This page is part of the CCDA: Consolidated CDA Release (v5.0.0-ballot: CCDA 5.0 Ballot) generated with FHIR (HL7® FHIR® Standard) v5.0.0. This version is a pre-release. The current official version is 4.0.0. For a full list of available versions, see the Directory of published versions
<observation xmlns="urn:hl7-org:v3" moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.38" extension="2022-06-01"/>
<templateId root="2.16.840.1.113883.10.20.22.4.506" extension="2023-05-01"/>
<id root="c6b5a04b-2bf4-49d1-8336-636a3813df0bc"/>
<sdtc:category xmlns:sdtc="urn:hl7-org:sdtc" displayName="social-history"
codeSystem="2.16.840.1.113883.4.642.1.1125" code="social-history"/>
<code xsi:type="CD" displayName="Tribal affiliation"
codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="95370-3"/>
<statusCode code="completed"/>
<!-- The effectiveTime reflects when the current tribal affiliation status was observed. -->
<effectiveTime value="20230501"/>
<value xsi:type="CD"
displayName="Cow Creek Band of Umpqua Tribe of Indians" codeSystemName="TribalEntityUS"
codeSystem="2.16.840.1.113883.5.140" code="68"/>
<author typeCode="AUT">
<templateId root="2.16.840.1.113883.10.20.22.4.119"/>
<time value="20120910114500-0800"/>
<assignedAuthor>
<id root="1.1.1.1.1.1.1.2" extension="555555555"/>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>2222 Home Street</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
</addr>
<telecom value="tel:+1(555)555-2003" use="HP"/>
<assignedPerson>
<name>
<given>Nurse</given>
<family>Nightingale</family>
<suffix>RN</suffix>
</name>
</assignedPerson>
</assignedAuthor>
</author>
</observation>