Consolidated CDA (C-CDA)
5.0.0 - STU5
Consolidated CDA (C-CDA)
5.0.0 - STU5
Consolidated CDA (C-CDA) - Downloaded Version 5.0.0 See the Directory of published versions
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
#
Title: Referral Note
Based on: C-CDA_R2_Referral_Note.xml
Updated for C-CDA R3.0 with a focus on header elements
- required/suggested sections are populated with nullFlavor="NI"
to demonstrate WHICH sections should be included, but they
all contain "No information" as this is an example of the header
********************************************************
Disclaimer: This sample file contains representative data elements to represent a Referral Note.
The file depicts a fictional character's health data. Any resemblance to a real person is coincidental.
To illustrate as many data elements as possible, the clinical scenario may not be plausible.
The data in this sample file is not intended to represent real patients, people or clinical events.
This sample is designed to be used in conjunction with the C-CDA Clinical Notes Implementation Guide.
********************************************************
a fhir:ClinicalDocument ;
fhir:nodeRole fhir:treeRoot ;
fhir:realmCode ( [
fhir:code [ fhir:v "US" ]
] ) ; # ** CDA Header **
fhir:typeId [
fhir:extension [ fhir:v "POCD_HD000040" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.1.3" ]
] ; #
fhir:templateId ( [
fhir:extension [ fhir:v "2024-05-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.1.1" ]
] [
fhir:extension [ fhir:v "2024-05-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.1.14" ]
] ) ; # Identifies document as conformant to US Realm Header (V2) Template
fhir:id [
fhir:root [ fhir:v "6f1bd58b-c58f-40b7-b314-caf1294ed98b" ]
] ; # DocumentID: unique ID for the document
fhir:sdtcCategory ( [
fhir:code [ fhir:v "57133-1" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:displayName [ fhir:v "Referral note" ]
] ) ; #
fhir:code [
fhir:code [ fhir:v "57133-1" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Referral Note" ]
] ; # Referral Note
fhir:title [
fhir:xmlText [ fhir:v "Referral Note" ]
] ; # Use the name of the code as the title
fhir:effectiveTime [
fhir:value [ fhir:v "2013-09-21T05:00:00-08:00"^^xsd:dateTime ]
] ; #
fhir:confidentialityCode [
fhir:code [ fhir:v "N" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.25" ]
] ; #
fhir:languageCode [
fhir:code [ fhir:v "en" ]
] ; #
fhir:setId [
fhir:extension [ fhir:v "sTT988" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.19.5.99999.19" ]
] ; #
fhir:versionNumber [
fhir:value [ fhir:v 1 ]
] ; #
fhir:recordTarget ( [
fhir:patientRole [
( fhir:id [
fhir:extension [ fhir:v "444222222" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.1" ] ] ) ;
( fhir:addr [
( fhir:use [ fhir:v "HP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "2222 Home Street" ] ] # HP is \"primary home\" from codeSystem 2.16.840.1.113883.5.1119 ] [
fhir:city [
fhir:xmlText [ fhir:v "Beaverton" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97867" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; # Example Social Security Number using the actual SSN OID. , US is \"United States\" from ISO 3166-1 Country Codes: 1.0.3166.1
( fhir:telecom [
( fhir:use [ fhir:v "HP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)555-2003"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)555-2003 ] ] ) ;
fhir:patient [
( fhir:name [
( fhir:use [ fhir:v "L" ] ) ;
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Eve" ] ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Betterhalf" ] ;
( fhir:qualifier [ fhir:v "SP" ] ) ] ) # The \"SP\" is \"Spouse\" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 ] ) ] [
( fhir:use [ fhir:v "SRCH" ] ) ;
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Eve" ] ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Everywoman" ] ;
( fhir:qualifier [ fhir:v "BR" ] ) ] ) # The \"BR\" is \"Birth\" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 ] ) ] ) ; # The first name element represents what the patient is known as
fhir:administrativeGenderCode [
fhir:code [ fhir:v "F" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.1" ] ;
fhir:codeSystemName [ fhir:v "AdministrativeGender" ] ;
fhir:displayName [ fhir:v "Female" ] ] ;
fhir:birthTime [
fhir:value [ fhir:v "1975-05-01"^^xsd:date ] ] ; # Date of birth need only be precise to the day
fhir:maritalStatusCode [
fhir:code [ fhir:v "M" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.2" ] ;
fhir:codeSystemName [ fhir:v "MaritalStatusCode" ] ;
fhir:displayName [ fhir:v "Married" ] ] ;
fhir:religiousAffiliationCode [
fhir:code [ fhir:v "1013" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.1076" ] ;
fhir:codeSystemName [ fhir:v "HL7 Religious Affiliation" ] ;
fhir:displayName [ fhir:v "Christian (non-Catholic, non-specific)" ] ] ;
fhir:raceCode [
fhir:code [ fhir:v "2106-3" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ;
fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ;
fhir:displayName [ fhir:v "White" ] ] ; # CDC Race and Ethnicity code set contains the five minimum race and ethnicity \n categories defined by OMB Standards
( fhir:sdtcRaceCode [
fhir:code [ fhir:v "2076-8" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ;
fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ;
fhir:displayName [ fhir:v "Native Hawaiian or Other Pacific Islander" ] ] ) ; # The raceCode extension is only used if raceCode is valued
fhir:ethnicGroupCode [
fhir:code [ fhir:v "2186-5" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ;
fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ;
fhir:displayName [ fhir:v "Not Hispanic or Latino" ] ] ;
( fhir:guardian [
fhir:code [
fhir:code [ fhir:v "POWATT" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.111" ] ;
fhir:codeSystemName [ fhir:v "RoleCode" ] ;
fhir:displayName [ fhir:v "Power of Attorney" ] ] ;
( fhir:addr [
( fhir:use [ fhir:v "HP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "2222 Home Street" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Beaverton" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97867" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "MC" ] ) ;
fhir:value [
fhir:v "tel:+1(555)555-2008"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)555-2008 ] ] ) ;
fhir:guardianPerson [
( fhir:name [
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Boris" ] ] ) ] [
( fhir:given [
fhir:xmlText [ fhir:v "Bo" ] ;
( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Betterhalf" ] ] ) ] ) ] ) ] ] ) ;
fhir:birthplace [
fhir:place [
fhir:addr [
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "4444 Home Street" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Beaverton" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97867" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ] ] ;
( fhir:languageCommunication [
fhir:languageCode [
fhir:code [ fhir:v "en" ] ] ;
fhir:modeCode [
fhir:code [ fhir:v "ESP" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.60" ] ;
fhir:codeSystemName [ fhir:v "LanguageAbilityMode" ] ;
fhir:displayName [ fhir:v "Expressed spoken" ] ] ;
fhir:proficiencyLevelCode [
fhir:code [ fhir:v "G" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.61" ] ;
fhir:codeSystemName [ fhir:v "LanguageAbilityProficiency" ] ;
fhir:displayName [ fhir:v "Good" ] ] ;
fhir:preferenceInd [
fhir:value [ fhir:v true ] ] # Patient's preferred language ] ) ] ; # HP is \"primary home\" from HL7 AddressUse 2.16.840.1.113883.5.1119
fhir:providerOrganization [
( fhir:id [
fhir:extension [ fhir:v "219BX" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ;
( fhir:name [
( fhir:item [
fhir:xmlText [ fhir:v "The DoctorsTogether Physician Group" ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)555-5000"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)555-5000 ] ] ) ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1007 Health Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ] ]
] ) ; #
fhir:author ( [
fhir:time [
fhir:value [ fhir:v "2013-03-11T10:30:00-08:00"^^xsd:dateTime ] ] ;
fhir:assignedAuthor [
( fhir:id [
fhir:extension [ fhir:v "5555555555" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "207QA0505X" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ;
fhir:codeSystemName [ fhir:v "Healthcare Provider Taxonomy (HIPAA)" ] ;
fhir:displayName [ fhir:v "Adult Medicine" ] ] ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1004 Healthcare Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)-1004"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)-1004 ] ] ) ;
fhir:assignedPerson [
( fhir:name [
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Patricia" ] ] ) ] [
( fhir:given [
fhir:xmlText [ fhir:v "Patty" ] ;
( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Primary" ] ] ) ] [
( fhir:suffix [
fhir:xmlText [ fhir:v "M.D." ] ;
( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ]
] ) ; #
fhir:dataEnterer [
fhir:assignedEntity [
( fhir:id [
fhir:extension [ fhir:v "333777777" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1007 Healthcare Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)-1050"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)-1050 ] ] ) ;
fhir:assignedPerson [
( fhir:name [
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Ellen" ] ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Enter" ] ] ) ] ) ] ) ] ]
] ; #
fhir:informant ( [
fhir:assignedEntity [
( fhir:id [
fhir:extension [ fhir:v "888888888" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.19.5" ] ] ) ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1007 Healthcare Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)-1003"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)-1003 ] ] ) ;
fhir:assignedPerson [
( fhir:name [
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Harold" ] ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Hippocrates" ] ] ) ] [
( fhir:suffix [
fhir:xmlText [ fhir:v "D.O." ] ;
( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ]
] ) ; #
fhir:custodian [
fhir:assignedCustodian [
fhir:representedCustodianOrganization [
( fhir:id [
fhir:extension [ fhir:v "321CX" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ;
fhir:name [
( fhir:item [
fhir:xmlText [ fhir:v "Good Health HIE" ] ] ) ] ;
fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)-1009"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)-1009 ] ] ;
fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1009 Healthcare Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ] ]
] ; #
fhir:informationRecipient ( [
fhir:intendedRecipient [
fhir:informationRecipient [
( fhir:name [
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Nancy" ] ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Nightingale" ] ] ) ] [
( fhir:suffix [
fhir:xmlText [ fhir:v "RN" ] ;
( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ;
fhir:receivedOrganization [
( fhir:name [
( fhir:item [
fhir:xmlText [ fhir:v "Community Health and Hospitals" ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)-555-1002"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)-555-1002 ] ] ) ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "Cardiac Stepdown Unit, 4B" ] ] ] [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1002 Healthcare Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Ann Arbor" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "MI" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97857" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ] ]
] ) ; #
fhir:legalAuthenticator [
fhir:time [
fhir:value [ fhir:v "2013-09-15T22:36:15-08:00"^^xsd:dateTime ] ] ;
fhir:signatureCode [
fhir:code [ fhir:v "S" ] ] ;
fhir:assignedEntity [
( fhir:id [
fhir:extension [ fhir:v "5555555555" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "207QA0505X" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ;
fhir:codeSystemName [ fhir:v "Healthcare Provider Taxonomy (HIPAA)" ] ;
fhir:displayName [ fhir:v "Adult Medicine Physician" ] ] ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1004 Healthcare Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)-1004"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)-1004 ] ] ) ;
fhir:assignedPerson [
( fhir:name [
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Patricia" ] ] ) ] [
( fhir:given [
fhir:xmlText [ fhir:v "Patty" ] ;
( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Primary" ] ] ) ] [
( fhir:suffix [
fhir:xmlText [ fhir:v "M.D." ] ;
( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ]
] ; #
fhir:authenticator ( [
fhir:time [
fhir:value [ fhir:v "2012-09-15T10:30:00-08:00"^^xsd:dateTime ] ] ;
fhir:signatureCode [
fhir:code [ fhir:v "S" ] ] ;
fhir:assignedEntity [
( fhir:id [
fhir:extension [ fhir:v "5555555555" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "207QA0505X" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ;
fhir:codeSystemName [ fhir:v "Healthcare Provider Taxonomy (HIPAA)" ] ;
fhir:displayName [ fhir:v "Adult Medicine" ] ] ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1004 Healthcare Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Portland" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "OR" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "99123" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:+1(555)-1004"^^xsd:anyURI ;
fhir:l fhir:tel:+1(555)-1004 ] ] ) ;
fhir:assignedPerson [
( fhir:name [
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Patricia" ] ] ) ] [
( fhir:given [
fhir:xmlText [ fhir:v "Patty" ] ;
( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Primary" ] ] ) ] [
( fhir:suffix [
fhir:xmlText [ fhir:v "M.D." ] ;
( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ]
] ) ; #
fhir:participant ( [
fhir:typeCode [ fhir:v "CALLBCK" ] ;
fhir:time [
fhir:value [ fhir:v "2005-03-29T22:44:11+05:00"^^xsd:dateTime ] ] ;
fhir:associatedEntity [
fhir:classCode [ fhir:v "ASSIGNED" ] ;
( fhir:id [
fhir:extension [ fhir:v "99999999" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "200000000X" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ;
fhir:displayName [ fhir:v "Allopathic & Osteopathic Physicians" ] ] ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "1002 Healthcare Drive" ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Ann Arbor" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "MI" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97857" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:555-555-1002"^^xsd:anyURI ;
fhir:l fhir:tel:555-555-1002 ] ] ) ;
fhir:associatedPerson [
( fhir:name [
( fhir:item [
( fhir:given [
fhir:xmlText [ fhir:v "Henry" ] ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Seven" ] ] ) ] [
( fhir:suffix [
fhir:xmlText [ fhir:v "DO" ] ] ) ] ) ] ) ] ]
] [
fhir:typeCode [ fhir:v "IND" ] ;
fhir:functionCode [
fhir:code [ fhir:v "407543004" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.96" ] ;
fhir:codeSystemName [ fhir:v "SNOMED-CT" ] ;
fhir:displayName [ fhir:v "Primary Carer" ] ] ;
fhir:associatedEntity [
fhir:classCode [ fhir:v "CAREGIVER" ] ;
fhir:code [
fhir:code [ fhir:v "MTH" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.111" ] ] ;
( fhir:addr [
( fhir:use [ fhir:v "WP" ] ) ;
( fhir:item [
fhir:streetAddressLine [
fhir:xmlText [ fhir:v "17 Daws Rd." ] ] ] [
fhir:city [
fhir:xmlText [ fhir:v "Ann Arbor" ] ] ] [
fhir:state [
fhir:xmlText [ fhir:v "MI" ] ] ] [
fhir:postalCode [
fhir:xmlText [ fhir:v "97857" ] ] ] [
fhir:country [
fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ;
( fhir:telecom [
( fhir:use [ fhir:v "WP" ] ) ;
fhir:value [
fhir:v "tel:1+(555)555-1212"^^xsd:anyURI ;
fhir:l fhir:tel:1+(555)555-1212 ] ] ) ;
fhir:associatedPerson [
( fhir:name [
( fhir:item [
( fhir:prefix [
fhir:xmlText [ fhir:v "Mrs." ] ] ) ] [
( fhir:given [
fhir:xmlText [ fhir:v "Martha" ] ] ) ] [
( fhir:family [
fhir:xmlText [ fhir:v "Jones" ] ] ) ] ) ] ) ] ] # Caregiver
] ) ; #
fhir:component [
fhir:structuredBody [
( fhir:component [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:extension [ fhir:v "2014-06-09" ] ;
fhir:root [ fhir:v "1.3.6.1.4.1.19376.1.5.3.1.3.1" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "42349-1" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Reason for Referral" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "REASON FOR REFERRAL" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.6.1" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "48765-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "ALLERGIES AND ADVERSE REACTIONS" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.5.1" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "11450-4" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "PROBLEM LIST" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "PROBLEMS" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:extension [ fhir:v "2014-06-09" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.1.1" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "10160-0" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "HISTORY OF MEDICATION USE" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "MEDICATIONS" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:extension [ fhir:v "2014-06-09" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.10" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "18776-5" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Treatment plan" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "TREATMENT PLAN" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.8" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "51848-0" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "ASSESSMENTS" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "ASSESSMENTS" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.3.1" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "30954-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "RESULTS" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "RESULTS" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:extension [ fhir:v "2014-06-09" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.14" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "47420-5" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Functional Status" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "FUNCTIONAL STATUS" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:extension [ fhir:v "2015-08-01" ] ;
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.56" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "10190-7" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Mental status Narrative" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "MENTAL STATUS" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] [
fhir:section [
fhir:nullFlavor [ fhir:v "NI" ] ;
( fhir:templateId [
fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.57" ] ] ) ;
fhir:code [
fhir:code [ fhir:v "61144-2" ] ;
fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ;
fhir:codeSystemName [ fhir:v "LOINC" ] ;
fhir:displayName [ fhir:v "Diet and Nutrition" ] ] ;
fhir:title [
fhir:xmlText [ fhir:v "NUTRITION SECTION" ] ] ;
fhir:text [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"^^rdf:XMLLiteral ] ] ] ) # Reason for Referral ] # All sections are set to nullFlavor \/ text = No information, \n as this is a header example, not a complete body example
] . #
IG © 2019+ Health Level Seven. Package hl7.cda.us.ccda#5.0.0 based on FHIR 5.0.0. Generated 2026-06-13
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