C-CDA on FHIR
1.2.0-ballot - CI Build United States of America flag

This page is part of the C-CDA on FHIR Implementation Guide (v1.2.0-ballot: STU 1 Ballot 4) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Example Bundle: Complete Document Bundle Example

Amy V. SHAW
Identifier 1032702
Address 49 Meadow St
Mounds OK US
Date of birth 20 February 2007
Document Id 12345
Document Created: June 15, 2016, 16:14, PST
Care Provision Care Plan for Amy Shaw
Performer Ronald Boone, MD
Author Ronald Boone, MD
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Encounter Id 9937012 2.16.840.1.113883.19
Encounter Type Care Plan
Encounter Period From June 15, 2016, 16:20 to Sept 18, 2016, 18:20
Encounter Location Ambulatory Care at Acme Laboratories
Responsible party Ronald Boone, MD
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Assigned entity Acme Laboratories
Emergency contact Michael Shaw

Contact info 49 Meadow St
Amherst MA 01003, US
Tel: (555)555-1212
Care giver Mrs. Lillian White
Contact info 49 Meadow St
Amherst MA 01003, US
Tel: (555)555-1215
Entered by Sally Jones
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Signed Ronald Boone at June 15, 2016
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Informant Henry Vincent, CPh
Contact info 1007 Pharmacy Drive
Portland, OR 99123, US
Tel: +1(555)555-1215
Information recipient: Primary Physician, MD
Contact info 1005 St. Clair Avenue
Amherst MA 01002, US
Tel: +1(555)555-1666
Legal authenticator Ronald Boone, MD signed at June 15, 2016
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003
Document maintained by Acme Laboratories
Contact info 1003 Healthcare Drive
Amherst MA 01002, US
Tel: +1(555)555-1003

Health Concerns Section

Concern Status Date
Current every day smoker Active Concern from June 16, 2015
Respiratory insufficiency Completed Concern from June 13, 2015
Pneumonia Completed June 16, 2015

Goals Section

Goal Value Date
Pulse oximetry 92% September 2, 2015

Interventions Section

Planned Intervention Status Date
Elevate head of bed active June 18, 2016
Oxygen administration by nasal cannula active June 18, 2016
pulse oximetry monitoring active June 18, 2016

Health Status Evaluations and Outcomes Section

Item Outcome Date
Pulse oximetry 95% June 20, 2016

Additional Document Content

2. urn:uuid:23d3a2c1-44ae-491b-94d3-764d2a9d8f8c (PractitionerRole/ccda-practitionerrole-example)

Generated Narrative: PractitionerRole

Resource PractitionerRole "ccda-practitionerrole-example"

Texts

-Div
*<div/>

practitioner: See above (urn:uuid:51819bca-6cdd-4a9c-a76f-51b4f50e7fd2: Brenda Jennings Richard MD)

organization: See above (urn:uuid:58d390ba-6348-4b0d-b85f-7fbd94223718: Acme Lab)

3. urn:uuid:d0dbd5a1-0bd7-4205-b936-09482c02c6d9 (Patient/example)

Amy V. SHAW
Identifier 1032702
Address 49 Meadow St
Mounds OK US
Date of birth 20 February 2007

4. urn:uuid:58d390ba-6348-4b0d-b85f-7fbd94223718 (Organization/acme-lab)

Generated Narrative: Organization

Resource Organization "acme-lab"

Texts

-Div
*<div/>

identifier: id: 1144221847, id: 2523423456

active: true

type: Healthcare Provider (Organization type#prov)

name: Acme Labs

Contacts

-TelecomAddress
*ph: (+1) 734-677-7777, hq@acme.org3300 Washtenaw Avenue, Suite 227 Amherst MA 01002 USA

5. urn:uuid:51819bca-6cdd-4a9c-a76f-51b4f50e7fd2 (Practitioner/ccda-practitioner-example)

Generated Narrative: Practitioner

Resource Practitioner "ccda-practitioner-example"

Texts

-Div
*<div/>

identifier: US National Provider Identifier: 9999991011 (use: OFFICIAL)

name: Brenda Jennings Richard

telecom: ph: 313-555-6868(HOME), ph: 313-555-6443(WORK)

gender: FEMALE

birthDate: 1976-11-15

address: 346 W Plum Avenu Dearborn MI 48123