assignedAuthor.code.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.code.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.author.assignedAuthor.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.author.assignedAuthor.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.author.assignedAuthor.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.author.assignedAuthor.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.classCode | required | Fixed Value: DEV |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.code | example | EntityCode |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.manufacturerModelName | example | ManufacturerModelNameExample |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.softwareName | example | SoftwareNameExample |
ClinicalDocument.dataEnterer.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.typeCode | required | Fixed Value: ENT |
ClinicalDocument.dataEnterer.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.dataEnterer.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.dataEnterer.assignedEntity.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.dataEnterer.assignedEntity.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.typeCode | required | Fixed Value: INF |
ClinicalDocument.informant:provider.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.informant:provider.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.informant:provider.assignedEntity.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:non-provider.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:non-provider.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:non-provider.typeCode | required | Fixed Value: INF |
ClinicalDocument.informant:non-provider.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.custodian.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.typeCode | required | Fixed Value: CST |
ClinicalDocument.custodian.assignedCustodian.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.classCode | required | Fixed Value: ORG |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.informationRecipient.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.typeCode | required | XInformationRecipient |
ClinicalDocument.informationRecipient.intendedRecipient.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.classCode | required | Fixed Value: PSN |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.classCode | required | Fixed Value: ORG |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.standardIndustryClassCode | example | OrganizationIndustryClassNAICS |
ClinicalDocument.legalAuthenticator.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.typeCode | required | Fixed Value: LA |
ClinicalDocument.legalAuthenticator.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.legalAuthenticator.signatureCode | required | CDASignatureCode |
ClinicalDocument.legalAuthenticator.signatureCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.legalAuthenticator.assignedEntity.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.legalAuthenticator.assignedEntity.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.typeCode | required | Fixed Value: AUTHEN |
ClinicalDocument.authenticator.signatureCode | required | CDASignatureCode |
ClinicalDocument.authenticator.signatureCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.authenticator.assignedEntity.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.code | example | RoleCode |
ClinicalDocument.authenticator.assignedEntity.code.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.code.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.authenticator.assignedEntity.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.participant.nullFlavor | required | CDANullFlavor |
ClinicalDocument.participant.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.participant.typeCode | required | ParticipationType |
ClinicalDocument.participant.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.inFulfillmentOf.nullFlavor | required | CDANullFlavor |
ClinicalDocument.inFulfillmentOf.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.inFulfillmentOf.typeCode | required | Fixed Value: FLFS |
ClinicalDocument.inFulfillmentOf.order.nullFlavor | required | CDANullFlavor |
ClinicalDocument.inFulfillmentOf.order.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.inFulfillmentOf.order.classCode | required | ActClass |
ClinicalDocument.inFulfillmentOf.order.moodCode | required | Fixed Value: RQO |
ClinicalDocument.inFulfillmentOf.order.code | example | ActCode |
ClinicalDocument.inFulfillmentOf.order.priorityCode | example | ActPriority |
ClinicalDocument.documentationOf.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.typeCode | required | Fixed Value: DOC |
ClinicalDocument.documentationOf.serviceEvent.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.classCode | required | Fixed Value: PCPR |
ClinicalDocument.documentationOf.serviceEvent.moodCode | required | Fixed Value: EVN |
ClinicalDocument.documentationOf.serviceEvent.effectiveTime.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.effectiveTime.operator | required | SetOperator |
ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.typeCode | required | Fixed Value: PRF |
ClinicalDocument.documentationOf.serviceEvent.performer.functionCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.functionCode.code | preferred | CareTeamMemberFunction |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.authorization.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authorization.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authorization.typeCode | required | Fixed Value: AUTH |
ClinicalDocument.authorization.consent.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authorization.consent.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authorization.consent.classCode | required | Fixed Value: CONS |
ClinicalDocument.authorization.consent.moodCode | required | Fixed Value: EVN |
ClinicalDocument.authorization.consent.code | example | ActCode |
ClinicalDocument.authorization.consent.statusCode | required | ActStatus |
ClinicalDocument.authorization.consent.statusCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.typeCode | required | Fixed Value: COMP |
ClinicalDocument.componentOf.encompassingEncounter.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.classCode | required | Fixed Value: ENC |
ClinicalDocument.componentOf.encompassingEncounter.moodCode | required | Fixed Value: EVN |
ClinicalDocument.componentOf.encompassingEncounter.code | preferred | ActEncounterCodes |
ClinicalDocument.componentOf.encompassingEncounter.dischargeDispositionCode | example | USEncounterDischargeDisposition |
ClinicalDocument.componentOf.encompassingEncounter.responsibleParty.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.responsibleParty.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.responsibleParty.typeCode | required | Fixed Value: RESP |
ClinicalDocument.componentOf.encompassingEncounter.location.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.location.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.location.typeCode | required | Fixed Value: LOC |
ClinicalDocument.component.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.typeCode | required | Fixed Value: COMP |
ClinicalDocument.component.structuredBody.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.classCode | required | Fixed Value: DOCBODY |
ClinicalDocument.component.structuredBody.moodCode | required | Fixed Value: EVN |
ClinicalDocument.component.structuredBody.languageCode | required | AllLanguages |
ClinicalDocument.component.structuredBody.component.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:allergies.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:allergies.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:medications.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:medications.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:problems.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:problems.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:procedures.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:procedures.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:results.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:results.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:advDirectives.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:advDirectives.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:encounters.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:encounters.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:famHistory.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:famHistory.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:functionalStatus.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:functionalStatus.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:immunizations.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:immunizations.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:medEquipment.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:medEquipment.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:payers.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:payers.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:planOfTreatment.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:planOfTreatment.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:socialHist.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:socialHist.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:vitalSigns.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:vitalSigns.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:mentalStatus.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:mentalStatus.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:nutrition.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:nutrition.typeId.nullFlavor | required | CDANullFlavor |
Id | Grade | Path(s) | Details | Requirements |
1198-8456 | error | ClinicalDocument.author.assignedAuthor | Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). : assignedPerson.exists() or (assignedAuthoringDevice.exists() and representedOrganization.exists()) | |
1198-32466 | warning | ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). : assignedPerson.exists() implies id.where(root = '2.16.840.1.113883.4.6') | |
1198-32905 | error | ClinicalDocument.componentOf.encompassingEncounter.responsibleParty.assignedEntity | This assignedEntity SHALL contain an assignedPerson or a representedOrganization or both (CONF:1198-32905). : assignedPerson.exists() or representedOrganization.exists() | |
4537-5402 | error | ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr | If country is US, this addr **SHALL** contain exactly one [1..1] state, which **SHALL** be selected from ValueSet US Core USPS State *DYNAMIC* (CONF:4537-5402). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')) | |
4537-5403 | warning | ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr | If country is US, this addr **MAY** contain zero or one [0..1] postalCode, which **SHALL** be selected from ValueSet PostalCode urn:oid:2.16.840.1.113883.3.88.12.80.2 *DYNAMIC* (CONF:4537-5403). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.empty() or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')) | |
4537-6380 | error | ClinicalDocument | If setId is present versionNumber **SHALL** be present (CONF:4537-6380). : setId.exists() implies versionNumber.exists() | |
4537-6387 | error | ClinicalDocument | If versionNumber is present setId **SHALL** be present (CONF:4537-6387). : versionNumber.exists() implies setId.exists() | |
4537-10006 | error | ClinicalDocument.participant | **SHALL** contain associatedEntity/associatedPerson *AND/OR* associatedEntity/scopingOrganization (CONF:4537-10006). : associatedEntity.associatedPerson.exists() or associatedEntity.scopingOrganization.exists() | |
4537-10007 | warning | ClinicalDocument.participant | When participant/@typeCode is *IND*, associatedEntity/@classCode **SHOULD** be selected from ValueSet 2.16.840.1.113883.11.20.9.33 INDRoleclassCodes *DYNAMIC* (CONF:4537-10007). : typeCode = 'IND' implies associatedEntity.classCode.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.33') | |
4537-16790 | error | ClinicalDocument.author.assignedAuthor | There **SHALL** be exactly one assignedAuthor/assignedPerson or exactly one assignedAuthor/assignedAuthoringDevice (CONF:4537-16790). : (assignedPerson | assignedAuthoringDevice).count() = 1 | |
4537-21000 | error | ClinicalDocument.recordTarget.patientRole.patient | If sdtc:deceasedTime/@value is present, then sdtc:deceasedInd SHALL be present with value=true : sdtcDeceasedTime.value.exists() implies sdtcDeceasedInd.exists(value='true') | |
4537-32948 | error | ClinicalDocument.code | This code **SHALL** be drawn from the LOINC document type ontology (LOINC codes where SCALE = DOC) (CONF:4537-32948). : codeSystem = '2.16.840.1.113883.6.1' | |
4537-32993 | error | ClinicalDocument.recordTarget.patientRole.patient | If sdtc:deceasedInd="true", then sdtc:deceasedTime **SHALL** be present with either a @value or @nullFlavor=UNK (CONF:4537-32993). : sdtcDeceasedInd.exists(value='true') implies sdtcDeceasedTime.exists() | |
81-7278 | error | ClinicalDocument.recordTarget.patientRole.patient.name | **SHALL NOT** have mixed content except for white space (CONF:81-7278). : item.xmlText.empty() | |
81-7296 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | **SHALL NOT** have mixed content except for white space (CONF:81-7296) : item.xmlText.empty() | |
81-9371 | error | ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.name, ClinicalDocument.author.assignedAuthor.assignedPerson.name, ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.name, ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name, ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.name, ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.name, ClinicalDocument.authenticator.assignedEntity.assignedPerson.name | The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists() | |
81-9372 | error | ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.name, ClinicalDocument.author.assignedAuthor.assignedPerson.name, ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.name, ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name, ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.name, ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.name, ClinicalDocument.authenticator.assignedEntity.assignedPerson.name | The string **SHALL NOT** contain name parts (CONF:81-9372). : item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty() | |
81-10024 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')) | |
81-10025 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')) | |
AD-1 | error | ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item | Can only have only one of the possible item elements in each choice : (delimiter | country | state | county | city | postalCode | streetAddressLine | houseNumber | houseNumberNumeric | direction | streetName | streetNameBase | streetNameType | additionalLocator | unitID | unitType | careOf | censusTract | deliveryAddressLine | deliveryInstallationType | deliveryInstallationArea | deliveryInstallationQualifier | deliveryMode | deliveryModeIdentifier | buildingNumberSuffix | postBox | precinct | xmlText).count() = 1 | |
ivl-ts-center | error | ClinicalDocument.participant.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime, ClinicalDocument.documentationOf.serviceEvent.performer.time, ClinicalDocument.componentOf.encompassingEncounter.effectiveTime | Center cannot co-exist with low or high : center.empty() or (low.empty() and high.empty()) | |
ivl-value-shall | error | ClinicalDocument.participant.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime, ClinicalDocument.documentationOf.serviceEvent.performer.time, ClinicalDocument.componentOf.encompassingEncounter.effectiveTime | If a time interval contains @value, then it shall be precise to at least the day. : value.exists() implies value.toString().length() >= 10 | |
ivl-value-should | warning | ClinicalDocument.participant.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime, ClinicalDocument.documentationOf.serviceEvent.performer.time, ClinicalDocument.componentOf.encompassingEncounter.effectiveTime | If a time interval contains @value, then it SHOULD contain a time component. : value.exists() implies value.toString().length() > 10 | |
pn-no-ls | error | ClinicalDocument.recordTarget.patientRole.patient.name, ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.name, ClinicalDocument.author.assignedAuthor.assignedPerson.name, ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.name, ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name, ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.name, ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.name, ClinicalDocument.authenticator.assignedEntity.assignedPerson.name | No PN name part may have a qualifier of LS. : (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty() | |
shall-adv-directive-organizer | error | ClinicalDocument.component.structuredBody.component:advDirectives.section | SHALL contain at least one Advance Directive Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveOrganizer')) | |
shall-allergy-concern | error | ClinicalDocument.component.structuredBody.component:allergies.section | SHALL contain at least one Allergy Concern Act : nullFlavor.exists() or entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/AllergyConcernAct')) | |
shall-city | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | SHALL contain exactly one [1..1] city (CONF:81-7292). : nullFlavor.exists() or item.city.count() = 1 | |
shall-encounter-activity | error | ClinicalDocument.component.structuredBody.component:encounters.section | SHALL contain at least one Encounter Activity : nullFlavor.exists() or entry.where(encounter.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/EncounterActivity')) | |
shall-family | error | ClinicalDocument.recordTarget.patientRole.patient.name | SHALL contain exactly one [1..1] family (CONF:81-7159). : nullFlavor.exists() or item.family.count() = 1 | |
shall-given | error | ClinicalDocument.recordTarget.patientRole.patient.name | SHALL contain at least one [1..*] given (CONF:81-7157). : nullFlavor.exists() or item.given.exists() | |
shall-immunization-activity | error | ClinicalDocument.component.structuredBody.component:immunizations.section | SHALL contain at least one Immunization Activity : nullFlavor.exists() or entry.where(substanceAdministration.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity')) | |
shall-max-ad-parts | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | SHALL have at most one of each: state, city, postalCode, and country : (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1) | |
shall-max-suffix | error | ClinicalDocument.recordTarget.patientRole.patient.name | There may be at most one suffix : (item.suffix.empty() or item.suffix.count() = 1) | |
shall-med-activity | error | ClinicalDocument.component.structuredBody.component:medications.section | SHALL contain at least one Medication Activity : nullFlavor.exists() or entry.where(substanceAdministration.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/MedicationActivity')) | |
shall-problem-concern-act | error | ClinicalDocument.component.structuredBody.component:problems.section | SHALL contain at least one Problem Concern Act : nullFlavor.exists() or entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProblemConcernAct')) | |
shall-procedure-act-procedure | error | ClinicalDocument.component.structuredBody.component:procedures.section | SHALL contain at least one Procedure Activity Procedure : nullFlavor.exists() or entry.where(procedure.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure')) | |
shall-result-org | error | ClinicalDocument.component.structuredBody.component:results.section | SHALL contain at least one Result Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ResultOrganizer')) | |
shall-streetAddressLine | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291). : nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4) | |
shall-vital-signs-org | error | ClinicalDocument.component.structuredBody.component:vitalSigns.section | SHALL contain at least one Vital Signs Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/VitalSignsOrganizer')) | |
should-country | warning | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | SHOULD contain country : nullFlavor.exists() or item.country.exists() | |
should-coverage-activity | warning | ClinicalDocument.component.structuredBody.component:payers.section | SHOULD contain Coverage Activity : entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/CoverageActivity')) | |
should-extension | warning | ClinicalDocument.author.assignedAuthor.id:npi | SHOULD contain extension : extension.exists() | |
should-id-npi | warning | ClinicalDocument.author.assignedAuthor | SHOULD contain an id with root='2.16.840.1.113883.4.6' (NPI) : id.where(root = '2.16.840.1.113883.4.6') | |
should-legalAuthenticator | warning | ClinicalDocument | SHOULD contain legalAuthenticator : legalAuthenticator.exists() | |
should-maritalStatusCode | warning | ClinicalDocument.recordTarget.patientRole.patient | SHOULD contain maritalStatusCode : maritalStatusCode.exists() | |
should-non-med-supply | warning | ClinicalDocument.component.structuredBody.component:medEquipment.section | SHOULD contain Non-Medicinal Supply Activity : entry.where(supply.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/NonMedicinalSupplyActivity')) | |
should-npi | warning | ClinicalDocument.recordTarget.patientRole.providerOrganization.id.root, ClinicalDocument.dataEnterer.assignedEntity.id.root, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.id.root, ClinicalDocument.authenticator.assignedEntity.id.root, ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.id.root | SHOULD be NPI : $this = '2.16.840.1.113883.4.6' | |
should-nutritional-status-obs | warning | ClinicalDocument.component.structuredBody.component:nutrition.section | SHOULD contain Nutritional Status Observation : entry.where(observation.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/NutritionalStatusObservation')) | |
should-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-preferenceInd | warning | ClinicalDocument.recordTarget.patientRole.patient.languageCommunication | SHOULD contain preferenceInd : preferenceInd.exists() | |
should-procedure-act-procedure | warning | ClinicalDocument.component.structuredBody.component:medEquipment.section | SHOULD contain Procedure Activity Procedure : entry.where(procedure.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure')) | |
should-proficiencyLevelCode | warning | ClinicalDocument.recordTarget.patientRole.patient.languageCommunication | SHOULD contain proficiencyLevelCode : proficiencyLevelCode.exists() | |
should-relatedParticipant | warning | ClinicalDocument | Documents SHOULD contain a RelatedPerson participant : participant.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/RelatedPersonRelationshipAndNameParticipant').exists() | |
should-responsibleParty | warning | ClinicalDocument.componentOf.encompassingEncounter | SHOULD contain responsibleParty : responsibleParty.exists() | |
should-section-plan-of-treatment | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Plan of Treatment Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/PlanofTreatmentSection')) | |
should-section-procedures | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Procedures Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProceduresSection')) | |
should-smoking-status | warning | ClinicalDocument.component.structuredBody.component:socialHist.section | SHOULD contain Smoking Status - Meaningful Use : entry.where(observation.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/SmokingStatusMeaningfulUse')) | |
should-us-addr | warning | ClinicalDocument.recordTarget.patientRole.patient.guardian | SHOULD contain addr : addr.exists() | |
should-us-code | warning | ClinicalDocument.recordTarget.patientRole.patient.guardian, ClinicalDocument.author.assignedAuthor, ClinicalDocument.documentationOf.serviceEvent.performer.functionCode, ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | SHOULD contain code : code.exists() | |
should-us-languageCommunication | warning | ClinicalDocument.recordTarget.patientRole.patient | SHOULD contain languageCommunication : languageCommunication.exists() | |
should-us-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-us-telecom | warning | ClinicalDocument.recordTarget.patientRole.patient.guardian | SHOULD contain telecom : telecom.exists() | |
should-use | warning | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.telecom, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.telecom, ClinicalDocument.recordTarget.patientRole.providerOrganization.telecom, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.author.assignedAuthor.telecom, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.dataEnterer.assignedEntity.telecom, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.legalAuthenticator.assignedEntity.telecom, ClinicalDocument.authenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.telecom | SHOULD contain @use : nullFlavor.exists() or use.exists() | |
should-value-att | warning | ClinicalDocument.recordTarget.patientRole.patient.sdtcDeceasedTime | SHOULD contain @value : value.exists() | |
signature | warning | ClinicalDocument.legalAuthenticator.signatureCode, ClinicalDocument.authenticator.signatureCode | CDA Release One represented either an intended ('X') or actual ('S') authenticator. CDA Release Two only represents an actual authenticator, so has deprecated the value of 'X'. : code.exists() implies code != 'X' | |
text-null | error | ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.delimiter, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.country, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.state, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.county, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.city, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.postalCode, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetAddressLine, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.houseNumber, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.houseNumberNumeric, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.direction, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetName, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetNameBase, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetNameType, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.additionalLocator, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.unitID, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.unitType, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.careOf, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.censusTract, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryAddressLine, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationType, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationArea, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationQualifier, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryMode, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryModeIdentifier, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.buildingNumberSuffix, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.postBox, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.precinct | xmlText and nullFlavor are mutually exclusive (one must be present) : (xmlText | nullFlavor).count() = 1 | |
ts-shall-day | error | ClinicalDocument.effectiveTime, ClinicalDocument.author.time, ClinicalDocument.dataEnterer.time, ClinicalDocument.legalAuthenticator.time, ClinicalDocument.authenticator.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high | **SHALL** be precise to at least the day : nullFlavor.exists() or value.toString().length() >= 10 | |
ts-shall-year | error | ClinicalDocument.recordTarget.patientRole.patient.birthTime, ClinicalDocument.recordTarget.patientRole.patient.sdtcDeceasedTime | **SHALL** be precise to at least the year : nullFlavor.exists() or value.toString().length() >= 4 | |
ts-should-day | warning | ClinicalDocument.recordTarget.patientRole.patient.birthTime, ClinicalDocument.recordTarget.patientRole.patient.sdtcDeceasedTime | **SHOULD** be precise to at least the day : nullFlavor.exists() or value.toString().length() >= 10 | |
ts-should-minute | warning | ClinicalDocument.effectiveTime, ClinicalDocument.author.time, ClinicalDocument.dataEnterer.time, ClinicalDocument.legalAuthenticator.time, ClinicalDocument.authenticator.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high | **SHOULD** be precise to at least the minute : nullFlavor.exists() or value.toString().length() > 10 |
This structure is derived from USRealmHeader
Summary
Mandatory: 14 elements
Fixed Value: 2 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices:
Differential View
This structure is derived from USRealmHeader
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ClinicalDocument | 1..1 | USRealmHeader | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, @classCode, @moodCode, realmCode, typeId, templateId, id, code, title, sdtcStatusCode, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, copyTime, recordTarget, author, dataEnterer, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, relatedDocument, authorization, componentOf, component, realmCode, typeId, templateId, templateId, id, code, title, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, recordTarget, author, dataEnterer, informant, informant, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, authorization, componentOf Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) | |
templateId | 2..* | II | ||
templateId:CCD | 1..1 | II | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.2 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
code | 1..1 | CE | Summarization of Episode Note | |
@code | 1..1 | cs | Required Pattern: 34133-9 | |
@codeSystem | 1..1 | oid, uuid, ruid | LOINC Required Pattern: 2.16.840.1.113883.6.1 | |
author | 1..* | Author | The author element represents the creator of the clinical document. The author may be a device or a person. | |
assignedAuthor | C | 1..1 | AssignedAuthor | 1198-8456: Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). |
documentationOf | 1..1 | DocumentationOf | The documentationOf relationship in a Continuity Care Document contains the representation of providers who are wholly or partially responsible for the safety and well-being of a subject of care. | |
serviceEvent | C | 1..1 | ServiceEvent | The main activity being described by a CCD is the provision of healthcare over a period of time. This is shown by setting the value of serviceEvent/@classCode to 'PCPR' (care provision) and indicating the duration over which care was provided in serviceEvent/effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g., reviewed during the stated time range).
NOTE: Implementations originating a CCD should take care to discover what the episode of care being summarized is. For example, when a patient fills out a form providing relevant health history, the episode of care being documented might be from birth to the present. should-performer: SHOULD contain performer |
@classCode | 1..1 | cs | Fixed Value: PCPR | |
effectiveTime | 1..1 | USRealmDateTimeInterval | Base for all types and resources | |
low | 1..1 | IVXB_TS | **MAY** be precise to at least the second | |
high | 1..1 | IVXB_TS | **MAY** be precise to at least the second | |
performer | 0..* | Performer1 | The serviceEvent/performer represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patient's key healthcare providers would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors. | |
@typeCode | 1..1 | cs | Fixed Value: PRF | |
assignedEntity | C | 1..1 | AssignedEntity | SG 20230709: Illegal constraint - base has min = 1 (deleted min=0) 1198-32466: If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). |
id | 1..* | II | ||
assignedPerson | 0..1 | Person | ||
component | 1..1 | Component | ||
structuredBody | C | 1..1 | StructuredBody | should-section-procedures: SHOULD contain a Procedures Section should-section-plan-of-treatment: SHOULD contain a Plan of Treatment Section |
Slices for component | 6..* | InfrastructureRoot | Slice: Unordered, Open by profile:section | |
component:allergies | 1..1 | InfrastructureRoot | ||
section | 1..1 | AllergiesAndIntolerancesSection | Base for all types and resources | |
component:medications | 1..1 | InfrastructureRoot | ||
section | 1..1 | MedicationsSection | Base for all types and resources | |
component:problems | 1..1 | InfrastructureRoot | ||
section | 1..1 | ProblemSection | Base for all types and resources | |
component:procedures | 0..1 | InfrastructureRoot | ||
section | 1..1 | ProceduresSection | Base for all types and resources | |
component:results | 1..1 | InfrastructureRoot | ||
section | 1..1 | ResultsSection | Base for all types and resources | |
component:advDirectives | 0..1 | InfrastructureRoot | ||
section | 1..1 | AdvanceDirectivesSection | Base for all types and resources | |
component:encounters | 0..1 | InfrastructureRoot | ||
section | 1..1 | EncountersSection | Base for all types and resources | |
component:famHistory | 0..1 | InfrastructureRoot | ||
section | 1..1 | FamilyHistorySection | Base for all types and resources | |
component:functionalStatus | 0..1 | InfrastructureRoot | ||
section | 1..1 | FunctionalStatusSection | Base for all types and resources | |
component:immunizations | 0..1 | InfrastructureRoot | ||
section | 1..1 | ImmunizationsSection | Base for all types and resources | |
component:medEquipment | 0..1 | InfrastructureRoot | ||
section | 1..1 | MedicalEquipmentSection | Base for all types and resources | |
component:payers | 0..1 | InfrastructureRoot | ||
section | 1..1 | PayersSection | Base for all types and resources | |
component:planOfTreatment | 0..1 | InfrastructureRoot | ||
section | 1..1 | PlanofTreatmentSection | Base for all types and resources | |
component:socialHist | 1..1 | InfrastructureRoot | ||
section | 1..1 | SocialHistorySection | Base for all types and resources | |
component:vitalSigns | 1..1 | InfrastructureRoot | ||
section | 1..1 | VitalSignsSection | Base for all types and resources | |
component:mentalStatus | 0..1 | InfrastructureRoot | ||
section | 1..1 | MentalStatusSection | Base for all types and resources | |
component:nutrition | 0..1 | InfrastructureRoot | ||
section | 1..1 | NutritionSection | Base for all types and resources | |
Documentation for this format |
Id | Grade | Path(s) | Details | Requirements |
1198-8456 | error | ClinicalDocument.author.assignedAuthor | Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). : assignedPerson.exists() or (assignedAuthoringDevice.exists() and representedOrganization.exists()) | |
1198-32466 | warning | ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). : assignedPerson.exists() implies id.where(root = '2.16.840.1.113883.4.6') | |
should-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-section-plan-of-treatment | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Plan of Treatment Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/PlanofTreatmentSection')) | |
should-section-procedures | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Procedures Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProceduresSection')) |
Key Elements View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ClinicalDocument | C | 1..1 | USRealmHeader | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, @classCode, @moodCode, realmCode, typeId, templateId, id, code, title, sdtcStatusCode, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, copyTime, recordTarget, author, dataEnterer, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, relatedDocument, authorization, componentOf, component, realmCode, typeId, templateId, templateId, id, code, title, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, recordTarget, author, dataEnterer, informant, informant, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, authorization, componentOf Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) |
realmCode | 1..1 | CS | ||
@code | 1..1 | cs | Required Pattern: US | |
typeId | 1..1 | II | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | Fixed Value: POCD_HD000040 | |
Slices for templateId | 2..* | II | Slice: Unordered, Open by value:root, value:extension | |
templateId:us-realm | 1..1 | II | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.1 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
templateId:CCD | 1..1 | II | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.2 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
id | 1..1 | II | **SHALL** be a globally unique identifier for the document (CONF:4537-9991). | |
code | C | 1..1 | CE | Summarization of Episode Note Binding: FHIRDocumentTypeCodes (example) |
@code | 1..1 | cs | Required Pattern: 34133-9 | |
@codeSystem | 1..1 | oid, uuid, ruid | LOINC Required Pattern: 2.16.840.1.113883.6.1 | |
title | 1..1 | ST | The title can either be a locally defined name or the displayName corresponding to clinicalDocument/code | |
effectiveTime | C | 1..1 | USRealmDateTime | Base for all types and resources |
confidentialityCode | 1..1 | CE | Binding: HL7 BasicConfidentialityKind (preferred) | |
@code | 1..1 | cs | ||
languageCode | 1..1 | CS | Binding: AllLanguages (required) | |
recordTarget | 1..* | RecordTarget | The recordTarget records the administrative and demographic data of the patient whose health information is described by the clinical document; each recordTarget must contain at least one patientRole element | |
patientRole | 1..1 | PatientRole | ||
id | 1..* | II | ||
addr | C | 1..* | USRealmAddress | (USCDI) Address |
telecom | C | 1..* | TEL | (USCDI) Phone Number / Email |
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
patient | C | 1..1 | Patient | |
name | C | 1..* | USRealmPatientNamePTNUSFIELDED | Base for all types and resources |
administrativeGenderCode | 1..1 | CE | Binding: Administrative Gender (HL7 V3) (required) | |
birthTime | C | 1..1 | TS | (USCDI) Date of Birth - **MAY** be precise to the minute (CONF:4537-32418) (For cases where information about newborn's time of birth needs to be captured) |
raceCode | 1..1 | CE | (USCDI) Race Binding: Race Category Excluding Nulls (required) | |
ethnicGroupCode | 1..1 | CE | (USCDI) Ethnicity Binding: Ethnicity (required) | |
author | 1..* | Author | The author element represents the creator of the clinical document. The author may be a device or a person. | |
time | C | 1..1 | USRealmDateTime | Base for all types and resources |
assignedAuthor | C | 1..1 | AssignedAuthor | 1198-8456: Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). |
Slices for id | 1..* | II | Slice: Unordered, Open by value:root | |
id:npi | C | 0..1 | II | |
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.4.6 | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
Slices for informant | 0..* | Informant | Slice: Unordered, Open by exists:relatedEntity, exists:assignedEntity | |
informant:provider | 0..* | Informant | The informant element describes an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient. | |
assignedEntity | 1..1 | AssignedEntity | ||
id | 1..* | II | If assignedEntity/id is a provider then this id, **SHOULD** include zero or one [0..1] id where id/@root ="2.16.840.1.113883.4.6" National Provider Identifier (CONF:4537-9946). | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
assignedPerson | 1..1 | Person | ||
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
informant:non-provider | 0..* | Informant | The informant element describes an information source (who is not a provider) for any content within the clinical document. This informant would be used when the source of information has a personal relationship with the patient or is the patient. | |
relatedEntity | 1..1 | RelatedEntity | ||
custodian | 1..1 | Custodian | The custodian element represents the organization that is in charge of maintaining and is entrusted with the care of the document. There is only one custodian per CDA document. Allowing that a CDA document may not represent the original form of the authenticated document, the custodian represents the steward of the original source document. The custodian may be the document originator, a health information exchange, or other responsible party. | |
assignedCustodian | 1..1 | AssignedCustodian | ||
representedCustodianOrganization | 1..1 | CustodianOrganization | ||
id | 1..* | II | ||
name | 1..1 | ON | ||
telecom | C | 1..1 | TEL | |
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
addr | C | 1..1 | USRealmAddress | Base for all types and resources |
documentationOf | 1..1 | DocumentationOf | The documentationOf relationship in a Continuity Care Document contains the representation of providers who are wholly or partially responsible for the safety and well-being of a subject of care. | |
serviceEvent | C | 1..1 | ServiceEvent | The main activity being described by a CCD is the provision of healthcare over a period of time. This is shown by setting the value of serviceEvent/@classCode to 'PCPR' (care provision) and indicating the duration over which care was provided in serviceEvent/effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g., reviewed during the stated time range).
NOTE: Implementations originating a CCD should take care to discover what the episode of care being summarized is. For example, when a patient fills out a form providing relevant health history, the episode of care being documented might be from birth to the present. should-performer: SHOULD contain performer |
@classCode | 1..1 | cs | Binding: ActClass (required) Fixed Value: PCPR | |
effectiveTime | C | 1..1 | USRealmDateTimeInterval | Base for all types and resources |
low | C | 1..1 | IVXB_TS | **MAY** be precise to at least the second |
high | C | 1..1 | IVXB_TS | **MAY** be precise to at least the second |
performer | 0..* | Performer1 | The serviceEvent/performer represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patient's key healthcare providers would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors. | |
@typeCode | 1..1 | cs | Binding: x_ServiceEventPerformer (required) Fixed Value: PRF | |
assignedEntity | C | 1..1 | AssignedEntity | SG 20230709: Illegal constraint - base has min = 1 (deleted min=0) 1198-32466: If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). |
id | 1..* | II | ||
assignedPerson | 0..1 | Person | ||
component | 1..1 | Component | ||
structuredBody | C | 1..1 | StructuredBody | should-section-procedures: SHOULD contain a Procedures Section should-section-plan-of-treatment: SHOULD contain a Plan of Treatment Section |
Slices for component | 6..* | InfrastructureRoot | Slice: Unordered, Open by profile:section | |
component:All Slices | Content/Rules for all slices | |||
section | 1..1 | Section | ||
component:allergies | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | AllergiesAndIntolerancesSection | Base for all types and resources |
component:medications | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | MedicationsSection | Base for all types and resources |
component:problems | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | ProblemSection | Base for all types and resources |
component:procedures | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | ProceduresSection | Base for all types and resources |
component:results | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | ResultsSection | Base for all types and resources |
component:advDirectives | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | AdvanceDirectivesSection | Base for all types and resources |
component:encounters | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | EncountersSection | Base for all types and resources |
component:famHistory | 0..1 | InfrastructureRoot | ||
section | 1..1 | FamilyHistorySection | Base for all types and resources | |
component:functionalStatus | 0..1 | InfrastructureRoot | ||
section | 1..1 | FunctionalStatusSection | Base for all types and resources | |
component:immunizations | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | ImmunizationsSection | Base for all types and resources |
component:medEquipment | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | MedicalEquipmentSection | Base for all types and resources |
component:payers | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | PayersSection | Base for all types and resources |
component:planOfTreatment | 0..1 | InfrastructureRoot | ||
section | 1..1 | PlanofTreatmentSection | Base for all types and resources | |
component:socialHist | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | SocialHistorySection | Base for all types and resources |
component:vitalSigns | 1..1 | InfrastructureRoot | ||
section | C | 1..1 | VitalSignsSection | Base for all types and resources |
component:mentalStatus | 0..1 | InfrastructureRoot | ||
section | 1..1 | MentalStatusSection | Base for all types and resources | |
component:nutrition | 0..1 | InfrastructureRoot | ||
section | C | 1..1 | NutritionSection | Base for all types and resources |
Documentation for this format |
Path | Conformance | ValueSet / Code |
ClinicalDocument.code | example | FHIRDocumentTypeCodes |
ClinicalDocument.confidentialityCode | preferred | HL7BasicConfidentialityKind |
ClinicalDocument.languageCode | required | AllLanguages |
ClinicalDocument.recordTarget.patientRole.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.recordTarget.patientRole.patient.administrativeGenderCode | required | AdministrativeGenderHL7V3 |
ClinicalDocument.recordTarget.patientRole.patient.raceCode | required | RaceCategoryExcludingNulls |
ClinicalDocument.recordTarget.patientRole.patient.ethnicGroupCode | required | Ethnicity |
ClinicalDocument.author.assignedAuthor.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.documentationOf.serviceEvent.classCode | required | Fixed Value: PCPR |
ClinicalDocument.documentationOf.serviceEvent.performer.typeCode | required | Fixed Value: PRF |
Id | Grade | Path(s) | Details | Requirements |
1198-8456 | error | ClinicalDocument.author.assignedAuthor | Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). : assignedPerson.exists() or (assignedAuthoringDevice.exists() and representedOrganization.exists()) | |
1198-32466 | warning | ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). : assignedPerson.exists() implies id.where(root = '2.16.840.1.113883.4.6') | |
4537-6380 | error | ClinicalDocument | If setId is present versionNumber **SHALL** be present (CONF:4537-6380). : setId.exists() implies versionNumber.exists() | |
4537-6387 | error | ClinicalDocument | If versionNumber is present setId **SHALL** be present (CONF:4537-6387). : versionNumber.exists() implies setId.exists() | |
4537-16790 | error | ClinicalDocument.author.assignedAuthor | There **SHALL** be exactly one assignedAuthor/assignedPerson or exactly one assignedAuthor/assignedAuthoringDevice (CONF:4537-16790). : (assignedPerson | assignedAuthoringDevice).count() = 1 | |
4537-21000 | error | ClinicalDocument.recordTarget.patientRole.patient | If sdtc:deceasedTime/@value is present, then sdtc:deceasedInd SHALL be present with value=true : sdtcDeceasedTime.value.exists() implies sdtcDeceasedInd.exists(value='true') | |
4537-32948 | error | ClinicalDocument.code | This code **SHALL** be drawn from the LOINC document type ontology (LOINC codes where SCALE = DOC) (CONF:4537-32948). : codeSystem = '2.16.840.1.113883.6.1' | |
4537-32993 | error | ClinicalDocument.recordTarget.patientRole.patient | If sdtc:deceasedInd="true", then sdtc:deceasedTime **SHALL** be present with either a @value or @nullFlavor=UNK (CONF:4537-32993). : sdtcDeceasedInd.exists(value='true') implies sdtcDeceasedTime.exists() | |
81-7278 | error | ClinicalDocument.recordTarget.patientRole.patient.name | **SHALL NOT** have mixed content except for white space (CONF:81-7278). : item.xmlText.empty() | |
81-7296 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | **SHALL NOT** have mixed content except for white space (CONF:81-7296) : item.xmlText.empty() | |
81-9371 | error | ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name | The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists() | |
81-9372 | error | ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name | The string **SHALL NOT** contain name parts (CONF:81-9372). : item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty() | |
81-10024 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')) | |
81-10025 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')) | |
ivl-ts-center | error | ClinicalDocument.documentationOf.serviceEvent.effectiveTime | Center cannot co-exist with low or high : center.empty() or (low.empty() and high.empty()) | |
ivl-value-shall | error | ClinicalDocument.documentationOf.serviceEvent.effectiveTime | If a time interval contains @value, then it shall be precise to at least the day. : value.exists() implies value.toString().length() >= 10 | |
ivl-value-should | warning | ClinicalDocument.documentationOf.serviceEvent.effectiveTime | If a time interval contains @value, then it SHOULD contain a time component. : value.exists() implies value.toString().length() > 10 | |
pn-no-ls | error | ClinicalDocument.recordTarget.patientRole.patient.name, ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name | No PN name part may have a qualifier of LS. : (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty() | |
shall-adv-directive-organizer | error | ClinicalDocument.component.structuredBody.component:advDirectives.section | SHALL contain at least one Advance Directive Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveOrganizer')) | |
shall-allergy-concern | error | ClinicalDocument.component.structuredBody.component:allergies.section | SHALL contain at least one Allergy Concern Act : nullFlavor.exists() or entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/AllergyConcernAct')) | |
shall-city | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHALL contain exactly one [1..1] city (CONF:81-7292). : nullFlavor.exists() or item.city.count() = 1 | |
shall-encounter-activity | error | ClinicalDocument.component.structuredBody.component:encounters.section | SHALL contain at least one Encounter Activity : nullFlavor.exists() or entry.where(encounter.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/EncounterActivity')) | |
shall-family | error | ClinicalDocument.recordTarget.patientRole.patient.name | SHALL contain exactly one [1..1] family (CONF:81-7159). : nullFlavor.exists() or item.family.count() = 1 | |
shall-given | error | ClinicalDocument.recordTarget.patientRole.patient.name | SHALL contain at least one [1..*] given (CONF:81-7157). : nullFlavor.exists() or item.given.exists() | |
shall-immunization-activity | error | ClinicalDocument.component.structuredBody.component:immunizations.section | SHALL contain at least one Immunization Activity : nullFlavor.exists() or entry.where(substanceAdministration.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity')) | |
shall-max-ad-parts | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHALL have at most one of each: state, city, postalCode, and country : (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1) | |
shall-max-suffix | error | ClinicalDocument.recordTarget.patientRole.patient.name | There may be at most one suffix : (item.suffix.empty() or item.suffix.count() = 1) | |
shall-med-activity | error | ClinicalDocument.component.structuredBody.component:medications.section | SHALL contain at least one Medication Activity : nullFlavor.exists() or entry.where(substanceAdministration.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/MedicationActivity')) | |
shall-problem-concern-act | error | ClinicalDocument.component.structuredBody.component:problems.section | SHALL contain at least one Problem Concern Act : nullFlavor.exists() or entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProblemConcernAct')) | |
shall-procedure-act-procedure | error | ClinicalDocument.component.structuredBody.component:procedures.section | SHALL contain at least one Procedure Activity Procedure : nullFlavor.exists() or entry.where(procedure.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure')) | |
shall-result-org | error | ClinicalDocument.component.structuredBody.component:results.section | SHALL contain at least one Result Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ResultOrganizer')) | |
shall-streetAddressLine | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291). : nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4) | |
shall-vital-signs-org | error | ClinicalDocument.component.structuredBody.component:vitalSigns.section | SHALL contain at least one Vital Signs Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/VitalSignsOrganizer')) | |
should-country | warning | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHOULD contain country : nullFlavor.exists() or item.country.exists() | |
should-coverage-activity | warning | ClinicalDocument.component.structuredBody.component:payers.section | SHOULD contain Coverage Activity : entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/CoverageActivity')) | |
should-extension | warning | ClinicalDocument.author.assignedAuthor.id:npi | SHOULD contain extension : extension.exists() | |
should-id-npi | warning | ClinicalDocument.author.assignedAuthor | SHOULD contain an id with root='2.16.840.1.113883.4.6' (NPI) : id.where(root = '2.16.840.1.113883.4.6') | |
should-legalAuthenticator | warning | ClinicalDocument | SHOULD contain legalAuthenticator : legalAuthenticator.exists() | |
should-maritalStatusCode | warning | ClinicalDocument.recordTarget.patientRole.patient | SHOULD contain maritalStatusCode : maritalStatusCode.exists() | |
should-non-med-supply | warning | ClinicalDocument.component.structuredBody.component:medEquipment.section | SHOULD contain Non-Medicinal Supply Activity : entry.where(supply.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/NonMedicinalSupplyActivity')) | |
should-nutritional-status-obs | warning | ClinicalDocument.component.structuredBody.component:nutrition.section | SHOULD contain Nutritional Status Observation : entry.where(observation.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/NutritionalStatusObservation')) | |
should-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-procedure-act-procedure | warning | ClinicalDocument.component.structuredBody.component:medEquipment.section | SHOULD contain Procedure Activity Procedure : entry.where(procedure.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure')) | |
should-relatedParticipant | warning | ClinicalDocument | Documents SHOULD contain a RelatedPerson participant : participant.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/RelatedPersonRelationshipAndNameParticipant').exists() | |
should-section-plan-of-treatment | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Plan of Treatment Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/PlanofTreatmentSection')) | |
should-section-procedures | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Procedures Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProceduresSection')) | |
should-smoking-status | warning | ClinicalDocument.component.structuredBody.component:socialHist.section | SHOULD contain Smoking Status - Meaningful Use : entry.where(observation.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/SmokingStatusMeaningfulUse')) | |
should-us-code | warning | ClinicalDocument.author.assignedAuthor, ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | SHOULD contain code : code.exists() | |
should-us-languageCommunication | warning | ClinicalDocument.recordTarget.patientRole.patient | SHOULD contain languageCommunication : languageCommunication.exists() | |
should-us-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-use | warning | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.telecom, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.author.assignedAuthor.telecom, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr | SHOULD contain @use : nullFlavor.exists() or use.exists() | |
ts-shall-day | error | ClinicalDocument.effectiveTime, ClinicalDocument.author.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high | **SHALL** be precise to at least the day : nullFlavor.exists() or value.toString().length() >= 10 | |
ts-shall-year | error | ClinicalDocument.recordTarget.patientRole.patient.birthTime | **SHALL** be precise to at least the year : nullFlavor.exists() or value.toString().length() >= 4 | |
ts-should-day | warning | ClinicalDocument.recordTarget.patientRole.patient.birthTime | **SHOULD** be precise to at least the day : nullFlavor.exists() or value.toString().length() >= 10 | |
ts-should-minute | warning | ClinicalDocument.effectiveTime, ClinicalDocument.author.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high | **SHOULD** be precise to at least the minute : nullFlavor.exists() or value.toString().length() > 10 |
Snapshot View
Name | Flags | Card. | Type | Description & Constraints |
---|---|---|---|---|
ClinicalDocument | C | 1..1 | USRealmHeader | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, @classCode, @moodCode, realmCode, typeId, templateId, id, code, title, sdtcStatusCode, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, copyTime, recordTarget, author, dataEnterer, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, relatedDocument, authorization, componentOf, component, realmCode, typeId, templateId, templateId, id, code, title, effectiveTime, confidentialityCode, languageCode, setId, versionNumber, recordTarget, author, dataEnterer, informant, informant, informant, custodian, informationRecipient, legalAuthenticator, authenticator, participant, inFulfillmentOf, documentationOf, authorization, componentOf Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@classCode | 0..1 | cs | Binding: ActClass (example) Fixed Value: DOCCLIN | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
realmCode | 1..1 | CS | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Required Pattern: US | |
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
typeId | 1..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | Fixed Value: POCD_HD000040 | |
Slices for templateId | 2..* | II | Slice: Unordered, Open by value:root, value:extension | |
templateId:us-realm | 1..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.1 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
templateId:CCD | 1..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.1.2 | |
@extension | 1..1 | st | Required Pattern: 2024-05-01 | |
id | 1..1 | II | **SHALL** be a globally unique identifier for the document (CONF:4537-9991). | |
code | C | 1..1 | CE | Summarization of Episode Note Binding: FHIRDocumentTypeCodes (example) |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Required Pattern: 34133-9 | |
@codeSystem | 1..1 | oid, uuid, ruid | LOINC Required Pattern: 2.16.840.1.113883.6.1 | |
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
title | 1..1 | ST | The title can either be a locally defined name or the displayName corresponding to clinicalDocument/code | |
sdtcStatusCode | 0..1 | CS | XML Namespace: urn:hl7-org:sdtc XML: statusCode (urn:hl7-org:sdtc) Binding: ActStatus (required) | |
effectiveTime | C | 1..1 | USRealmDateTime | Base for all types and resources |
confidentialityCode | 1..1 | CE | Binding: HL7 BasicConfidentialityKind (preferred) | |
@code | 1..1 | cs | ||
@codeSystem | 0..1 | oid, uuid, ruid | ||
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
languageCode | 1..1 | CS | Binding: AllLanguages (required) | |
setId | 0..1 | II | ||
versionNumber | 0..1 | INT | ||
copyTime | 0..1 | TS | ||
recordTarget | 1..* | RecordTarget | The recordTarget records the administrative and demographic data of the patient whose health information is described by the clinical document; each recordTarget must contain at least one patientRole element | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: RCT | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
patientRole | 1..1 | PatientRole | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassRelationshipFormal (required) Fixed Value: PAT | |
id | 1..* | II | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
addr | C | 1..* | USRealmAddress | (USCDI) Address |
telecom | C | 1..* | TEL | (USCDI) Phone Number / Email |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
patient | C | 1..1 | Patient | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
id | 0..1 | II | ||
name | C | 1..* | USRealmPatientNamePTNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
administrativeGenderCode | 1..1 | CE | Binding: Administrative Gender (HL7 V3) (required) | |
birthTime | C | 1..1 | TS | (USCDI) Date of Birth - **MAY** be precise to the minute (CONF:4537-32418) (For cases where information about newborn's time of birth needs to be captured) |
sdtcDeceasedInd | 0..1 | BL | XML Namespace: urn:hl7-org:sdtc sdtc:deceasedInd XML: deceasedInd (urn:hl7-org:sdtc) | |
sdtcDeceasedTime | C | 0..1 | TS | XML Namespace: urn:hl7-org:sdtc (USCDI) Date of Death XML: deceasedTime (urn:hl7-org:sdtc) |
sdtcMultipleBirthInd | 0..1 | BL | XML Namespace: urn:hl7-org:sdtc XML: multipleBirthInd (urn:hl7-org:sdtc) | |
sdtcMultipleBirthOrderNumber | 0..1 | INT_POS | XML Namespace: urn:hl7-org:sdtc XML: multipleBirthOrderNumber (urn:hl7-org:sdtc) | |
maritalStatusCode | 0..1 | CE | Binding: Marital Status (required) | |
religiousAffiliationCode | 0..1 | CE | Binding: Religious Affiliation (required) | |
raceCode | 1..1 | CE | (USCDI) Race Binding: Race Category Excluding Nulls (required) | |
sdtcRaceCode | 0..* | CE | XML Namespace: urn:hl7-org:sdtc (USCDI) Race - The sdtc:raceCode is only used to record additional values when the patient has indicated multiple races or additional race detail beyond the five categories required for Meaningful Use Stage 2. The prefix sdtc: SHALL be bound to the namespace “urn:hl7-org:sdtc”. The use of the namespace provides a necessary extension to CDA R2 for the use of the additional raceCode elements. XML: raceCode (urn:hl7-org:sdtc) Binding: Race Value Set (required) | |
ethnicGroupCode | 1..1 | CE | (USCDI) Ethnicity Binding: Ethnicity (required) | |
sdtcEthnicGroupCode | 0..* | CE | XML Namespace: urn:hl7-org:sdtc (USCDI) Ethnicity XML: ethnicGroupCode (urn:hl7-org:sdtc) Binding: Detailed Ethnicity (required) | |
guardian | C | 0..* | Guardian | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAgent (required) Fixed Value: GUARD | |
id | 0..* | II | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Personal And Legal Relationship Role Type (required) | |
addr | C | 0..* | USRealmAddress | Base for all types and resources |
telecom | C | 0..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
guardianPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
guardianOrganization | 0..1 | Organization | ||
birthplace | 0..1 | Birthplace | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassPassive (required) Fixed Value: BIRTHPL | |
place | 1..1 | Place | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassPlace (required) Fixed Value: PLC | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | 0..1 | EN | ||
addr | C | 1..1 | AD | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@isNotOrdered | 0..1 | bl | ||
@use | 0..* | cs | Binding: CDAPostalAddressUse (required) | |
item | C | 0..* | Base | Choice Group: This is a repeating choice group that does not appear directly in the instance |
(Choice of one) | 1..1 | |||
delimiter | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DEL | |
country | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CNT | |
state | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: STA | |
county | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CPA | |
city | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CTY | |
postalCode | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: ZIP | |
streetAddressLine | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: SAL | |
houseNumber | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: BNR | |
houseNumberNumeric | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: BNN | |
direction | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DIR | |
streetName | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: STR | |
streetNameBase | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: STB | |
streetNameType | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: STTYP | |
additionalLocator | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: ADL | |
unitID | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: UNID | |
unitType | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: UNIT | |
careOf | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CAR | |
censusTract | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: CEN | |
deliveryAddressLine | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DAL | |
deliveryInstallationType | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DINST | |
deliveryInstallationArea | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DINSTA | |
deliveryInstallationQualifier | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DINSTQ | |
deliveryMode | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DMOD | |
deliveryModeIdentifier | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: DMODID | |
buildingNumberSuffix | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: BNS | |
postBox | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: POB | |
precinct | C | 0..1 | ADXP | |
(Choice of one) | 1..1 | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
xmlText | 0..1 | st | Allows for mixed text content | |
@representation | 0..1 | cs | Fixed Value: TXT | |
@mediaType | 0..1 | cs | Fixed Value: text/plain | |
@language | 0..1 | cs | ||
@partType | 0..1 | cs | Fixed Value: PRE | |
xmlText | 0..1 | st | Allows for mixed text content | |
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
languageCommunication | C | 0..* | LanguageCommunication | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
languageCode | 1..1 | CS | Binding: AllLanguages (required) | |
modeCode | 0..1 | CE | Binding: LanguageAbilityMode (required) | |
proficiencyLevelCode | 0..1 | CE | Binding: LanguageAbilityProficiency (required) | |
preferenceInd | 0..1 | BL | ||
providerOrganization | 0..1 | Organization | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassOrganization (required) Fixed Value: ORG | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
name | 1..* | ON | ||
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
standardIndustryClassCode | 0..1 | CE | Binding: OrganizationIndustryClassNAICS (example) | |
asOrganizationPartOf | 0..1 | OrganizationPartOf | ||
author | 1..* | Author | The author element represents the creator of the clinical document. The author may be a device or a person. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: AUT | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
functionCode | 0..1 | CE | ||
time | C | 1..1 | USRealmDateTime | Base for all types and resources |
assignedAuthor | C | 1..1 | AssignedAuthor | 1198-8456: Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
Slices for id | 1..* | II | Slice: Unordered, Open by value:root | |
id:npi | C | 0..1 | II | |
@nullFlavor | 0..1 | cs | If NPI is unknown, set @nullFlavor to UNK Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.4.6 | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Only if this assignedAuthor is an assignedPerson should the assignedAuthor contain a code. Binding: v3 Code System RoleCode (example) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Binding: Healthcare Provider Taxonomy (preferred) | |
@codeSystem | 0..1 | oid, uuid, ruid | ||
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
(Choice of one) | 1..1 | |||
assignedPerson | 0..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
assignedAuthoringDevice | 0..1 | AuthoringDevice | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassDevice (required) Fixed Value: DEV | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
code | 0..1 | CE | Binding: EntityCode (example) | |
manufacturerModelName | 1..1 | SC | Binding: Manufacturer Model Name Example (example) | |
softwareName | 1..1 | SC | Binding: Software Name Example (example) | |
asMaintainedEntity | 0..* | MaintainedEntity | ||
representedOrganization | 0..1 | Organization | ||
dataEnterer | 0..1 | DataEnterer | The dataEnterer element represents the person who transferred the content, written or dictated, into the clinical document. To clarify, an author provides the content found within the header or body of a document, subject to their own interpretation; a dataEnterer adds an author's information to the electronic system. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: ENT | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
time | C | 0..1 | USRealmDateTime | Base for all types and resources |
assignedEntity | 1..1 | AssignedEntity | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred) | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
assignedPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
Slices for informant | 0..* | Informant | Slice: Unordered, Open by exists:relatedEntity, exists:assignedEntity | |
informant:provider | 0..* | Informant | The informant element describes an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: INF | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
assignedEntity | 1..1 | AssignedEntity | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | If assignedEntity/id is a provider then this id, **SHOULD** include zero or one [0..1] id where id/@root ="2.16.840.1.113883.4.6" National Provider Identifier (CONF:4537-9946). | |
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred) | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | 0..* | TEL | ||
assignedPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
informant:non-provider | 0..* | Informant | The informant element describes an information source (who is not a provider) for any content within the clinical document. This informant would be used when the source of information has a personal relationship with the patient or is the patient. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: INF | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
relatedEntity | 1..1 | RelatedEntity | ||
custodian | 1..1 | Custodian | The custodian element represents the organization that is in charge of maintaining and is entrusted with the care of the document. There is only one custodian per CDA document. Allowing that a CDA document may not represent the original form of the authenticated document, the custodian represents the steward of the original source document. The custodian may be the document originator, a health information exchange, or other responsible party. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: CST | |
assignedCustodian | 1..1 | AssignedCustodian | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
representedCustodianOrganization | 1..1 | CustodianOrganization | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassOrganization (required) Fixed Value: ORG | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
name | 1..1 | ON | ||
telecom | C | 1..1 | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
addr | C | 1..1 | USRealmAddress | Base for all types and resources |
informationRecipient | 0..* | InformationRecipient | The informationRecipient element records the intended recipient of the information at the time the document was created. In cases where the intended recipient of the document is the patient's health chart, set the receivedOrganization to the scoping organization for that chart. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: XInformationRecipient (2.0.0) (required) | |
intendedRecipient | 1..1 | IntendedRecipient | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | ||
id | 0..* | II | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
addr | 0..* | AD | ||
telecom | 0..* | TEL | ||
informationRecipient | 0..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
receivedOrganization | 0..1 | Organization | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassOrganization (required) Fixed Value: ORG | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
id | 0..* | II | ||
name | 1..1 | ON | ||
telecom | 0..* | TEL | ||
addr | 0..* | AD | ||
standardIndustryClassCode | 0..1 | CE | Binding: OrganizationIndustryClassNAICS (example) | |
asOrganizationPartOf | 0..1 | OrganizationPartOf | ||
legalAuthenticator | 0..1 | LegalAuthenticator | The legalAuthenticator identifies the single person legally responsible for the document and must be present if the document has been legally authenticated. A clinical document that does not contain this element has not been legally authenticated. The act of legal authentication requires a certain privilege be granted to the legal authenticator depending upon local policy. Based on local practice, clinical documents may be released before legal authentication. All clinical documents have the potential for legal authentication, given the appropriate credentials. Local policies MAY choose to delegate the function of legal authentication to a device or system that generates the clinical document. In these cases, the legal authenticator is a person accepting responsibility for the document, not the generating device or system. Note that the legal authenticator, if present, must be a person. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: LA | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
time | C | 1..1 | USRealmDateTime | Base for all types and resources |
signatureCode | C | 1..1 | CS | Binding: CDASignatureCode (required) |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Required Pattern: S | |
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
sdtcSignatureText | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc The signature can be represented either inline or by reference according to the ED data type. Typical cases for CDA are: 1) Electronic signature: this attribute can represent virtually any electronic signature scheme. 2) Digital signature: this attribute can represent digital signatures by reference to a signature data block that is constructed in accordance to a digital signature standard, such as XML-DSIG, PKCS#7, PGP, etc. The sdtc:signatureText extension provides a location in CDA for a textual or multimedia depiction of the signature by which the participant endorses and accepts responsibility for his or her participation in the Act as specified in the Participation.typeCode. Details of what goes in the field are described in the HL7 CDA Digital Signature Standard balloted in Fall 2013. XML: signatureText (urn:hl7-org:sdtc) | |
assignedEntity | 1..1 | AssignedEntity | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 0..1 | oid, uuid, ruid | MAY contain '2.16.840.1.113883.4.6' (NPI) | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred) | |
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
assignedPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
authenticator | 0..* | Authenticator | The authenticator identifies a participant or participants who attest to the accuracy of the information in the document. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: AUTHEN | |
time | C | 1..1 | USRealmDateTime | Base for all types and resources |
signatureCode | C | 1..1 | CS | Binding: CDASignatureCode (required) |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Required Pattern: S | |
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
sdtcSignatureText | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc The signature can be represented either inline or by reference according to the ED data type. Typical cases for CDA are: 1) Electronic signature: this attribute can represent virtually any electronic signature scheme. 2) Digital signature: this attribute can represent digital signatures by reference to a signature data block that is constructed in accordance to a digital signature standard, such as XML-DSIG, PKCS#7, PGP, etc. The sdtc:signatureText extension provides a location in CDA for a textual or multimedia depiction of the signature by which the participant endorses and accepts responsibility for his or her participation in the Act as specified in the Participation.typeCode. Details of what goes in the field are described in the HL7 CDA Digital Signature Standard balloted in Fall of 2013. XML: signatureText (urn:hl7-org:sdtc) | |
assignedEntity | 1..1 | AssignedEntity | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: v3 Code System RoleCode (example) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 0..1 | cs | Binding: Healthcare Provider Taxonomy (preferred) | |
@codeSystem | 0..1 | oid, uuid, ruid | ||
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
addr | C | 1..* | USRealmAddress | Base for all types and resources |
telecom | C | 1..* | TEL | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | url | ||
useablePeriod | 0..* | |||
useablePeriod | IVL_TS | |||
useablePeriod | EIVL_TS | |||
useablePeriod | PIVL_TS | |||
useablePeriod | SXPR_TS | |||
@use | 0..1 | cs | Binding: Telecom Use (US Realm Header) (required) | |
assignedPerson | 1..1 | Person | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: EntityClassLivingSubject (required) Fixed Value: PSN | |
@determinerCode | 0..1 | cs | Binding: EntityDeterminer (required) Fixed Value: INSTANCE | |
name | C | 1..* | USRealmPersonNamePNUSFIELDED | Base for all types and resources |
sdtcDesc | 0..1 | ED | XML Namespace: urn:hl7-org:sdtc XML: desc (urn:hl7-org:sdtc) | |
sdtcAsPatientRelationship | 0..* | InfrastructureRoot | XML Namespace: urn:hl7-org:sdtc XML: asPatientRelationship (urn:hl7-org:sdtc) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Fixed Value: PRS | |
@determinerCode | 0..1 | cs | Fixed Value: INSTANCE | |
code | 1..1 | CE | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
participant | C | 0..* | Participant1 | The participant element identifies supporting entities, including parents, relatives, caregivers, insurance policyholders, guarantors, and others related in some way to the patient. A supporting person or organization is an individual or an organization with a relationship to the patient. A supporting person who is playing multiple roles would be recorded in multiple participants (e.g., emergency contact and next-of-kin). |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 1..1 | cs | Binding: ParticipationType (required) | |
@contextControlCode | 0..1 | cs | Binding: ContextControl (required) Fixed Value: OP | |
functionCode | 0..1 | CE | ||
time | C | 0..1 | USRealmDateTimeInterval | Base for all types and resources |
associatedEntity | 1..1 | AssociatedEntity | ||
inFulfillmentOf | 0..* | InFulfillmentOf | The inFulfillmentOf element represents orders that are fulfilled by this document such as a radiologists' report of an x-ray. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ActRelationshipFulfills (2.0.0) (required) Fixed Value: FLFS | |
order | 1..1 | Order | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Binding: ActClass (required) | |
@moodCode | 0..1 | cs | Binding: ActMoodIntent (required) Fixed Value: RQO | |
id | 1..* | II | ||
code | 0..1 | CE | Binding: v3 Code System ActCode (example) | |
priorityCode | 0..1 | CE | Binding: ActPriority (example) | |
documentationOf | 1..1 | DocumentationOf | The documentationOf relationship in a Continuity Care Document contains the representation of providers who are wholly or partially responsible for the safety and well-being of a subject of care. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: DOC | |
serviceEvent | C | 1..1 | ServiceEvent | The main activity being described by a CCD is the provision of healthcare over a period of time. This is shown by setting the value of serviceEvent/@classCode to 'PCPR' (care provision) and indicating the duration over which care was provided in serviceEvent/effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g., reviewed during the stated time range).
NOTE: Implementations originating a CCD should take care to discover what the episode of care being summarized is. For example, when a patient fills out a form providing relevant health history, the episode of care being documented might be from birth to the present. should-performer: SHOULD contain performer |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 1..1 | cs | Binding: ActClass (required) Fixed Value: PCPR | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
id | 0..* | II | ||
code | 0..1 | CE | ||
effectiveTime | C | 1..1 | USRealmDateTimeInterval | Base for all types and resources |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | ts | Either @value or low/high should be present, but not both Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz] | |
@operator | 0..1 | cs | Binding: SetOperator (required) | |
low | C | 1..1 | IVXB_TS | **MAY** be precise to at least the second |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | ts | Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz] | |
@inclusive | 0..1 | bl | ||
center | 0..1 | TS | ||
width | 0..1 | PQ | ||
high | C | 1..1 | IVXB_TS | **MAY** be precise to at least the second |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@value | 0..1 | ts | Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz] | |
@inclusive | 0..1 | bl | ||
performer | 0..* | Performer1 | The serviceEvent/performer represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patient's key healthcare providers would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 1..1 | cs | Binding: x_ServiceEventPerformer (required) Fixed Value: PRF | |
functionCode | C | 0..1 | CE | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 0..1 | cs | Binding: Care Team Member Function (preferred) | |
@codeSystem | 0..1 | oid, uuid, ruid | ||
@codeSystemName | 0..1 | st | ||
@codeSystemVersion | 0..1 | st | ||
@displayName | 0..1 | st | ||
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
originalText | 0..1 | ED | ||
translation | 0..* | CD | ||
time | C | 0..1 | USRealmDateTimeInterval | Base for all types and resources |
assignedEntity | C | 1..1 | AssignedEntity | SG 20230709: Illegal constraint - base has min = 1 (deleted min=0) 1198-32466: If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: RoleClassAssignedEntity (required) Fixed Value: ASSIGNED | |
id | 1..* | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | C | 0..1 | oid, uuid, ruid | |
@extension | 0..1 | st | ||
sdtcIdentifiedBy | 0..* | IdentifiedBy | XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc) | |
code | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred) | |
addr | 0..* | AD | ||
telecom | 0..* | TEL | ||
assignedPerson | 0..1 | Person | ||
representedOrganization | 0..1 | Organization | ||
sdtcPatient | 0..1 | Base | XML Namespace: urn:hl7-org:sdtc XML: patient (urn:hl7-org:sdtc) | |
id | 1..1 | II | XML Namespace: urn:hl7-org:sdtc XML Namespace: urn:hl7-org:sdtc | |
relatedDocument | 0..* | RelatedDocument | ||
authorization | 0..* | Authorization | The authorization element represents information about the patient's consent. The type of consent is conveyed in consent/code. Consents in the header have been finalized (consent/statusCode must equal Completed) and should be on file. This specification does not address how 'Privacy Consent' is represented, but does not preclude the inclusion of 'Privacy Consent'. The authorization consent is used for referring to consents that are documented elsewhere in the EHR or medical record for a health condition and/or treatment that is described in the CDA document. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: AUTH | |
consent | 1..1 | Consent | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: ActClass (required) Fixed Value: CONS | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
id | 0..* | II | ||
code | 0..1 | CE | The type of consent (e.g., a consent to perform the related serviceEvent) is conveyed in consent/code. Binding: v3 Code System ActCode (example) | |
statusCode | 1..1 | CS | Binding: ActStatus (required) | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@code | 1..1 | cs | Fixed Value: completed | |
@sdtcValueSet | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc) | |
@sdtcValueSetVersion | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc) | |
componentOf | 0..1 | ComponentOf | The encompassing encounter represents the setting of the clinical encounter during which the document act(s) or ServiceEvent(s) occurred. In order to represent providers associated with a specific encounter, they are recorded within the encompassingEncounter as participants. In a CCD, the encompassingEncounter may be used when documenting a specific encounter and its participants. All relevant encounters in a CCD may be listed in the encounters section. | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ActRelationshipHasComponent (required) Fixed Value: COMP | |
encompassingEncounter | C | 1..1 | EncompassingEncounter | |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: ActClass (required) Fixed Value: ENC | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
id | 1..* | II | ||
code | 0..1 | CE | Binding: Act Encounter Codes (preferred) | |
effectiveTime | C | 1..1 | USRealmDateTimeInterval | Base for all types and resources |
sdtcAdmissionReferralSourceCode | 0..1 | CE | XML Namespace: urn:hl7-org:sdtc XML: admissionReferralSourceCode (urn:hl7-org:sdtc) | |
dischargeDispositionCode | 0..1 | CE | Binding: USEncounterDischargeDisposition (example) | |
responsibleParty | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationType (required) Fixed Value: RESP | |
assignedEntity | C | 1..1 | AssignedEntity | |
encounterParticipant | 0..* | EncounterParticipant | ||
location | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ParticipationTargetLocation (required) Fixed Value: LOC | |
healthCareFacility | 1..1 | HealthCareFacility | ||
component | 1..1 | Component | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Binding: ActRelationshipHasComponent (required) Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
nonXMLBody | 0..1 | NonXMLBody | ||
structuredBody | C | 1..1 | StructuredBody | should-section-procedures: SHOULD contain a Procedures Section should-section-plan-of-treatment: SHOULD contain a Plan of Treatment Section |
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@classCode | 0..1 | cs | Binding: ActClassRecordOrganizer (required) Fixed Value: DOCBODY | |
@moodCode | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN | |
confidentialityCode | 0..1 | CE | ||
languageCode | 0..1 | CS | Binding: AllLanguages (required) | |
Slices for component | 6..* | InfrastructureRoot | Slice: Unordered, Open by profile:section | |
component:All Slices | Content/Rules for all slices | |||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | Section | ||
component:allergies | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | AllergiesAndIntolerancesSection | Base for all types and resources |
component:medications | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | MedicationsSection | Base for all types and resources |
component:problems | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | ProblemSection | Base for all types and resources |
component:procedures | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | ProceduresSection | Base for all types and resources |
component:results | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | ResultsSection | Base for all types and resources |
component:advDirectives | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | AdvanceDirectivesSection | Base for all types and resources |
component:encounters | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | EncountersSection | Base for all types and resources |
component:famHistory | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | FamilyHistorySection | Base for all types and resources | |
component:functionalStatus | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | FunctionalStatusSection | Base for all types and resources | |
component:immunizations | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | ImmunizationsSection | Base for all types and resources |
component:medEquipment | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | MedicalEquipmentSection | Base for all types and resources |
component:payers | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | PayersSection | Base for all types and resources |
component:planOfTreatment | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | PlanofTreatmentSection | Base for all types and resources | |
component:socialHist | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | SocialHistorySection | Base for all types and resources |
component:vitalSigns | 1..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | VitalSignsSection | Base for all types and resources |
component:mentalStatus | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | 1..1 | MentalStatusSection | Base for all types and resources | |
component:nutrition | 0..1 | InfrastructureRoot | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
realmCode | 0..* | CS | ||
typeId | 0..1 | II | ||
@nullFlavor | 0..1 | cs | Binding: CDANullFlavor (required) | |
@assigningAuthorityName | 0..1 | st | ||
@displayable | 0..1 | bl | ||
@root | 1..1 | oid, uuid, ruid | Fixed Value: 2.16.840.1.113883.1.3 | |
@extension | 1..1 | st | ||
templateId | 0..* | II | ||
@typeCode | 0..1 | cs | Fixed Value: COMP | |
@contextConductionInd | 0..1 | bl | Fixed Value: true | |
section | C | 1..1 | NutritionSection | Base for all types and resources |
Documentation for this format |
Path | Conformance | ValueSet / Code |
ClinicalDocument.nullFlavor | required | CDANullFlavor |
ClinicalDocument.classCode | example | Fixed Value: DOCCLIN |
ClinicalDocument.moodCode | required | Fixed Value: EVN |
ClinicalDocument.realmCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.templateId:us-realm.nullFlavor | required | CDANullFlavor |
ClinicalDocument.templateId:CCD.nullFlavor | required | CDANullFlavor |
ClinicalDocument.code | example | FHIRDocumentTypeCodes |
ClinicalDocument.code.nullFlavor | required | CDANullFlavor |
ClinicalDocument.sdtcStatusCode | required | ActStatus |
ClinicalDocument.confidentialityCode | preferred | HL7BasicConfidentialityKind |
ClinicalDocument.languageCode | required | AllLanguages |
ClinicalDocument.recordTarget.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.typeCode | required | Fixed Value: RCT |
ClinicalDocument.recordTarget.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.recordTarget.patientRole.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.classCode | required | Fixed Value: PAT |
ClinicalDocument.recordTarget.patientRole.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.recordTarget.patientRole.patient.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.classCode | required | Fixed Value: PSN |
ClinicalDocument.recordTarget.patientRole.patient.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.recordTarget.patientRole.patient.administrativeGenderCode | required | AdministrativeGenderHL7V3 |
ClinicalDocument.recordTarget.patientRole.patient.maritalStatusCode | required | MaritalStatus |
ClinicalDocument.recordTarget.patientRole.patient.religiousAffiliationCode | required | ReligiousAffiliation |
ClinicalDocument.recordTarget.patientRole.patient.raceCode | required | RaceCategoryExcludingNulls |
ClinicalDocument.recordTarget.patientRole.patient.sdtcRaceCode | required | RaceValueSet |
ClinicalDocument.recordTarget.patientRole.patient.ethnicGroupCode | required | Ethnicity |
ClinicalDocument.recordTarget.patientRole.patient.sdtcEthnicGroupCode | required | DetailedEthnicity |
ClinicalDocument.recordTarget.patientRole.patient.guardian.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.classCode | required | Fixed Value: GUARD |
ClinicalDocument.recordTarget.patientRole.patient.guardian.code | required | PersonalAndLegalRelationshipRoleType |
ClinicalDocument.recordTarget.patientRole.patient.guardian.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.classCode | required | Fixed Value: BIRTHPL |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.classCode | required | Fixed Value: PLC |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.use | required | CDAPostalAddressUse |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.delimiter.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.country.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.state.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.county.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.city.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.postalCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetAddressLine.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.houseNumber.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.houseNumberNumeric.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.direction.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetName.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetNameBase.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetNameType.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.additionalLocator.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.unitID.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.unitType.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.careOf.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.censusTract.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryAddressLine.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationType.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationArea.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationQualifier.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryMode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryModeIdentifier.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.buildingNumberSuffix.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.postBox.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.precinct.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.languageCode | required | AllLanguages |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.modeCode | required | LanguageAbilityMode |
ClinicalDocument.recordTarget.patientRole.patient.languageCommunication.proficiencyLevelCode | required | LanguageAbilityProficiency |
ClinicalDocument.recordTarget.patientRole.providerOrganization.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.providerOrganization.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.providerOrganization.classCode | required | Fixed Value: ORG |
ClinicalDocument.recordTarget.patientRole.providerOrganization.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.recordTarget.patientRole.providerOrganization.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.providerOrganization.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.recordTarget.patientRole.providerOrganization.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.recordTarget.patientRole.providerOrganization.standardIndustryClassCode | example | OrganizationIndustryClassNAICS |
ClinicalDocument.author.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.typeCode | required | Fixed Value: AUT |
ClinicalDocument.author.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.author.assignedAuthor.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.author.assignedAuthor.id:npi.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.code | example | RoleCode |
ClinicalDocument.author.assignedAuthor.code.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.code.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.author.assignedAuthor.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.author.assignedAuthor.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.author.assignedAuthor.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.author.assignedAuthor.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.classCode | required | Fixed Value: DEV |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.code | example | EntityCode |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.manufacturerModelName | example | ManufacturerModelNameExample |
ClinicalDocument.author.assignedAuthor.assignedAuthoringDevice.softwareName | example | SoftwareNameExample |
ClinicalDocument.dataEnterer.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.typeCode | required | Fixed Value: ENT |
ClinicalDocument.dataEnterer.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.dataEnterer.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.dataEnterer.assignedEntity.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.dataEnterer.assignedEntity.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.typeCode | required | Fixed Value: INF |
ClinicalDocument.informant:provider.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.informant:provider.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.informant:provider.assignedEntity.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:provider.assignedEntity.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:non-provider.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:non-provider.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informant:non-provider.typeCode | required | Fixed Value: INF |
ClinicalDocument.informant:non-provider.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.custodian.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.typeCode | required | Fixed Value: CST |
ClinicalDocument.custodian.assignedCustodian.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.classCode | required | Fixed Value: ORG |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.informationRecipient.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.typeCode | required | XInformationRecipient |
ClinicalDocument.informationRecipient.intendedRecipient.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.classCode | required | Fixed Value: PSN |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.classCode | required | Fixed Value: ORG |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.informationRecipient.intendedRecipient.receivedOrganization.standardIndustryClassCode | example | OrganizationIndustryClassNAICS |
ClinicalDocument.legalAuthenticator.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.typeCode | required | Fixed Value: LA |
ClinicalDocument.legalAuthenticator.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.legalAuthenticator.signatureCode | required | CDASignatureCode |
ClinicalDocument.legalAuthenticator.signatureCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.legalAuthenticator.assignedEntity.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.legalAuthenticator.assignedEntity.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.typeCode | required | Fixed Value: AUTHEN |
ClinicalDocument.authenticator.signatureCode | required | CDASignatureCode |
ClinicalDocument.authenticator.signatureCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.authenticator.assignedEntity.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.code | example | RoleCode |
ClinicalDocument.authenticator.assignedEntity.code.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.code.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.authenticator.assignedEntity.telecom.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.telecom.use | required | TelecomUseUSRealmHeader |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.classCode | required | Fixed Value: PSN |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.determinerCode | required | Fixed Value: INSTANCE |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.sdtcAsPatientRelationship.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authenticator.assignedEntity.assignedPerson.sdtcAsPatientRelationship.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.participant.nullFlavor | required | CDANullFlavor |
ClinicalDocument.participant.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.participant.typeCode | required | ParticipationType |
ClinicalDocument.participant.contextControlCode | required | Fixed Value: OP |
ClinicalDocument.inFulfillmentOf.nullFlavor | required | CDANullFlavor |
ClinicalDocument.inFulfillmentOf.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.inFulfillmentOf.typeCode | required | Fixed Value: FLFS |
ClinicalDocument.inFulfillmentOf.order.nullFlavor | required | CDANullFlavor |
ClinicalDocument.inFulfillmentOf.order.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.inFulfillmentOf.order.classCode | required | ActClass |
ClinicalDocument.inFulfillmentOf.order.moodCode | required | Fixed Value: RQO |
ClinicalDocument.inFulfillmentOf.order.code | example | ActCode |
ClinicalDocument.inFulfillmentOf.order.priorityCode | example | ActPriority |
ClinicalDocument.documentationOf.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.typeCode | required | Fixed Value: DOC |
ClinicalDocument.documentationOf.serviceEvent.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.classCode | required | Fixed Value: PCPR |
ClinicalDocument.documentationOf.serviceEvent.moodCode | required | Fixed Value: EVN |
ClinicalDocument.documentationOf.serviceEvent.effectiveTime.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.effectiveTime.operator | required | SetOperator |
ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.typeCode | required | Fixed Value: PRF |
ClinicalDocument.documentationOf.serviceEvent.performer.functionCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.functionCode.code | preferred | CareTeamMemberFunction |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.classCode | required | Fixed Value: ASSIGNED |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.id.nullFlavor | required | CDANullFlavor |
ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.code | preferred | HealthcareProviderTaxonomy (a valid code from http://nucc.org/provider-taxonomy ) |
ClinicalDocument.authorization.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authorization.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authorization.typeCode | required | Fixed Value: AUTH |
ClinicalDocument.authorization.consent.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authorization.consent.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.authorization.consent.classCode | required | Fixed Value: CONS |
ClinicalDocument.authorization.consent.moodCode | required | Fixed Value: EVN |
ClinicalDocument.authorization.consent.code | example | ActCode |
ClinicalDocument.authorization.consent.statusCode | required | ActStatus |
ClinicalDocument.authorization.consent.statusCode.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.typeCode | required | Fixed Value: COMP |
ClinicalDocument.componentOf.encompassingEncounter.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.classCode | required | Fixed Value: ENC |
ClinicalDocument.componentOf.encompassingEncounter.moodCode | required | Fixed Value: EVN |
ClinicalDocument.componentOf.encompassingEncounter.code | preferred | ActEncounterCodes |
ClinicalDocument.componentOf.encompassingEncounter.dischargeDispositionCode | example | USEncounterDischargeDisposition |
ClinicalDocument.componentOf.encompassingEncounter.responsibleParty.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.responsibleParty.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.responsibleParty.typeCode | required | Fixed Value: RESP |
ClinicalDocument.componentOf.encompassingEncounter.location.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.location.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.componentOf.encompassingEncounter.location.typeCode | required | Fixed Value: LOC |
ClinicalDocument.component.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.typeCode | required | Fixed Value: COMP |
ClinicalDocument.component.structuredBody.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.classCode | required | Fixed Value: DOCBODY |
ClinicalDocument.component.structuredBody.moodCode | required | Fixed Value: EVN |
ClinicalDocument.component.structuredBody.languageCode | required | AllLanguages |
ClinicalDocument.component.structuredBody.component.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:allergies.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:allergies.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:medications.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:medications.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:problems.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:problems.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:procedures.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:procedures.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:results.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:results.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:advDirectives.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:advDirectives.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:encounters.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:encounters.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:famHistory.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:famHistory.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:functionalStatus.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:functionalStatus.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:immunizations.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:immunizations.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:medEquipment.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:medEquipment.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:payers.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:payers.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:planOfTreatment.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:planOfTreatment.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:socialHist.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:socialHist.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:vitalSigns.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:vitalSigns.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:mentalStatus.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:mentalStatus.typeId.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:nutrition.nullFlavor | required | CDANullFlavor |
ClinicalDocument.component.structuredBody.component:nutrition.typeId.nullFlavor | required | CDANullFlavor |
Id | Grade | Path(s) | Details | Requirements |
1198-8456 | error | ClinicalDocument.author.assignedAuthor | Such assignedAuthors **SHALL** contain (exactly one [1..1] assignedPerson) or (exactly one [1..1] assignedAuthoringDevice and exactly one [1..1] representedOrganization) (CONF:1198-8456). : assignedPerson.exists() or (assignedAuthoringDevice.exists() and representedOrganization.exists()) | |
1198-32466 | warning | ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | If this assignedEntity is an assignedPerson, the assignedEntity/id **SHOULD** contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32466). : assignedPerson.exists() implies id.where(root = '2.16.840.1.113883.4.6') | |
1198-32905 | error | ClinicalDocument.componentOf.encompassingEncounter.responsibleParty.assignedEntity | This assignedEntity SHALL contain an assignedPerson or a representedOrganization or both (CONF:1198-32905). : assignedPerson.exists() or representedOrganization.exists() | |
4537-5402 | error | ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr | If country is US, this addr **SHALL** contain exactly one [1..1] state, which **SHALL** be selected from ValueSet US Core USPS State *DYNAMIC* (CONF:4537-5402). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')) | |
4537-5403 | warning | ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr | If country is US, this addr **MAY** contain zero or one [0..1] postalCode, which **SHALL** be selected from ValueSet PostalCode urn:oid:2.16.840.1.113883.3.88.12.80.2 *DYNAMIC* (CONF:4537-5403). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.empty() or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')) | |
4537-6380 | error | ClinicalDocument | If setId is present versionNumber **SHALL** be present (CONF:4537-6380). : setId.exists() implies versionNumber.exists() | |
4537-6387 | error | ClinicalDocument | If versionNumber is present setId **SHALL** be present (CONF:4537-6387). : versionNumber.exists() implies setId.exists() | |
4537-10006 | error | ClinicalDocument.participant | **SHALL** contain associatedEntity/associatedPerson *AND/OR* associatedEntity/scopingOrganization (CONF:4537-10006). : associatedEntity.associatedPerson.exists() or associatedEntity.scopingOrganization.exists() | |
4537-10007 | warning | ClinicalDocument.participant | When participant/@typeCode is *IND*, associatedEntity/@classCode **SHOULD** be selected from ValueSet 2.16.840.1.113883.11.20.9.33 INDRoleclassCodes *DYNAMIC* (CONF:4537-10007). : typeCode = 'IND' implies associatedEntity.classCode.memberOf('http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.33') | |
4537-16790 | error | ClinicalDocument.author.assignedAuthor | There **SHALL** be exactly one assignedAuthor/assignedPerson or exactly one assignedAuthor/assignedAuthoringDevice (CONF:4537-16790). : (assignedPerson | assignedAuthoringDevice).count() = 1 | |
4537-21000 | error | ClinicalDocument.recordTarget.patientRole.patient | If sdtc:deceasedTime/@value is present, then sdtc:deceasedInd SHALL be present with value=true : sdtcDeceasedTime.value.exists() implies sdtcDeceasedInd.exists(value='true') | |
4537-32948 | error | ClinicalDocument.code | This code **SHALL** be drawn from the LOINC document type ontology (LOINC codes where SCALE = DOC) (CONF:4537-32948). : codeSystem = '2.16.840.1.113883.6.1' | |
4537-32993 | error | ClinicalDocument.recordTarget.patientRole.patient | If sdtc:deceasedInd="true", then sdtc:deceasedTime **SHALL** be present with either a @value or @nullFlavor=UNK (CONF:4537-32993). : sdtcDeceasedInd.exists(value='true') implies sdtcDeceasedTime.exists() | |
81-7278 | error | ClinicalDocument.recordTarget.patientRole.patient.name | **SHALL NOT** have mixed content except for white space (CONF:81-7278). : item.xmlText.empty() | |
81-7296 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | **SHALL NOT** have mixed content except for white space (CONF:81-7296) : item.xmlText.empty() | |
81-9371 | error | ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.name, ClinicalDocument.author.assignedAuthor.assignedPerson.name, ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.name, ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name, ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.name, ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.name, ClinicalDocument.authenticator.assignedEntity.assignedPerson.name | The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists() | |
81-9372 | error | ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.name, ClinicalDocument.author.assignedAuthor.assignedPerson.name, ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.name, ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name, ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.name, ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.name, ClinicalDocument.authenticator.assignedEntity.assignedPerson.name | The string **SHALL NOT** contain name parts (CONF:81-9372). : item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty() | |
81-10024 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')) | |
81-10025 | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). : nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')) | |
AD-1 | error | ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item | Can only have only one of the possible item elements in each choice : (delimiter | country | state | county | city | postalCode | streetAddressLine | houseNumber | houseNumberNumeric | direction | streetName | streetNameBase | streetNameType | additionalLocator | unitID | unitType | careOf | censusTract | deliveryAddressLine | deliveryInstallationType | deliveryInstallationArea | deliveryInstallationQualifier | deliveryMode | deliveryModeIdentifier | buildingNumberSuffix | postBox | precinct | xmlText).count() = 1 | |
ivl-ts-center | error | ClinicalDocument.participant.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime, ClinicalDocument.documentationOf.serviceEvent.performer.time, ClinicalDocument.componentOf.encompassingEncounter.effectiveTime | Center cannot co-exist with low or high : center.empty() or (low.empty() and high.empty()) | |
ivl-value-shall | error | ClinicalDocument.participant.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime, ClinicalDocument.documentationOf.serviceEvent.performer.time, ClinicalDocument.componentOf.encompassingEncounter.effectiveTime | If a time interval contains @value, then it shall be precise to at least the day. : value.exists() implies value.toString().length() >= 10 | |
ivl-value-should | warning | ClinicalDocument.participant.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime, ClinicalDocument.documentationOf.serviceEvent.performer.time, ClinicalDocument.componentOf.encompassingEncounter.effectiveTime | If a time interval contains @value, then it SHOULD contain a time component. : value.exists() implies value.toString().length() > 10 | |
pn-no-ls | error | ClinicalDocument.recordTarget.patientRole.patient.name, ClinicalDocument.recordTarget.patientRole.patient.guardian.guardianPerson.name, ClinicalDocument.author.assignedAuthor.assignedPerson.name, ClinicalDocument.dataEnterer.assignedEntity.assignedPerson.name, ClinicalDocument.informant:provider.assignedEntity.assignedPerson.name, ClinicalDocument.informationRecipient.intendedRecipient.informationRecipient.name, ClinicalDocument.legalAuthenticator.assignedEntity.assignedPerson.name, ClinicalDocument.authenticator.assignedEntity.assignedPerson.name | No PN name part may have a qualifier of LS. : (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty() | |
shall-adv-directive-organizer | error | ClinicalDocument.component.structuredBody.component:advDirectives.section | SHALL contain at least one Advance Directive Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveOrganizer')) | |
shall-allergy-concern | error | ClinicalDocument.component.structuredBody.component:allergies.section | SHALL contain at least one Allergy Concern Act : nullFlavor.exists() or entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/AllergyConcernAct')) | |
shall-city | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | SHALL contain exactly one [1..1] city (CONF:81-7292). : nullFlavor.exists() or item.city.count() = 1 | |
shall-encounter-activity | error | ClinicalDocument.component.structuredBody.component:encounters.section | SHALL contain at least one Encounter Activity : nullFlavor.exists() or entry.where(encounter.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/EncounterActivity')) | |
shall-family | error | ClinicalDocument.recordTarget.patientRole.patient.name | SHALL contain exactly one [1..1] family (CONF:81-7159). : nullFlavor.exists() or item.family.count() = 1 | |
shall-given | error | ClinicalDocument.recordTarget.patientRole.patient.name | SHALL contain at least one [1..*] given (CONF:81-7157). : nullFlavor.exists() or item.given.exists() | |
shall-immunization-activity | error | ClinicalDocument.component.structuredBody.component:immunizations.section | SHALL contain at least one Immunization Activity : nullFlavor.exists() or entry.where(substanceAdministration.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ImmunizationActivity')) | |
shall-max-ad-parts | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | SHALL have at most one of each: state, city, postalCode, and country : (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1) | |
shall-max-suffix | error | ClinicalDocument.recordTarget.patientRole.patient.name | There may be at most one suffix : (item.suffix.empty() or item.suffix.count() = 1) | |
shall-med-activity | error | ClinicalDocument.component.structuredBody.component:medications.section | SHALL contain at least one Medication Activity : nullFlavor.exists() or entry.where(substanceAdministration.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/MedicationActivity')) | |
shall-problem-concern-act | error | ClinicalDocument.component.structuredBody.component:problems.section | SHALL contain at least one Problem Concern Act : nullFlavor.exists() or entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProblemConcernAct')) | |
shall-procedure-act-procedure | error | ClinicalDocument.component.structuredBody.component:procedures.section | SHALL contain at least one Procedure Activity Procedure : nullFlavor.exists() or entry.where(procedure.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure')) | |
shall-result-org | error | ClinicalDocument.component.structuredBody.component:results.section | SHALL contain at least one Result Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ResultOrganizer')) | |
shall-streetAddressLine | error | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291). : nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4) | |
shall-vital-signs-org | error | ClinicalDocument.component.structuredBody.component:vitalSigns.section | SHALL contain at least one Vital Signs Organizer : nullFlavor.exists() or entry.where(organizer.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/VitalSignsOrganizer')) | |
should-country | warning | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.addr | SHOULD contain country : nullFlavor.exists() or item.country.exists() | |
should-coverage-activity | warning | ClinicalDocument.component.structuredBody.component:payers.section | SHOULD contain Coverage Activity : entry.where(act.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/CoverageActivity')) | |
should-extension | warning | ClinicalDocument.author.assignedAuthor.id:npi | SHOULD contain extension : extension.exists() | |
should-id-npi | warning | ClinicalDocument.author.assignedAuthor | SHOULD contain an id with root='2.16.840.1.113883.4.6' (NPI) : id.where(root = '2.16.840.1.113883.4.6') | |
should-legalAuthenticator | warning | ClinicalDocument | SHOULD contain legalAuthenticator : legalAuthenticator.exists() | |
should-maritalStatusCode | warning | ClinicalDocument.recordTarget.patientRole.patient | SHOULD contain maritalStatusCode : maritalStatusCode.exists() | |
should-non-med-supply | warning | ClinicalDocument.component.structuredBody.component:medEquipment.section | SHOULD contain Non-Medicinal Supply Activity : entry.where(supply.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/NonMedicinalSupplyActivity')) | |
should-npi | warning | ClinicalDocument.recordTarget.patientRole.providerOrganization.id.root, ClinicalDocument.dataEnterer.assignedEntity.id.root, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.id.root, ClinicalDocument.authenticator.assignedEntity.id.root, ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity.id.root | SHOULD be NPI : $this = '2.16.840.1.113883.4.6' | |
should-nutritional-status-obs | warning | ClinicalDocument.component.structuredBody.component:nutrition.section | SHOULD contain Nutritional Status Observation : entry.where(observation.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/NutritionalStatusObservation')) | |
should-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-preferenceInd | warning | ClinicalDocument.recordTarget.patientRole.patient.languageCommunication | SHOULD contain preferenceInd : preferenceInd.exists() | |
should-procedure-act-procedure | warning | ClinicalDocument.component.structuredBody.component:medEquipment.section | SHOULD contain Procedure Activity Procedure : entry.where(procedure.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProcedureActivityProcedure')) | |
should-proficiencyLevelCode | warning | ClinicalDocument.recordTarget.patientRole.patient.languageCommunication | SHOULD contain proficiencyLevelCode : proficiencyLevelCode.exists() | |
should-relatedParticipant | warning | ClinicalDocument | Documents SHOULD contain a RelatedPerson participant : participant.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/RelatedPersonRelationshipAndNameParticipant').exists() | |
should-responsibleParty | warning | ClinicalDocument.componentOf.encompassingEncounter | SHOULD contain responsibleParty : responsibleParty.exists() | |
should-section-plan-of-treatment | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Plan of Treatment Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/PlanofTreatmentSection')) | |
should-section-procedures | warning | ClinicalDocument.component.structuredBody | SHOULD contain a Procedures Section : component.where(section.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/ProceduresSection')) | |
should-smoking-status | warning | ClinicalDocument.component.structuredBody.component:socialHist.section | SHOULD contain Smoking Status - Meaningful Use : entry.where(observation.hasTemplateIdOf('http://hl7.org/cda/us/ccda/StructureDefinition/SmokingStatusMeaningfulUse')) | |
should-us-addr | warning | ClinicalDocument.recordTarget.patientRole.patient.guardian | SHOULD contain addr : addr.exists() | |
should-us-code | warning | ClinicalDocument.recordTarget.patientRole.patient.guardian, ClinicalDocument.author.assignedAuthor, ClinicalDocument.documentationOf.serviceEvent.performer.functionCode, ClinicalDocument.documentationOf.serviceEvent.performer.assignedEntity | SHOULD contain code : code.exists() | |
should-us-languageCommunication | warning | ClinicalDocument.recordTarget.patientRole.patient | SHOULD contain languageCommunication : languageCommunication.exists() | |
should-us-performer | warning | ClinicalDocument.documentationOf.serviceEvent | SHOULD contain performer : performer.exists() | |
should-us-telecom | warning | ClinicalDocument.recordTarget.patientRole.patient.guardian | SHOULD contain telecom : telecom.exists() | |
should-use | warning | ClinicalDocument.recordTarget.patientRole.addr, ClinicalDocument.recordTarget.patientRole.telecom, ClinicalDocument.recordTarget.patientRole.patient.guardian.addr, ClinicalDocument.recordTarget.patientRole.patient.guardian.telecom, ClinicalDocument.recordTarget.patientRole.providerOrganization.telecom, ClinicalDocument.recordTarget.patientRole.providerOrganization.addr, ClinicalDocument.author.assignedAuthor.addr, ClinicalDocument.author.assignedAuthor.telecom, ClinicalDocument.dataEnterer.assignedEntity.addr, ClinicalDocument.dataEnterer.assignedEntity.telecom, ClinicalDocument.informant:provider.assignedEntity.addr, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.telecom, ClinicalDocument.custodian.assignedCustodian.representedCustodianOrganization.addr, ClinicalDocument.legalAuthenticator.assignedEntity.addr, ClinicalDocument.legalAuthenticator.assignedEntity.telecom, ClinicalDocument.authenticator.assignedEntity.addr, ClinicalDocument.authenticator.assignedEntity.telecom | SHOULD contain @use : nullFlavor.exists() or use.exists() | |
should-value-att | warning | ClinicalDocument.recordTarget.patientRole.patient.sdtcDeceasedTime | SHOULD contain @value : value.exists() | |
signature | warning | ClinicalDocument.legalAuthenticator.signatureCode, ClinicalDocument.authenticator.signatureCode | CDA Release One represented either an intended ('X') or actual ('S') authenticator. CDA Release Two only represents an actual authenticator, so has deprecated the value of 'X'. : code.exists() implies code != 'X' | |
text-null | error | ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.delimiter, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.country, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.state, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.county, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.city, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.postalCode, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetAddressLine, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.houseNumber, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.houseNumberNumeric, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.direction, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetName, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetNameBase, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.streetNameType, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.additionalLocator, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.unitID, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.unitType, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.careOf, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.censusTract, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryAddressLine, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationType, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationArea, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryInstallationQualifier, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryMode, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.deliveryModeIdentifier, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.buildingNumberSuffix, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.postBox, ClinicalDocument.recordTarget.patientRole.patient.birthplace.place.addr.item.precinct | xmlText and nullFlavor are mutually exclusive (one must be present) : (xmlText | nullFlavor).count() = 1 | |
ts-shall-day | error | ClinicalDocument.effectiveTime, ClinicalDocument.author.time, ClinicalDocument.dataEnterer.time, ClinicalDocument.legalAuthenticator.time, ClinicalDocument.authenticator.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high | **SHALL** be precise to at least the day : nullFlavor.exists() or value.toString().length() >= 10 | |
ts-shall-year | error | ClinicalDocument.recordTarget.patientRole.patient.birthTime, ClinicalDocument.recordTarget.patientRole.patient.sdtcDeceasedTime | **SHALL** be precise to at least the year : nullFlavor.exists() or value.toString().length() >= 4 | |
ts-should-day | warning | ClinicalDocument.recordTarget.patientRole.patient.birthTime, ClinicalDocument.recordTarget.patientRole.patient.sdtcDeceasedTime | **SHOULD** be precise to at least the day : nullFlavor.exists() or value.toString().length() >= 10 | |
ts-should-minute | warning | ClinicalDocument.effectiveTime, ClinicalDocument.author.time, ClinicalDocument.dataEnterer.time, ClinicalDocument.legalAuthenticator.time, ClinicalDocument.authenticator.time, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.low, ClinicalDocument.documentationOf.serviceEvent.effectiveTime.high | **SHOULD** be precise to at least the minute : nullFlavor.exists() or value.toString().length() > 10 |
This structure is derived from USRealmHeader
Summary
Mandatory: 14 elements
Fixed Value: 2 elements
Structures
This structure refers to these other structures:
Slices
This structure defines the following Slices: