C-CDA on FHIR Implementation Guide STU 1 (v1.0.0)
This page is part of the C-CDA on FHIR Implementation Guide (v1.0.0: STU 1) based on FHIR R3. This is the current published version. For a full list of available versions, see the Directory of published versions 
<Composition xmlns="http://hl7.org/fhir"> <id value="CCDA-on-FHIR-Care-Plan-Example"/> <meta> <versionId value="1"/> <lastUpdated value="2016-06-15T08:16:14Z"/> <profile value="http://hl7.org/fhir/us/ccda/StructureDefinition/CCDA-on-FHIR-Care-Plan"/> </meta> <language value="en-US"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Document Id</span> </td> <td class="td_header_role_value">12345</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Document Created:</span> </td> <td class="td_header_role_value">June 15, 2016, 16:14, PST </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Care Provision</span> </td> <td class="td_header_role_value">Care Plan for Amy Shaw</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Performer</span> </td> <td class="td_header_role_value">Ronald Boone, MD</td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Author</span> </td> <td class="td_header_role_value">Ronald Boone, MD</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">1003 Healthcare Drive<br/>Amherst MA 01002, US<br/>Tel: +1(555)555-1003<br/> </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Encounter Id</span> </td> <td class="td_header_role_value">9937012 2.16.840.1.113883.19</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Encounter Type</span> </td> <td class="td_header_role_value">Care Plan</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Encounter Period</span> </td> <td class="td_header_role_value"> From June 15, 2016, 16:20 to Sept 18, 2016, 18:20 </td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Encounter Location</span> </td> <td class="td_header_role_value">Ambulatory Care at Acme Laboratories</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Responsible party</span> </td> <td class="td_header_role_value">Ronald Boone, MD</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">1003 Healthcare Drive<br/>Amherst MA 01002, US<br/>Tel: +1(555)555-1003<br/> </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Assigned entity</span> </td> <td class="td_header_role_value">Acme Laboratories<br/> </td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Emergency contact</span> </td> <td class="td_header_role_value">Michael Shaw<br/> <br/> </td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">49 Meadow St<br/>Amherst MA 01003, US<br/>Tel: (555)555-1212<br/> </td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Care giver</span> </td> <td class="td_header_role_value">Mrs. Lillian White<br/> </td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">49 Meadow St<br/>Amherst MA 01003, US<br/>Tel: (555)555-1215<br/> </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Entered by</span> </td> <td class="td_header_role_value">Sally Jones</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">1003 Healthcare Drive<br/>Amherst MA 01002, US<br/>Tel: +1(555)555-1003<br/> </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Signed </span> </td> <td class="td_header_role_value">Ronald Boone at June 15, 2016 </td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">1003 Healthcare Drive<br/>Amherst MA 01002, US<br/>Tel: +1(555)555-1003<br/> </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Informant</span> </td> <td class="td_header_role_value">Henry Vincent, CPh</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">1007 Pharmacy Drive<br/>Portland, OR 99123, US<br/>Tel: +1(555)555-1215<br/> </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Information recipient:</span> </td> <td class="td_header_role_value">Primary Physician, MD</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">1005 St. Clair Avenue<br/>Amherst MA 01002, US<br/>Tel: +1(555)555-1666<br/> </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Legal authenticator</span> </td> <td class="td_header_role_value">Ronald Boone, MD signed at June 15, 2016 </td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">1003 Healthcare Drive<br/>Amherst MA 01002, US<br/>Tel: +1(555)555-1003<br/> </td> </tr> </tbody> </table> <table style="border: 1pt inset #00008b; line-height: 10pt; width: 100%;" class="header_table"> <tbody> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Document maintained by</span> </td> <td class="td_header_role_value">Acme Laboratories</td> </tr> <tr> <td style="width: 20%; background-color: #3399ff; padding: 0.1cm 0.2cm; vertical-align: top; background-color: #ffffcc;" class="td_header_role_name"> <span class="td_label">Contact info</span> </td> <td class="td_header_role_value">1003 Healthcare Drive<br/>Amherst MA 01002, US<br/>Tel: +1(555)555-1003<br/> </td> </tr> </tbody> </table> </div> </text> <identifier> <system value="urn:ietf:rfc:3986"/> <value value="urn:uuid:39067866-6319-4008-9c6d-3f0176d6826c"/> </identifier> <!-- <extension url="http://hl7.org/fhir/us/ccda/StructureDefinition/CCDA-on-FHIR-Data-Enterer"> <valueReference> <reference value="Practitioner/practitioner-1"/> </valueReference> </extension> <extension url="http://hl7.org/fhir/us/ccda/StructureDefinition/CCDA-on-FHIR-Informant"> <valueReference> <reference value="Practitioner/practitioner-1"/> </valueReference> </extension> <extension url="http://hl7.org/fhir/us/ccda/StructureDefinition/CCDA-on-FHIR-Information-Recipient"> <valueReference> <reference value="Practitioner/practitioner-1"/> </valueReference> </extension> <extension url="http://hl7.org/fhir/us/ccda/StructureDefinition/CCDA-on-FHIR-Participant"> <valueReference> <reference value="RelatedPerson/related-person"/> </valueReference> </extension> <extension url="http://hl7.org/fhir/us/ccda/StructureDefinition/CCDA-on-FHIR-Performer"> <valueReference> <reference value="Practitioner/practitioner-1"/> </valueReference> </extension> --> <status value="preliminary"/> <type> <coding> <system value="http://loinc.org"/> <code value="52521-2"/> <display value="Overall Plan of Care/Advance Care Directives"/> </coding> </type> <!-- Patient Resource --> <subject> <reference value="Patient/patient-1"/> <display value="Amy V. Shaw"/> </subject> <date value="2016-06-15T09:10:14Z"/> <!-- Practitioner Resource --> <author> <reference value="Practitioner/practitioner-1"/> <display value="Ronald Bone, MD"/> </author> <title value="Care Plan"/> <confidentiality value="N"/> <attester> <mode value="legal"/> <time value="2016-06-15T09:10:14Z"/> <party> <reference value="Practitioner/practitioner-1"/> <display value="Ronald Boone, MD"/> </party> </attester> <!-- Organization Resource --> <custodian> <reference value="Organization/organization-1"/> <display value="Acme Labs"/> </custodian> <event> <code> <coding> <system value="http://snomed.info/sct"/> <code value="73761001"/> <display value="Colonoscopy"/> </coding> </code> <period> <start value="2016-06-15"/> <end value="2016-09-18"/> </period> </event> <!-- Encounter Resource --> <!-- <encounter><reference value="http://fhirtest.uhn.ca/baseDstu3/Encounter/117630"/></encounter> --> <!-- Health Concerns Section Narrative --> <section> <title value="Health Concerns Section"/> <code> <coding> <system value="http://loinc.org"/> <code value="75310-3"/> <display value="Health concerns Document"/> </coding> </code> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <table> <tr> <td> <b>Concern</b> </td> <td> <b>Status</b> </td> <td> <b>Date</b> </td> </tr> <tr> <td>Current every day smoker</td> <td>Active</td> <td>Concern from June 16, 2015</td> </tr> <tr> <td>Respiratory insufficiency</td> <td>Completed</td> <td>Concern from June 13, 2015</td> </tr> <tr> <td>Pneumonia</td> <td>Completed</td> <td>June 16, 2015</td> </tr> </table> </div> </text> <mode value="snapshot"/> <orderedBy> <coding> <system value="http://hl7.org/fhir/list-order"/> <code value="event-date"/> <display value="Sorted by Event Date"/> </coding> </orderedBy> </section> <!-- Goals Section Narrative --> <section> <title value="Goals Section"/> <code> <coding> <system value="http://loinc.org"/> <code value="61146-7"/> <display value="Goals"/> </coding> </code> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <table> <tr> <td> <b>Goal</b> </td> <td> <b>Value</b> </td> <td> <b>Date</b> </td> </tr> <tr> <td>Pulse oximetry</td> <td>92%</td> <td>September 2, 2015</td> </tr> </table> </div> </text> </section> <!-- Interventions Section Narrative --> <section> <title value="Interventions Section"/> <code> <coding> <system value="http://loinc.org"/> <code value="62387-6"/> <display value="Interventions provided"/> </coding> </code> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <table> <tr> <td> <b>Planned Intervention</b> </td> <td> <b>Status</b> </td> <td> <b>Date</b> </td> </tr> <tr> <td>Elevate head of bed</td> <td>active</td> <td>June 18, 2016</td> </tr> <tr> <td>Oxygen administration by nasal cannula</td> <td>active</td> <td>June 18, 2016</td> </tr> <tr> <td>pulse oximetry monitoring</td> <td>active</td> <td>June 18, 2016</td> </tr> </table> </div> </text> </section> <!-- Health Status Evaluations and Outcomes Section Narrative --> <section> <title value="Health Status Evaluations and Outcomes Section"/> <code> <coding> <system value="http://loinc.org"/> <code value="11383-7"/> <display value="Patient problem outcome"/> </coding> </code> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"> <table> <tr> <td> <b>Item</b> </td> <td> <b>Outcome</b> </td> <td> <b>Date</b> </td> </tr> <tr> <td>Pulse oximetry</td> <td>95%</td> <td>June 20, 2016</td> </tr> </table> </div> </text> </section> </Composition>
© HL7.org 2011+. C-CDA on FHIR Implementation Guide v1.0.0 based on FHIR version (v3.0.1) generated on
Sat, Apr 7, 2018 06:53+1000. QA Page
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