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
This content is an example of the Disability Status Observation Logical Model and is not a FHIR Resource
<observation xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.505" extension="2023-05-01"/>
<code code="89571-4" displayName="Disability Status [CUBS]" codeSystem="2.16.840.1.113883.6.1"/>
<text><reference value="#disabilityStatus"/></text>
<statusCode code="completed"/>
<effectiveTime value="20221111"/>
<!-- From LOINC Answer Set associated with Disability Status [CUBS] -->
<value xsi:type="CD" code="LA29243-5" displayName="I'm Vulnerable - I sometimes or periodically have acute or chronic symptoms affecting housing, employment, social interactions, etc." codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<!-- Assessment Scale template With Assessment Scale observation containing the disability related questions -->
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.69" extension="2022-06-01"/>
<id root="c6b5a04b-2bf4-49d1-8336-636a3813df0b"/>
<code code="54614-3" displayName="Brief Interview for Mental Status" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<derivationExpr>Sum of the yes answers.</derivationExpr>
<statusCode code="completed"/>
<effectiveTime value="20120214"/>
<!-- Summed score of the component values -->
<value xsi:type="INT" value="6"/>
<!-- Supporting observations -->
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a44"/>
<code code="69856-3" displayName="Are you deaf, or do you have serious difficulty hearing?" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#deafhohq"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="LA33-6" displayName="Yes"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a44"/>
<code code="69857-1" displayName="Are you blind, or do you have serious difficulty seeing, even when wearing glasses?" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#blindq"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="LA33-6" displayName="Yes" codeSystem="2.16.840.1.113883.6.1"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a44"/>
<code code="69858-9" displayName="Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions??" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#memq"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="LA33-6" displayName="Yes" codeSystem="2.16.840.1.113883.6.1"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a44"/>
<code code="69859-7" displayName="Do you have serious difficulty walking or climbing stairs?" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#mobilityq"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="LA33-6" displayName="Yes" codeSystem="2.16.840.1.113883.6.1"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a44"/>
<code code="69860-5" displayName="Do you have difficulty dressing or bathing?" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#selfcareq"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="LA33-6" displayName="Yes" codeSystem="2.16.840.1.113883.6.1"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a44"/>
<code code="69861-3" displayName="Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a physician's office or shopping?" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
<text>
<reference value="#activityq"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" code="LA33-6" displayName="Yes" codeSystem="2.16.840.1.113883.6.1"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</observation>