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

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON

Logical Model: Policy Activity

A policy activity represents the policy or program providing the coverage. The person for whom payment is being provided (i.e., the patient) is the covered party. The subscriber of the policy or program is represented as a participant that is the holder of the coverage. The payer is represented as the performer of the policy activity. Note that the absence of a Policy Activity Act is not confirmation the patient does not have coverage. A Patient’s coverage may not have been documented yet or not known to the healthcare provider.

• Absence of a Policy Activity Act may mean that the patient has no coverage or the healthcare provider may not know it.
• A self pay payer type MAY be used to imply that the patient has no coverage or that an individual or organization other than an insurer is taking responsibility for payment for a portion of the health care costs.

Usage:

• Use this Logical Model: Coverage Activity

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Act

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime 4537-17139: When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139).
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:policy-activity		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.61
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Fixed Value: ACT
@moodCode		1..1	cs	Fixed Value: EVN
id		1..*	II	(USCDI) **GROUP NUMBER**: This is the identifier used to uniquely refer to a specific health insurance plan.
code
@code		0..1	cs	Binding: Payer Type (preferred)
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS
@code		1..1	cs	Fixed Value: completed
effectiveTime		0..1	IVL_TS	This records the policy coverage period, or self-pay period.
Slices for performer		1..*	Performer2	Slice: Unordered, Open by value:templateId.root
performer:performer1		1..1	Performer2	This performer represents the Payer.
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.87
@extension		0..0
@typeCode		1..1	cs
assignedEntity	C	1..1	AssignedEntity	should-code: SHOULD contain code should-representedOrganization: SHOULD contain representedOrganization
id		1..*	II	(USCDI) **PAYER IDENTIFIER**: This is the Payer id. The root is a unique identifier to an openly available assigning authority, such as National Association of Insurance Commissioners (NAIC) (2.16.840.1.113883.6.300), and the extension identifiers the payer within that authority.
code		0..1	CE
@code		1..1	cs	Binding: Financially Responsible Party Type Value Set (preferred)
addr		0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
representedOrganization	C	0..1	Organization	should-name: SHOULD contain name
name		0..1	ON
performer:performer2	C	0..*	Performer2	This performer represents the Guarantor. should-time: SHOULD contain time
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.88
@extension		0..0
@typeCode		1..1	cs
time		0..1	IVL_TS
assignedEntity	C	1..1	AssignedEntity	4537-8967: **SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). should-addr: SHOULD contain addr should-telecom: SHOULD contain telecom
code		1..1	CE
@code		1..1	cs	Required Pattern: GUAR
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.5.110
addr		0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
Slices for participant		1..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:coverage-target	C	1..1	Participant2	participant should-time: SHOULD contain time
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.89
@extension		0..0
@typeCode		1..1	cs	Fixed Value: COV
time	C	0..1	IVL_TS	should-low: SHOULD contain low should-high: SHOULD contain high
low		0..1	IVXB_TS
high		0..1	IVXB_TS
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr should-playingEntity: SHOULD contain playingEntity
id		1..*	II	(USCDI) **MEMBER IDENTIFIER**: This id is a unique identifier for the covered party member. Implementers **SHOULD** use the same GUID for each instance of a member identifier from the same health plan (CONF:4537-8984).
code	C	1..1	CE	(USCDI) **RELATIONSHIP TO SUBSCRIBER**: Records the relationship of a patient to the primary insured person. should-code-attr: SHOULD contain @code
@code		0..1	cs	Binding: Coverage Role Type Value Set (preferred)
addr		0..1	USRealmAddress	Base for all types and resources
playingEntity		0..1	PlayingEntity	This playingEntity records the covered party name and birthTime as represented by the health plan. This could match the information in recordTarget, or be different due to marriage or other reasons.
name		1..1	PN
sdtcBirthTime		1..1	TS	sdtc:birthTime
participant:subscriber		0..1	Participant2	When the Subscriber is the patient, the participant element describing the subscriber *SHALL NOT* be present. This information will be recorded instead in the data elements used to record member information.
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.90
@extension		0..0
@typeCode		1..1	cs	Fixed Value: HLD
time		0..1	IVL_TS
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr
id		1..*	II	(USCDI) **SUBSCRIBER ID**: This id is a unique identifier for the subscriber of the coverage (CONF:4537-10120).
addr		0..1	USRealmAddress	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by value:act.moodCode
entryRelationship:authorization		0..*	EntryRelationship	entryRelationship
@typeCode		1..1	cs	Fixed Value: REFR
act		1..1	AuthorizationActivity	Base for all types and resources
entryRelationship:plan		0..*	EntryRelationship	Represents the Coverage Plan
@typeCode		1..1	cs	Fixed Value: REFR
act		1..1	Act
@classCode		1..1	cs	Fixed Value: ACT
@moodCode		1..1	cs	Fixed Value: DEF
id		1..*	II	Plan identifier
text		1..1	ED	Name of the plan
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Act.code.code	preferred	PayerType
Act.performer:performer1.assignedEntity.code.code	preferred	FinanciallyResponsiblePartyTypeValueSet
Act.participant:coverage-target.participantRole.code.code	preferred	CoverageRoleTypeValueSet

Constraints

Id	Grade	Path(s)	Details	Requirements
4537-8967	warning	Act.performer:performer2.assignedEntity	**SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). : assignedPerson.name.exists() or representedOrganization.name.exists()
4537-17139	error	Act	When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139). : participant.where(typeCode='COV').participantRole.code.where(code = 'SELF') implies participant.where(typeCode='HLD').empty()
should-addr	warning	Act.performer:performer2.assignedEntity, Act.participant:coverage-target.participantRole, Act.participant:subscriber.participantRole	SHOULD contain addr : addr.exists()
should-code	warning	Act.performer:performer1.assignedEntity	SHOULD contain code : code.exists()
should-code-attr	warning	Act.participant:coverage-target.participantRole.code	SHOULD contain @code : code.exists()
should-effectiveTime	warning	Act	SHOULD contain effectiveTime : effectiveTime.exists()
should-high	warning	Act.participant:coverage-target.time	SHOULD contain high : high.exists()
should-low	warning	Act.participant:coverage-target.time	SHOULD contain low : low.exists()
should-name	warning	Act.performer:performer1.assignedEntity.representedOrganization	SHOULD contain name : name.exists()
should-playingEntity	warning	Act.participant:coverage-target.participantRole	SHOULD contain playingEntity : playingEntity.exists()
should-representedOrganization	warning	Act.performer:performer1.assignedEntity	SHOULD contain representedOrganization : representedOrganization.exists()
should-telecom	warning	Act.performer:performer2.assignedEntity	SHOULD contain telecom : telecom.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-time	warning	Act.performer:performer2, Act.participant:coverage-target	SHOULD contain time : time.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime 4537-17139: When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139).
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:policy-activity		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.61
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN
id		1..*	II	(USCDI) **GROUP NUMBER**: This is the identifier used to uniquely refer to a specific health insurance plan.
code		1..1	CD	Binding: v3 Code System ActCode (example)
@code		0..1	cs	Binding: Payer Type (preferred)
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS	Binding: ActStatus (required)
@code		1..1	cs	Fixed Value: completed
effectiveTime		0..1	IVL_TS	This records the policy coverage period, or self-pay period.
Slices for performer		1..*	Performer2	Slice: Unordered, Open by value:templateId.root
performer:performer1		1..1	Performer2	This performer represents the Payer.
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.87
@typeCode		1..1	cs	Binding: ParticipationPhysicalPerformer (required) Fixed Value: PRF
assignedEntity	C	1..1	AssignedEntity	should-code: SHOULD contain code should-representedOrganization: SHOULD contain representedOrganization
id		1..*	II	(USCDI) **PAYER IDENTIFIER**: This is the Payer id. The root is a unique identifier to an openly available assigning authority, such as National Association of Insurance Commissioners (NAIC) (2.16.840.1.113883.6.300), and the extension identifiers the payer within that authority.
code		0..1	CE	Binding: v3 Code System RoleCode (example)
@code		1..1	cs	Binding: Financially Responsible Party Type Value Set (preferred)
addr	C	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
representedOrganization	C	0..1	Organization	should-name: SHOULD contain name
name		0..1	ON
performer:performer2	C	0..*	Performer2	This performer represents the Guarantor. should-time: SHOULD contain time
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.88
@typeCode		1..1	cs	Binding: ParticipationPhysicalPerformer (required) Fixed Value: PRF
time		0..1	IVL_TS
assignedEntity	C	1..1	AssignedEntity	4537-8967: **SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). should-addr: SHOULD contain addr should-telecom: SHOULD contain telecom
id		1..*	II
code		1..1	CE	Binding: v3 Code System RoleCode (example)
@code		1..1	cs	Required Pattern: GUAR
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.5.110
addr	C	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
Slices for participant		1..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:coverage-target	C	1..1	Participant2	participant should-time: SHOULD contain time
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.89
@typeCode		1..1	cs	Binding: ParticipationType (required) Fixed Value: COV
time	C	0..1	IVL_TS	should-low: SHOULD contain low should-high: SHOULD contain high
low		0..1	IVXB_TS
high		0..1	IVXB_TS
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr should-playingEntity: SHOULD contain playingEntity
@classCode		1..1	cs	Binding: RoleClassRoot (required)
id		1..*	II	(USCDI) **MEMBER IDENTIFIER**: This id is a unique identifier for the covered party member. Implementers **SHOULD** use the same GUID for each instance of a member identifier from the same health plan (CONF:4537-8984).
code	C	1..1	CE	(USCDI) **RELATIONSHIP TO SUBSCRIBER**: Records the relationship of a patient to the primary insured person. Binding: v3 Code System RoleCode (example) should-code-attr: SHOULD contain @code
@code		0..1	cs	Binding: Coverage Role Type Value Set (preferred)
addr	C	0..1	USRealmAddress	Base for all types and resources
playingEntity		0..1	PlayingEntity	This playingEntity records the covered party name and birthTime as represented by the health plan. This could match the information in recordTarget, or be different due to marriage or other reasons.
@classCode		1..1	cs	Binding: EntityClassRoot (required)
name		1..1	PN
sdtcBirthTime		1..1	TS	XML Namespace: urn:hl7-org:sdtc sdtc:birthTime XML: birthTime (urn:hl7-org:sdtc)
participant:subscriber		0..1	Participant2	When the Subscriber is the patient, the participant element describing the subscriber *SHALL NOT* be present. This information will be recorded instead in the data elements used to record member information.
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.90
@typeCode		1..1	cs	Binding: ParticipationType (required) Fixed Value: HLD
time		0..1	IVL_TS
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr
@classCode		1..1	cs	Binding: RoleClassRoot (required)
id		1..*	II	(USCDI) **SUBSCRIBER ID**: This id is a unique identifier for the subscriber of the coverage (CONF:4537-10120).
addr	C	0..1	USRealmAddress	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by value:act.moodCode
entryRelationship:authorization		0..*	EntryRelationship	entryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
act	C	1..1	AuthorizationActivity	Base for all types and resources
entryRelationship:plan		0..*	EntryRelationship	Represents the Coverage Plan
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
act		1..1	Act
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: DEF
id		1..*	II	Plan identifier
code		1..1	CD	Binding: v3 Code System ActCode (example)
text		1..1	ED	Name of the plan
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Act.classCode	required	Fixed Value: ACT
Act.moodCode	required	Fixed Value: EVN
Act.code	example	ActCode
Act.code.code	preferred	PayerType
Act.statusCode	required	ActStatus
Act.performer:performer1.typeCode	required	Fixed Value: PRF
Act.performer:performer1.assignedEntity.code	example	RoleCode
Act.performer:performer1.assignedEntity.code.code	preferred	FinanciallyResponsiblePartyTypeValueSet
Act.performer:performer2.typeCode	required	Fixed Value: PRF
Act.performer:performer2.assignedEntity.code	example	RoleCode
Act.participant:coverage-target.typeCode	required	Fixed Value: COV
Act.participant:coverage-target.participantRole.classCode	required	RoleClassRoot
Act.participant:coverage-target.participantRole.code	example	RoleCode
Act.participant:coverage-target.participantRole.code.code	preferred	CoverageRoleTypeValueSet
Act.participant:coverage-target.participantRole.playingEntity.classCode	required	EntityClassRoot
Act.participant:subscriber.typeCode	required	Fixed Value: HLD
Act.participant:subscriber.participantRole.classCode	required	RoleClassRoot
Act.entryRelationship:authorization.typeCode	required	Fixed Value: REFR
Act.entryRelationship:plan.typeCode	required	Fixed Value: REFR
Act.entryRelationship:plan.act.classCode	required	Fixed Value: ACT
Act.entryRelationship:plan.act.moodCode	required	Fixed Value: DEF
Act.entryRelationship:plan.act.code	example	ActCode

Constraints

Id	Grade	Path(s)	Details	Requirements
4537-8967	warning	Act.performer:performer2.assignedEntity	**SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). : assignedPerson.name.exists() or representedOrganization.name.exists()
4537-17139	error	Act	When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139). : participant.where(typeCode='COV').participantRole.code.where(code = 'SELF') implies participant.where(typeCode='HLD').empty()
81-7296	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	**SHALL NOT** have mixed content except for white space (CONF:81-7296) : item.xmlText.empty()
81-10024	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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})?'))
shall-city	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHALL contain exactly one [1..1] city (CONF:81-7292). : nullFlavor.exists() or item.city.count() = 1
shall-max-ad-parts	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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-streetAddressLine	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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)
should-addr	warning	Act.performer:performer2.assignedEntity, Act.participant:coverage-target.participantRole, Act.participant:subscriber.participantRole	SHOULD contain addr : addr.exists()
should-code	warning	Act.performer:performer1.assignedEntity	SHOULD contain code : code.exists()
should-code-attr	warning	Act.participant:coverage-target.participantRole.code	SHOULD contain @code : code.exists()
should-country	warning	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHOULD contain country : nullFlavor.exists() or item.country.exists()
should-effectiveTime	warning	Act	SHOULD contain effectiveTime : effectiveTime.exists()
should-high	warning	Act.participant:coverage-target.time	SHOULD contain high : high.exists()
should-low	warning	Act.participant:coverage-target.time	SHOULD contain low : low.exists()
should-name	warning	Act.performer:performer1.assignedEntity.representedOrganization	SHOULD contain name : name.exists()
should-playingEntity	warning	Act.participant:coverage-target.participantRole	SHOULD contain playingEntity : playingEntity.exists()
should-representedOrganization	warning	Act.performer:performer1.assignedEntity	SHOULD contain representedOrganization : representedOrganization.exists()
should-telecom	warning	Act.performer:performer2.assignedEntity	SHOULD contain telecom : telecom.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Act.entryRelationship:authorization.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-time	warning	Act.performer:performer2, Act.participant:coverage-target	SHOULD contain time : time.exists()
should-use	warning	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHOULD contain @use : nullFlavor.exists() or use.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime 4537-17139: When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139).
@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
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:policy-activity		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: 2.16.840.1.113883.10.20.22.4.61
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl
id		1..*	II	(USCDI) **GROUP NUMBER**: This is the identifier used to uniquely refer to a specific health insurance plan.
code		1..1	CD	Binding: v3 Code System ActCode (example)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		0..1	cs	Binding: Payer Type (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
qualifier		0..*	CR
translation		0..*	CD
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	Binding: MediaType (example)
@representation		0..1	cs	Binding: Binary Data Encoding Value Set (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
thumbnail		0..1	ED
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)
effectiveTime		0..1	IVL_TS	This records the policy coverage period, or self-pay period.
priorityCode		0..1	CE	Binding: ActPriority (example)
languageCode		0..1	CS	Binding: AllLanguages (required)
subject		0..1	Subject
specimen		0..*	Specimen
Slices for performer		1..*	Performer2	Slice: Unordered, Open by value:templateId.root
performer:performer1		1..1	Performer2	This performer represents the Payer.
@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		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: 2.16.840.1.113883.10.20.22.4.87
@typeCode		1..1	cs	Binding: ParticipationPhysicalPerformer (required) Fixed Value: PRF
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time		0..1	IVL_TS
modeCode		0..1	CE
assignedEntity	C	1..1	AssignedEntity	should-code: SHOULD contain code should-representedOrganization: SHOULD contain representedOrganization
@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	(USCDI) **PAYER IDENTIFIER**: This is the Payer id. The root is a unique identifier to an openly available assigning authority, such as National Association of Insurance Commissioners (NAIC) (2.16.840.1.113883.6.300), and the extension identifiers the payer within that authority.
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		1..1	cs	Binding: Financially Responsible Party Type Value Set (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	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
assignedPerson		0..1	Person
representedOrganization	C	0..1	Organization	should-name: SHOULD contain name
@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		0..1	ON
telecom		0..*	TEL
addr		0..*	AD
standardIndustryClassCode		0..1	CE	Binding: OrganizationIndustryClassNAICS (example)
asOrganizationPartOf		0..1	OrganizationPartOf
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
performer:performer2	C	0..*	Performer2	This performer represents the Guarantor. should-time: SHOULD contain time
@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		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: 2.16.840.1.113883.10.20.22.4.88
@typeCode		1..1	cs	Binding: ParticipationPhysicalPerformer (required) Fixed Value: PRF
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time		0..1	IVL_TS
modeCode		0..1	CE
assignedEntity	C	1..1	AssignedEntity	4537-8967: **SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). should-addr: SHOULD contain addr should-telecom: SHOULD contain telecom
@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
sdtcIdentifiedBy		0..*	IdentifiedBy	XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc)
code		1..1	CE	Binding: v3 Code System RoleCode (example)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Required Pattern: GUAR
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.5.110
@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	0..1	USRealmAddress	Base for all types and resources
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
author		0..*	Author
informant		0..*	Informant
Slices for participant		1..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:coverage-target	C	1..1	Participant2	participant should-time: SHOULD contain time
@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		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: 2.16.840.1.113883.10.20.22.4.89
@typeCode		1..1	cs	Binding: ParticipationType (required) Fixed Value: COV
@contextControlCode		0..1	cs	Binding: ContextControl (required) Fixed Value: OP
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time	C	0..1	IVL_TS	should-low: SHOULD contain low should-high: SHOULD contain high
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
@operator		0..1	cs	Binding: SetOperator (required)
low		0..1	IVXB_TS
center		0..1	TS
width		0..1	PQ
high		0..1	IVXB_TS
awarenessCode		0..1	CE
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr should-playingEntity: SHOULD contain playingEntity
@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: RoleClassRoot (required)
id		1..*	II	(USCDI) **MEMBER IDENTIFIER**: This id is a unique identifier for the covered party member. Implementers **SHOULD** use the same GUID for each instance of a member identifier from the same health plan (CONF:4537-8984).
sdtcIdentifiedBy		0..*	IdentifiedBy	XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc)
code	C	1..1	CE	(USCDI) **RELATIONSHIP TO SUBSCRIBER**: Records the relationship of a patient to the primary insured person. Binding: v3 Code System RoleCode (example) should-code-attr: SHOULD contain @code
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		0..1	cs	Binding: Coverage Role Type Value Set (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	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
playingDevice		0..1	Device
playingEntity		0..1	PlayingEntity	This playingEntity records the covered party name and birthTime as represented by the health plan. This could match the information in recordTarget, or be different due to marriage or other reasons.
@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: EntityClassRoot (required)
@determinerCode		0..1	cs	Binding: EntityDeterminer (required) Fixed Value: INSTANCE
code		0..1	CE	Binding: EntityCode (example)
quantity		0..*	PQ
name		1..1	PN
sdtcBirthTime		1..1	TS	XML Namespace: urn:hl7-org:sdtc sdtc:birthTime XML: birthTime (urn:hl7-org:sdtc)
desc		0..1	ED
scopingEntity		0..1	Entity
participant:subscriber		0..1	Participant2	When the Subscriber is the patient, the participant element describing the subscriber *SHALL NOT* be present. This information will be recorded instead in the data elements used to record member information.
@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		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: 2.16.840.1.113883.10.20.22.4.90
@typeCode		1..1	cs	Binding: ParticipationType (required) Fixed Value: HLD
@contextControlCode		0..1	cs	Binding: ContextControl (required) Fixed Value: OP
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time		0..1	IVL_TS
awarenessCode		0..1	CE
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr
@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: RoleClassRoot (required)
id		1..*	II	(USCDI) **SUBSCRIBER ID**: This id is a unique identifier for the subscriber of the coverage (CONF:4537-10120).
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)
addr	C	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
playingDevice		0..1	Device
playingEntity		0..1	PlayingEntity
scopingEntity		0..1	Entity
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by value:act.moodCode
entryRelationship:authorization		0..*	EntryRelationship	entryRelationship
@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_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	AuthorizationActivity	Base for all types and resources
encounter		0..1	Encounter
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:plan		0..*	EntryRelationship	Represents the Coverage Plan
@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_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		1..1	Act
@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: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: DEF
@negationInd		0..1	bl
id		1..*	II	Plan identifier
code		1..1	CD	Binding: v3 Code System ActCode (example)
text		1..1	ED	Name of the plan
statusCode		0..1	CS	Binding: ActStatus (required)
effectiveTime		0..1	IVL_TS
priorityCode		0..1	CE	Binding: ActPriority (example)
languageCode		0..1	CS	Binding: AllLanguages (required)
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	Author
informant		0..*	Informant
participant		0..*	Participant2
entryRelationship		0..*	EntryRelationship
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
encounter		0..1	Encounter
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Act.nullFlavor	required	CDANullFlavor
Act.typeId.nullFlavor	required	CDANullFlavor
Act.templateId:policy-activity.nullFlavor	required	CDANullFlavor
Act.classCode	required	Fixed Value: ACT
Act.moodCode	required	Fixed Value: EVN
Act.code	example	ActCode
Act.code.nullFlavor	required	CDANullFlavor
Act.code.code	preferred	PayerType
Act.text.nullFlavor	required	CDANullFlavor
Act.text.compression	required	CDACompressionAlgorithm
Act.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm
Act.text.mediaType	example	MediaType
Act.text.representation	required	BinaryDataEncoding
Act.statusCode	required	ActStatus
Act.statusCode.nullFlavor	required	CDANullFlavor
Act.priorityCode	example	ActPriority
Act.languageCode	required	AllLanguages
Act.performer:performer1.nullFlavor	required	CDANullFlavor
Act.performer:performer1.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer1.templateId.nullFlavor	required	CDANullFlavor
Act.performer:performer1.typeCode	required	Fixed Value: PRF
Act.performer:performer1.assignedEntity.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.classCode	required	Fixed Value: ASSIGNED
Act.performer:performer1.assignedEntity.code	example	RoleCode
Act.performer:performer1.assignedEntity.code.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.code.code	preferred	FinanciallyResponsiblePartyTypeValueSet
Act.performer:performer1.assignedEntity.representedOrganization.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.representedOrganization.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.representedOrganization.classCode	required	Fixed Value: ORG
Act.performer:performer1.assignedEntity.representedOrganization.determinerCode	required	Fixed Value: INSTANCE
Act.performer:performer1.assignedEntity.representedOrganization.standardIndustryClassCode	example	OrganizationIndustryClassNAICS
Act.performer:performer2.nullFlavor	required	CDANullFlavor
Act.performer:performer2.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer2.templateId.nullFlavor	required	CDANullFlavor
Act.performer:performer2.typeCode	required	Fixed Value: PRF
Act.performer:performer2.assignedEntity.nullFlavor	required	CDANullFlavor
Act.performer:performer2.assignedEntity.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer2.assignedEntity.classCode	required	Fixed Value: ASSIGNED
Act.performer:performer2.assignedEntity.code	example	RoleCode
Act.performer:performer2.assignedEntity.code.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.typeId.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.templateId.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.typeCode	required	Fixed Value: COV
Act.participant:coverage-target.contextControlCode	required	Fixed Value: OP
Act.participant:coverage-target.time.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.time.operator	required	SetOperator
Act.participant:coverage-target.participantRole.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.typeId.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.classCode	required	RoleClassRoot
Act.participant:coverage-target.participantRole.code	example	RoleCode
Act.participant:coverage-target.participantRole.code.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.code.code	preferred	CoverageRoleTypeValueSet
Act.participant:coverage-target.participantRole.playingEntity.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.playingEntity.typeId.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.playingEntity.classCode	required	EntityClassRoot
Act.participant:coverage-target.participantRole.playingEntity.determinerCode	required	Fixed Value: INSTANCE
Act.participant:coverage-target.participantRole.playingEntity.code	example	EntityCode
Act.participant:subscriber.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.typeId.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.templateId.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.typeCode	required	Fixed Value: HLD
Act.participant:subscriber.contextControlCode	required	Fixed Value: OP
Act.participant:subscriber.participantRole.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.participantRole.typeId.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.participantRole.classCode	required	RoleClassRoot
Act.participant:subscriber.participantRole.code	example	RoleCode
Act.entryRelationship:authorization.nullFlavor	required	CDANullFlavor
Act.entryRelationship:authorization.typeId.nullFlavor	required	CDANullFlavor
Act.entryRelationship:authorization.typeCode	required	Fixed Value: REFR
Act.entryRelationship:plan.nullFlavor	required	CDANullFlavor
Act.entryRelationship:plan.typeId.nullFlavor	required	CDANullFlavor
Act.entryRelationship:plan.typeCode	required	Fixed Value: REFR
Act.entryRelationship:plan.act.nullFlavor	required	CDANullFlavor
Act.entryRelationship:plan.act.typeId.nullFlavor	required	CDANullFlavor
Act.entryRelationship:plan.act.classCode	required	Fixed Value: ACT
Act.entryRelationship:plan.act.moodCode	required	Fixed Value: DEF
Act.entryRelationship:plan.act.code	example	ActCode
Act.entryRelationship:plan.act.statusCode	required	ActStatus
Act.entryRelationship:plan.act.priorityCode	example	ActPriority
Act.entryRelationship:plan.act.languageCode	required	AllLanguages

Constraints

Id	Grade	Path(s)	Details	Requirements
4537-8967	warning	Act.performer:performer2.assignedEntity	**SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). : assignedPerson.name.exists() or representedOrganization.name.exists()
4537-17139	error	Act	When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139). : participant.where(typeCode='COV').participantRole.code.where(code = 'SELF') implies participant.where(typeCode='HLD').empty()
81-7296	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	**SHALL NOT** have mixed content except for white space (CONF:81-7296) : item.xmlText.empty()
81-10024	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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})?'))
shall-city	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHALL contain exactly one [1..1] city (CONF:81-7292). : nullFlavor.exists() or item.city.count() = 1
shall-max-ad-parts	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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-streetAddressLine	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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)
should-addr	warning	Act.performer:performer2.assignedEntity, Act.participant:coverage-target.participantRole, Act.participant:subscriber.participantRole	SHOULD contain addr : addr.exists()
should-code	warning	Act.performer:performer1.assignedEntity	SHOULD contain code : code.exists()
should-code-attr	warning	Act.participant:coverage-target.participantRole.code	SHOULD contain @code : code.exists()
should-country	warning	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHOULD contain country : nullFlavor.exists() or item.country.exists()
should-effectiveTime	warning	Act	SHOULD contain effectiveTime : effectiveTime.exists()
should-high	warning	Act.participant:coverage-target.time	SHOULD contain high : high.exists()
should-low	warning	Act.participant:coverage-target.time	SHOULD contain low : low.exists()
should-name	warning	Act.performer:performer1.assignedEntity.representedOrganization	SHOULD contain name : name.exists()
should-playingEntity	warning	Act.participant:coverage-target.participantRole	SHOULD contain playingEntity : playingEntity.exists()
should-representedOrganization	warning	Act.performer:performer1.assignedEntity	SHOULD contain representedOrganization : representedOrganization.exists()
should-telecom	warning	Act.performer:performer2.assignedEntity	SHOULD contain telecom : telecom.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Act.entryRelationship:authorization.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-time	warning	Act.performer:performer2, Act.participant:coverage-target	SHOULD contain time : time.exists()
should-use	warning	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHOULD contain @use : nullFlavor.exists() or use.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

This structure is derived from Act

Summary

Mandatory: 18 elements (16 nested mandatory elements)
Fixed Value: 9 elements
Prohibited: 4 elements

Structures

This structure refers to these other structures:

• US Realm Address (http://hl7.org/cda/us/ccda/StructureDefinition/USRealmAddress)
• Authorization Activity (http://hl7.org/cda/us/ccda/StructureDefinition/AuthorizationActivity)

Slices

This structure defines the following Slices:

• The element Act.templateId is sliced based on the values of value:root, value:extension
• The element Act.performer is sliced based on the value of value:templateId.root
• The element Act.participant is sliced based on the value of value:typeCode
• The element Act.entryRelationship is sliced based on the value of value:act.moodCode

Differential View

This structure is derived from Act

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime 4537-17139: When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139).
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:policy-activity		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.61
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Fixed Value: ACT
@moodCode		1..1	cs	Fixed Value: EVN
id		1..*	II	(USCDI) **GROUP NUMBER**: This is the identifier used to uniquely refer to a specific health insurance plan.
code
@code		0..1	cs	Binding: Payer Type (preferred)
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS
@code		1..1	cs	Fixed Value: completed
effectiveTime		0..1	IVL_TS	This records the policy coverage period, or self-pay period.
Slices for performer		1..*	Performer2	Slice: Unordered, Open by value:templateId.root
performer:performer1		1..1	Performer2	This performer represents the Payer.
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.87
@extension		0..0
@typeCode		1..1	cs
assignedEntity	C	1..1	AssignedEntity	should-code: SHOULD contain code should-representedOrganization: SHOULD contain representedOrganization
id		1..*	II	(USCDI) **PAYER IDENTIFIER**: This is the Payer id. The root is a unique identifier to an openly available assigning authority, such as National Association of Insurance Commissioners (NAIC) (2.16.840.1.113883.6.300), and the extension identifiers the payer within that authority.
code		0..1	CE
@code		1..1	cs	Binding: Financially Responsible Party Type Value Set (preferred)
addr		0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
representedOrganization	C	0..1	Organization	should-name: SHOULD contain name
name		0..1	ON
performer:performer2	C	0..*	Performer2	This performer represents the Guarantor. should-time: SHOULD contain time
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.88
@extension		0..0
@typeCode		1..1	cs
time		0..1	IVL_TS
assignedEntity	C	1..1	AssignedEntity	4537-8967: **SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). should-addr: SHOULD contain addr should-telecom: SHOULD contain telecom
code		1..1	CE
@code		1..1	cs	Required Pattern: GUAR
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.5.110
addr		0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
Slices for participant		1..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:coverage-target	C	1..1	Participant2	participant should-time: SHOULD contain time
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.89
@extension		0..0
@typeCode		1..1	cs	Fixed Value: COV
time	C	0..1	IVL_TS	should-low: SHOULD contain low should-high: SHOULD contain high
low		0..1	IVXB_TS
high		0..1	IVXB_TS
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr should-playingEntity: SHOULD contain playingEntity
id		1..*	II	(USCDI) **MEMBER IDENTIFIER**: This id is a unique identifier for the covered party member. Implementers **SHOULD** use the same GUID for each instance of a member identifier from the same health plan (CONF:4537-8984).
code	C	1..1	CE	(USCDI) **RELATIONSHIP TO SUBSCRIBER**: Records the relationship of a patient to the primary insured person. should-code-attr: SHOULD contain @code
@code		0..1	cs	Binding: Coverage Role Type Value Set (preferred)
addr		0..1	USRealmAddress	Base for all types and resources
playingEntity		0..1	PlayingEntity	This playingEntity records the covered party name and birthTime as represented by the health plan. This could match the information in recordTarget, or be different due to marriage or other reasons.
name		1..1	PN
sdtcBirthTime		1..1	TS	sdtc:birthTime
participant:subscriber		0..1	Participant2	When the Subscriber is the patient, the participant element describing the subscriber *SHALL NOT* be present. This information will be recorded instead in the data elements used to record member information.
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.90
@extension		0..0
@typeCode		1..1	cs	Fixed Value: HLD
time		0..1	IVL_TS
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr
id		1..*	II	(USCDI) **SUBSCRIBER ID**: This id is a unique identifier for the subscriber of the coverage (CONF:4537-10120).
addr		0..1	USRealmAddress	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by value:act.moodCode
entryRelationship:authorization		0..*	EntryRelationship	entryRelationship
@typeCode		1..1	cs	Fixed Value: REFR
act		1..1	AuthorizationActivity	Base for all types and resources
entryRelationship:plan		0..*	EntryRelationship	Represents the Coverage Plan
@typeCode		1..1	cs	Fixed Value: REFR
act		1..1	Act
@classCode		1..1	cs	Fixed Value: ACT
@moodCode		1..1	cs	Fixed Value: DEF
id		1..*	II	Plan identifier
text		1..1	ED	Name of the plan
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Act.code.code	preferred	PayerType
Act.performer:performer1.assignedEntity.code.code	preferred	FinanciallyResponsiblePartyTypeValueSet
Act.participant:coverage-target.participantRole.code.code	preferred	CoverageRoleTypeValueSet

Constraints

Id	Grade	Path(s)	Details	Requirements
4537-8967	warning	Act.performer:performer2.assignedEntity	**SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). : assignedPerson.name.exists() or representedOrganization.name.exists()
4537-17139	error	Act	When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139). : participant.where(typeCode='COV').participantRole.code.where(code = 'SELF') implies participant.where(typeCode='HLD').empty()
should-addr	warning	Act.performer:performer2.assignedEntity, Act.participant:coverage-target.participantRole, Act.participant:subscriber.participantRole	SHOULD contain addr : addr.exists()
should-code	warning	Act.performer:performer1.assignedEntity	SHOULD contain code : code.exists()
should-code-attr	warning	Act.participant:coverage-target.participantRole.code	SHOULD contain @code : code.exists()
should-effectiveTime	warning	Act	SHOULD contain effectiveTime : effectiveTime.exists()
should-high	warning	Act.participant:coverage-target.time	SHOULD contain high : high.exists()
should-low	warning	Act.participant:coverage-target.time	SHOULD contain low : low.exists()
should-name	warning	Act.performer:performer1.assignedEntity.representedOrganization	SHOULD contain name : name.exists()
should-playingEntity	warning	Act.participant:coverage-target.participantRole	SHOULD contain playingEntity : playingEntity.exists()
should-representedOrganization	warning	Act.performer:performer1.assignedEntity	SHOULD contain representedOrganization : representedOrganization.exists()
should-telecom	warning	Act.performer:performer2.assignedEntity	SHOULD contain telecom : telecom.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-time	warning	Act.performer:performer2, Act.participant:coverage-target	SHOULD contain time : time.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime 4537-17139: When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139).
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:policy-activity		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.61
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN
id		1..*	II	(USCDI) **GROUP NUMBER**: This is the identifier used to uniquely refer to a specific health insurance plan.
code		1..1	CD	Binding: v3 Code System ActCode (example)
@code		0..1	cs	Binding: Payer Type (preferred)
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS	Binding: ActStatus (required)
@code		1..1	cs	Fixed Value: completed
effectiveTime		0..1	IVL_TS	This records the policy coverage period, or self-pay period.
Slices for performer		1..*	Performer2	Slice: Unordered, Open by value:templateId.root
performer:performer1		1..1	Performer2	This performer represents the Payer.
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.87
@typeCode		1..1	cs	Binding: ParticipationPhysicalPerformer (required) Fixed Value: PRF
assignedEntity	C	1..1	AssignedEntity	should-code: SHOULD contain code should-representedOrganization: SHOULD contain representedOrganization
id		1..*	II	(USCDI) **PAYER IDENTIFIER**: This is the Payer id. The root is a unique identifier to an openly available assigning authority, such as National Association of Insurance Commissioners (NAIC) (2.16.840.1.113883.6.300), and the extension identifiers the payer within that authority.
code		0..1	CE	Binding: v3 Code System RoleCode (example)
@code		1..1	cs	Binding: Financially Responsible Party Type Value Set (preferred)
addr	C	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
representedOrganization	C	0..1	Organization	should-name: SHOULD contain name
name		0..1	ON
performer:performer2	C	0..*	Performer2	This performer represents the Guarantor. should-time: SHOULD contain time
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.88
@typeCode		1..1	cs	Binding: ParticipationPhysicalPerformer (required) Fixed Value: PRF
time		0..1	IVL_TS
assignedEntity	C	1..1	AssignedEntity	4537-8967: **SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). should-addr: SHOULD contain addr should-telecom: SHOULD contain telecom
id		1..*	II
code		1..1	CE	Binding: v3 Code System RoleCode (example)
@code		1..1	cs	Required Pattern: GUAR
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.5.110
addr	C	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
Slices for participant		1..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:coverage-target	C	1..1	Participant2	participant should-time: SHOULD contain time
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.89
@typeCode		1..1	cs	Binding: ParticipationType (required) Fixed Value: COV
time	C	0..1	IVL_TS	should-low: SHOULD contain low should-high: SHOULD contain high
low		0..1	IVXB_TS
high		0..1	IVXB_TS
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr should-playingEntity: SHOULD contain playingEntity
@classCode		1..1	cs	Binding: RoleClassRoot (required)
id		1..*	II	(USCDI) **MEMBER IDENTIFIER**: This id is a unique identifier for the covered party member. Implementers **SHOULD** use the same GUID for each instance of a member identifier from the same health plan (CONF:4537-8984).
code	C	1..1	CE	(USCDI) **RELATIONSHIP TO SUBSCRIBER**: Records the relationship of a patient to the primary insured person. Binding: v3 Code System RoleCode (example) should-code-attr: SHOULD contain @code
@code		0..1	cs	Binding: Coverage Role Type Value Set (preferred)
addr	C	0..1	USRealmAddress	Base for all types and resources
playingEntity		0..1	PlayingEntity	This playingEntity records the covered party name and birthTime as represented by the health plan. This could match the information in recordTarget, or be different due to marriage or other reasons.
@classCode		1..1	cs	Binding: EntityClassRoot (required)
name		1..1	PN
sdtcBirthTime		1..1	TS	XML Namespace: urn:hl7-org:sdtc sdtc:birthTime XML: birthTime (urn:hl7-org:sdtc)
participant:subscriber		0..1	Participant2	When the Subscriber is the patient, the participant element describing the subscriber *SHALL NOT* be present. This information will be recorded instead in the data elements used to record member information.
templateId		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.90
@typeCode		1..1	cs	Binding: ParticipationType (required) Fixed Value: HLD
time		0..1	IVL_TS
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr
@classCode		1..1	cs	Binding: RoleClassRoot (required)
id		1..*	II	(USCDI) **SUBSCRIBER ID**: This id is a unique identifier for the subscriber of the coverage (CONF:4537-10120).
addr	C	0..1	USRealmAddress	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by value:act.moodCode
entryRelationship:authorization		0..*	EntryRelationship	entryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
act	C	1..1	AuthorizationActivity	Base for all types and resources
entryRelationship:plan		0..*	EntryRelationship	Represents the Coverage Plan
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
act		1..1	Act
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: DEF
id		1..*	II	Plan identifier
code		1..1	CD	Binding: v3 Code System ActCode (example)
text		1..1	ED	Name of the plan
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Act.classCode	required	Fixed Value: ACT
Act.moodCode	required	Fixed Value: EVN
Act.code	example	ActCode
Act.code.code	preferred	PayerType
Act.statusCode	required	ActStatus
Act.performer:performer1.typeCode	required	Fixed Value: PRF
Act.performer:performer1.assignedEntity.code	example	RoleCode
Act.performer:performer1.assignedEntity.code.code	preferred	FinanciallyResponsiblePartyTypeValueSet
Act.performer:performer2.typeCode	required	Fixed Value: PRF
Act.performer:performer2.assignedEntity.code	example	RoleCode
Act.participant:coverage-target.typeCode	required	Fixed Value: COV
Act.participant:coverage-target.participantRole.classCode	required	RoleClassRoot
Act.participant:coverage-target.participantRole.code	example	RoleCode
Act.participant:coverage-target.participantRole.code.code	preferred	CoverageRoleTypeValueSet
Act.participant:coverage-target.participantRole.playingEntity.classCode	required	EntityClassRoot
Act.participant:subscriber.typeCode	required	Fixed Value: HLD
Act.participant:subscriber.participantRole.classCode	required	RoleClassRoot
Act.entryRelationship:authorization.typeCode	required	Fixed Value: REFR
Act.entryRelationship:plan.typeCode	required	Fixed Value: REFR
Act.entryRelationship:plan.act.classCode	required	Fixed Value: ACT
Act.entryRelationship:plan.act.moodCode	required	Fixed Value: DEF
Act.entryRelationship:plan.act.code	example	ActCode

Constraints

Id	Grade	Path(s)	Details	Requirements
4537-8967	warning	Act.performer:performer2.assignedEntity	**SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). : assignedPerson.name.exists() or representedOrganization.name.exists()
4537-17139	error	Act	When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139). : participant.where(typeCode='COV').participantRole.code.where(code = 'SELF') implies participant.where(typeCode='HLD').empty()
81-7296	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	**SHALL NOT** have mixed content except for white space (CONF:81-7296) : item.xmlText.empty()
81-10024	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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})?'))
shall-city	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHALL contain exactly one [1..1] city (CONF:81-7292). : nullFlavor.exists() or item.city.count() = 1
shall-max-ad-parts	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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-streetAddressLine	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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)
should-addr	warning	Act.performer:performer2.assignedEntity, Act.participant:coverage-target.participantRole, Act.participant:subscriber.participantRole	SHOULD contain addr : addr.exists()
should-code	warning	Act.performer:performer1.assignedEntity	SHOULD contain code : code.exists()
should-code-attr	warning	Act.participant:coverage-target.participantRole.code	SHOULD contain @code : code.exists()
should-country	warning	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHOULD contain country : nullFlavor.exists() or item.country.exists()
should-effectiveTime	warning	Act	SHOULD contain effectiveTime : effectiveTime.exists()
should-high	warning	Act.participant:coverage-target.time	SHOULD contain high : high.exists()
should-low	warning	Act.participant:coverage-target.time	SHOULD contain low : low.exists()
should-name	warning	Act.performer:performer1.assignedEntity.representedOrganization	SHOULD contain name : name.exists()
should-playingEntity	warning	Act.participant:coverage-target.participantRole	SHOULD contain playingEntity : playingEntity.exists()
should-representedOrganization	warning	Act.performer:performer1.assignedEntity	SHOULD contain representedOrganization : representedOrganization.exists()
should-telecom	warning	Act.performer:performer2.assignedEntity	SHOULD contain telecom : telecom.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Act.entryRelationship:authorization.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-time	warning	Act.performer:performer2, Act.participant:coverage-target	SHOULD contain time : time.exists()
should-use	warning	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHOULD contain @use : nullFlavor.exists() or use.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime 4537-17139: When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139).
@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
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:policy-activity		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: 2.16.840.1.113883.10.20.22.4.61
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl
id		1..*	II	(USCDI) **GROUP NUMBER**: This is the identifier used to uniquely refer to a specific health insurance plan.
code		1..1	CD	Binding: v3 Code System ActCode (example)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		0..1	cs	Binding: Payer Type (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
qualifier		0..*	CR
translation		0..*	CD
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	Binding: MediaType (example)
@representation		0..1	cs	Binding: Binary Data Encoding Value Set (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
thumbnail		0..1	ED
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)
effectiveTime		0..1	IVL_TS	This records the policy coverage period, or self-pay period.
priorityCode		0..1	CE	Binding: ActPriority (example)
languageCode		0..1	CS	Binding: AllLanguages (required)
subject		0..1	Subject
specimen		0..*	Specimen
Slices for performer		1..*	Performer2	Slice: Unordered, Open by value:templateId.root
performer:performer1		1..1	Performer2	This performer represents the Payer.
@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		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: 2.16.840.1.113883.10.20.22.4.87
@typeCode		1..1	cs	Binding: ParticipationPhysicalPerformer (required) Fixed Value: PRF
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time		0..1	IVL_TS
modeCode		0..1	CE
assignedEntity	C	1..1	AssignedEntity	should-code: SHOULD contain code should-representedOrganization: SHOULD contain representedOrganization
@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	(USCDI) **PAYER IDENTIFIER**: This is the Payer id. The root is a unique identifier to an openly available assigning authority, such as National Association of Insurance Commissioners (NAIC) (2.16.840.1.113883.6.300), and the extension identifiers the payer within that authority.
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		1..1	cs	Binding: Financially Responsible Party Type Value Set (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	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
assignedPerson		0..1	Person
representedOrganization	C	0..1	Organization	should-name: SHOULD contain name
@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		0..1	ON
telecom		0..*	TEL
addr		0..*	AD
standardIndustryClassCode		0..1	CE	Binding: OrganizationIndustryClassNAICS (example)
asOrganizationPartOf		0..1	OrganizationPartOf
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
performer:performer2	C	0..*	Performer2	This performer represents the Guarantor. should-time: SHOULD contain time
@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		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: 2.16.840.1.113883.10.20.22.4.88
@typeCode		1..1	cs	Binding: ParticipationPhysicalPerformer (required) Fixed Value: PRF
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time		0..1	IVL_TS
modeCode		0..1	CE
assignedEntity	C	1..1	AssignedEntity	4537-8967: **SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). should-addr: SHOULD contain addr should-telecom: SHOULD contain telecom
@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
sdtcIdentifiedBy		0..*	IdentifiedBy	XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc)
code		1..1	CE	Binding: v3 Code System RoleCode (example)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Required Pattern: GUAR
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.5.110
@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	0..1	USRealmAddress	Base for all types and resources
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
author		0..*	Author
informant		0..*	Informant
Slices for participant		1..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:coverage-target	C	1..1	Participant2	participant should-time: SHOULD contain time
@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		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: 2.16.840.1.113883.10.20.22.4.89
@typeCode		1..1	cs	Binding: ParticipationType (required) Fixed Value: COV
@contextControlCode		0..1	cs	Binding: ContextControl (required) Fixed Value: OP
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time	C	0..1	IVL_TS	should-low: SHOULD contain low should-high: SHOULD contain high
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
@operator		0..1	cs	Binding: SetOperator (required)
low		0..1	IVXB_TS
center		0..1	TS
width		0..1	PQ
high		0..1	IVXB_TS
awarenessCode		0..1	CE
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr should-playingEntity: SHOULD contain playingEntity
@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: RoleClassRoot (required)
id		1..*	II	(USCDI) **MEMBER IDENTIFIER**: This id is a unique identifier for the covered party member. Implementers **SHOULD** use the same GUID for each instance of a member identifier from the same health plan (CONF:4537-8984).
sdtcIdentifiedBy		0..*	IdentifiedBy	XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc)
code	C	1..1	CE	(USCDI) **RELATIONSHIP TO SUBSCRIBER**: Records the relationship of a patient to the primary insured person. Binding: v3 Code System RoleCode (example) should-code-attr: SHOULD contain @code
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		0..1	cs	Binding: Coverage Role Type Value Set (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	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
playingDevice		0..1	Device
playingEntity		0..1	PlayingEntity	This playingEntity records the covered party name and birthTime as represented by the health plan. This could match the information in recordTarget, or be different due to marriage or other reasons.
@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: EntityClassRoot (required)
@determinerCode		0..1	cs	Binding: EntityDeterminer (required) Fixed Value: INSTANCE
code		0..1	CE	Binding: EntityCode (example)
quantity		0..*	PQ
name		1..1	PN
sdtcBirthTime		1..1	TS	XML Namespace: urn:hl7-org:sdtc sdtc:birthTime XML: birthTime (urn:hl7-org:sdtc)
desc		0..1	ED
scopingEntity		0..1	Entity
participant:subscriber		0..1	Participant2	When the Subscriber is the patient, the participant element describing the subscriber *SHALL NOT* be present. This information will be recorded instead in the data elements used to record member information.
@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		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: 2.16.840.1.113883.10.20.22.4.90
@typeCode		1..1	cs	Binding: ParticipationType (required) Fixed Value: HLD
@contextControlCode		0..1	cs	Binding: ContextControl (required) Fixed Value: OP
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time		0..1	IVL_TS
awarenessCode		0..1	CE
participantRole	C	1..1	ParticipantRole	should-addr: SHOULD contain addr
@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: RoleClassRoot (required)
id		1..*	II	(USCDI) **SUBSCRIBER ID**: This id is a unique identifier for the subscriber of the coverage (CONF:4537-10120).
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)
addr	C	0..1	USRealmAddress	Base for all types and resources
telecom		0..*	TEL
playingDevice		0..1	Device
playingEntity		0..1	PlayingEntity
scopingEntity		0..1	Entity
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by value:act.moodCode
entryRelationship:authorization		0..*	EntryRelationship	entryRelationship
@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_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	AuthorizationActivity	Base for all types and resources
encounter		0..1	Encounter
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:plan		0..*	EntryRelationship	Represents the Coverage Plan
@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_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		1..1	Act
@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: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: DEF
@negationInd		0..1	bl
id		1..*	II	Plan identifier
code		1..1	CD	Binding: v3 Code System ActCode (example)
text		1..1	ED	Name of the plan
statusCode		0..1	CS	Binding: ActStatus (required)
effectiveTime		0..1	IVL_TS
priorityCode		0..1	CE	Binding: ActPriority (example)
languageCode		0..1	CS	Binding: AllLanguages (required)
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	Author
informant		0..*	Informant
participant		0..*	Participant2
entryRelationship		0..*	EntryRelationship
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
encounter		0..1	Encounter
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Act.nullFlavor	required	CDANullFlavor
Act.typeId.nullFlavor	required	CDANullFlavor
Act.templateId:policy-activity.nullFlavor	required	CDANullFlavor
Act.classCode	required	Fixed Value: ACT
Act.moodCode	required	Fixed Value: EVN
Act.code	example	ActCode
Act.code.nullFlavor	required	CDANullFlavor
Act.code.code	preferred	PayerType
Act.text.nullFlavor	required	CDANullFlavor
Act.text.compression	required	CDACompressionAlgorithm
Act.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm
Act.text.mediaType	example	MediaType
Act.text.representation	required	BinaryDataEncoding
Act.statusCode	required	ActStatus
Act.statusCode.nullFlavor	required	CDANullFlavor
Act.priorityCode	example	ActPriority
Act.languageCode	required	AllLanguages
Act.performer:performer1.nullFlavor	required	CDANullFlavor
Act.performer:performer1.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer1.templateId.nullFlavor	required	CDANullFlavor
Act.performer:performer1.typeCode	required	Fixed Value: PRF
Act.performer:performer1.assignedEntity.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.classCode	required	Fixed Value: ASSIGNED
Act.performer:performer1.assignedEntity.code	example	RoleCode
Act.performer:performer1.assignedEntity.code.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.code.code	preferred	FinanciallyResponsiblePartyTypeValueSet
Act.performer:performer1.assignedEntity.representedOrganization.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.representedOrganization.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer1.assignedEntity.representedOrganization.classCode	required	Fixed Value: ORG
Act.performer:performer1.assignedEntity.representedOrganization.determinerCode	required	Fixed Value: INSTANCE
Act.performer:performer1.assignedEntity.representedOrganization.standardIndustryClassCode	example	OrganizationIndustryClassNAICS
Act.performer:performer2.nullFlavor	required	CDANullFlavor
Act.performer:performer2.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer2.templateId.nullFlavor	required	CDANullFlavor
Act.performer:performer2.typeCode	required	Fixed Value: PRF
Act.performer:performer2.assignedEntity.nullFlavor	required	CDANullFlavor
Act.performer:performer2.assignedEntity.typeId.nullFlavor	required	CDANullFlavor
Act.performer:performer2.assignedEntity.classCode	required	Fixed Value: ASSIGNED
Act.performer:performer2.assignedEntity.code	example	RoleCode
Act.performer:performer2.assignedEntity.code.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.typeId.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.templateId.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.typeCode	required	Fixed Value: COV
Act.participant:coverage-target.contextControlCode	required	Fixed Value: OP
Act.participant:coverage-target.time.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.time.operator	required	SetOperator
Act.participant:coverage-target.participantRole.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.typeId.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.classCode	required	RoleClassRoot
Act.participant:coverage-target.participantRole.code	example	RoleCode
Act.participant:coverage-target.participantRole.code.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.code.code	preferred	CoverageRoleTypeValueSet
Act.participant:coverage-target.participantRole.playingEntity.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.playingEntity.typeId.nullFlavor	required	CDANullFlavor
Act.participant:coverage-target.participantRole.playingEntity.classCode	required	EntityClassRoot
Act.participant:coverage-target.participantRole.playingEntity.determinerCode	required	Fixed Value: INSTANCE
Act.participant:coverage-target.participantRole.playingEntity.code	example	EntityCode
Act.participant:subscriber.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.typeId.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.templateId.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.typeCode	required	Fixed Value: HLD
Act.participant:subscriber.contextControlCode	required	Fixed Value: OP
Act.participant:subscriber.participantRole.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.participantRole.typeId.nullFlavor	required	CDANullFlavor
Act.participant:subscriber.participantRole.classCode	required	RoleClassRoot
Act.participant:subscriber.participantRole.code	example	RoleCode
Act.entryRelationship:authorization.nullFlavor	required	CDANullFlavor
Act.entryRelationship:authorization.typeId.nullFlavor	required	CDANullFlavor
Act.entryRelationship:authorization.typeCode	required	Fixed Value: REFR
Act.entryRelationship:plan.nullFlavor	required	CDANullFlavor
Act.entryRelationship:plan.typeId.nullFlavor	required	CDANullFlavor
Act.entryRelationship:plan.typeCode	required	Fixed Value: REFR
Act.entryRelationship:plan.act.nullFlavor	required	CDANullFlavor
Act.entryRelationship:plan.act.typeId.nullFlavor	required	CDANullFlavor
Act.entryRelationship:plan.act.classCode	required	Fixed Value: ACT
Act.entryRelationship:plan.act.moodCode	required	Fixed Value: DEF
Act.entryRelationship:plan.act.code	example	ActCode
Act.entryRelationship:plan.act.statusCode	required	ActStatus
Act.entryRelationship:plan.act.priorityCode	example	ActPriority
Act.entryRelationship:plan.act.languageCode	required	AllLanguages

Constraints

Id	Grade	Path(s)	Details	Requirements
4537-8967	warning	Act.performer:performer2.assignedEntity	**SHOULD** include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name (CONF:4537-8967). : assignedPerson.name.exists() or representedOrganization.name.exists()
4537-17139	error	Act	When the Subscriber is the patient (COV participant code = 'SELF'), the participant element describing the subscriber **SHALL NOT** be present. This information will be recorded instead in the data elements used to record member information (CONF:4537-17139). : participant.where(typeCode='COV').participantRole.code.where(code = 'SELF') implies participant.where(typeCode='HLD').empty()
81-7296	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	**SHALL NOT** have mixed content except for white space (CONF:81-7296) : item.xmlText.empty()
81-10024	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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})?'))
shall-city	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHALL contain exactly one [1..1] city (CONF:81-7292). : nullFlavor.exists() or item.city.count() = 1
shall-max-ad-parts	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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-streetAddressLine	error	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.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)
should-addr	warning	Act.performer:performer2.assignedEntity, Act.participant:coverage-target.participantRole, Act.participant:subscriber.participantRole	SHOULD contain addr : addr.exists()
should-code	warning	Act.performer:performer1.assignedEntity	SHOULD contain code : code.exists()
should-code-attr	warning	Act.participant:coverage-target.participantRole.code	SHOULD contain @code : code.exists()
should-country	warning	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHOULD contain country : nullFlavor.exists() or item.country.exists()
should-effectiveTime	warning	Act	SHOULD contain effectiveTime : effectiveTime.exists()
should-high	warning	Act.participant:coverage-target.time	SHOULD contain high : high.exists()
should-low	warning	Act.participant:coverage-target.time	SHOULD contain low : low.exists()
should-name	warning	Act.performer:performer1.assignedEntity.representedOrganization	SHOULD contain name : name.exists()
should-playingEntity	warning	Act.participant:coverage-target.participantRole	SHOULD contain playingEntity : playingEntity.exists()
should-representedOrganization	warning	Act.performer:performer1.assignedEntity	SHOULD contain representedOrganization : representedOrganization.exists()
should-telecom	warning	Act.performer:performer2.assignedEntity	SHOULD contain telecom : telecom.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Act.entryRelationship:authorization.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-time	warning	Act.performer:performer2, Act.participant:coverage-target	SHOULD contain time : time.exists()
should-use	warning	Act.performer:performer1.assignedEntity.addr, Act.performer:performer2.assignedEntity.addr, Act.participant:coverage-target.participantRole.addr, Act.participant:subscriber.participantRole.addr	SHOULD contain @use : nullFlavor.exists() or use.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

This structure is derived from Act

Summary

Mandatory: 18 elements (16 nested mandatory elements)
Fixed Value: 9 elements
Prohibited: 4 elements

Structures

This structure refers to these other structures:

• US Realm Address (http://hl7.org/cda/us/ccda/StructureDefinition/USRealmAddress)
• Authorization Activity (http://hl7.org/cda/us/ccda/StructureDefinition/AuthorizationActivity)

Slices

This structure defines the following Slices:

• The element Act.templateId is sliced based on the values of value:root, value:extension
• The element Act.performer is sliced based on the value of value:templateId.root
• The element Act.participant is sliced based on the value of value:typeCode
• The element Act.entryRelationship is sliced based on the value of value:act.moodCode