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

• Content
• Detailed Descriptions
• Mappings
• XML
• JSON

Logical Model: Gender Identity Observation

This observation represents the gender identity of the patient, defined as:

“Ones basic sense of being male, female, or other gender (for example, transgender or gender queer). Gender identity can be congruent or incongruent with ones sex assigned at birth based on the appearance of external genitalia. (Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) CommunityA Field Guide, The Joint Commission (2011).)

This template follows the guidelines from the HL7 Gender Harmony project. This template is based on C-CDA Social History Observation template.

This observation is not appropriate for recording patient gender (administrativeGender) or birth sex.

Usage:

• This Logical Model is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from SocialHistoryObservation

Name	Flags	Card.	Type	Description & Constraints
Observation		1..1	SocialHistoryObservation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1, templateId, templateId, classCode, moodCode, id, code, text, statusCode, effectiveTime, value, author, entryRelationship, entryRelationship, entryRelationship Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class)
templateId		2..*	II
templateId:gender-identity-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.34.3.45
@extension		1..1	st	Required Pattern: 2023-05-01
@classCode		1..1	cs
@moodCode		1..1	cs
code		1..1	CD
@code		1..1	cs	Required Pattern: 76691-5
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
statusCode		1..1	CS
@code		1..1	cs
effectiveTime		1..1	IVL_TS	The effectiveTime represents the relevant time of the observation. A patient's "gender identity" may change and using effectiveTime/low and effectiveTime/high defines the time during which the patient had identified as specified.
low		1..1	IVXB_TS
high		0..1	IVXB_TS
value		1..1	CD	NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: Gender Identity USCDI core (required)
@nullFlavor		0..1	cs	To represent additional Gender Identities, set nullFlavor="OTH". To represent "choose not to disclose", set nullFlavor="ASKU". Binding: CDANullFlavor (required) Additional Bindings Purpose Documentation Asked but Unknown and Other Preferred Binding Recommended nullFlavors
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.value	required	GenderIdentityUSCDICore
Observation.value.nullFlavor	required	CDANullFlavor

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	SocialHistoryObservation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1, templateId, templateId, classCode, moodCode, id, code, text, statusCode, effectiveTime, value, author, entryRelationship, entryRelationship, entryRelationship Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class)
Slices for templateId		2..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
templateId:gender-identity-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.34.3.45
@extension		1..1	st	Required Pattern: 2023-05-01
@classCode		1..1	cs	Binding: ActClassObservation (2.0.0) (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred)
@code		1..1	cs	Required Pattern: 76691-5
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
statusCode		1..1	CS	Binding: ActStatus (required)
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS	The effectiveTime represents the relevant time of the observation. A patient's "gender identity" may change and using effectiveTime/low and effectiveTime/high defines the time during which the patient had identified as specified.
low		1..1	IVXB_TS
high		0..1	IVXB_TS
value		1..1	CD	NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: Gender Identity USCDI core (required) Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
@nullFlavor		0..1	cs	To represent additional Gender Identities, set nullFlavor="OTH". To represent "choose not to disclose", set nullFlavor="ASKU". Binding: CDANullFlavor (required) Additional Bindings Purpose Documentation Asked but Unknown and Other Preferred Binding Recommended nullFlavors
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
act	C	1..1	EntryReference	Base for all types and resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.classCode	required	Fixed Value: OBS
Observation.moodCode	required	Fixed Value: EVN
Observation.code	preferred	SocialHistoryType
Observation.statusCode	required	ActStatus
Observation.value	required	GenderIdentityUSCDICore
Observation.value.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeCode	required	Fixed Value: SPRT
Observation.entryRelationship:social-history-entry-sprt-act.typeCode	required	Fixed Value: SPRT

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation, Observation.entryRelationship:social-history-entry-sprt-obs.observation, Observation.entryRelationship:social-history-entry-sprt-act.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	SocialHistoryObservation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1, templateId, templateId, classCode, moodCode, id, code, text, statusCode, effectiveTime, value, author, entryRelationship, entryRelationship, entryRelationship Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
Slices for templateId		2..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
templateId:gender-identity-obs		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.34.3.45
@extension		1..1	st	Required Pattern: 2023-05-01
@classCode		1..1	cs	Binding: ActClassObservation (2.0.0) (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Required Pattern: 76691-5
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
@codeSystemName		0..1	st
@codeSystemVersion		0..1	st
@displayName		0..1	st
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
originalText		0..1	ED
qualifier		0..*	CR
translation		0..*	CD
derivationExpr		0..1	ST
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	Binding: MediaType (example)
@representation		0..1	cs	Binding: Binary Data Encoding Value Set (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL
thumbnail		0..1	ED
statusCode		1..1	CS	Binding: ActStatus (required)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Fixed Value: completed
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
effectiveTime		1..1	IVL_TS	The effectiveTime represents the relevant time of the observation. A patient's "gender identity" may change and using effectiveTime/low and effectiveTime/high defines the time during which the patient had identified as specified.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
@operator		0..1	cs	Binding: SetOperator (required)
low		1..1	IVXB_TS
center		0..1	TS
width		0..1	PQ
high		0..1	IVXB_TS
priorityCode		0..1	CE	Binding: ActPriority (example)
repeatNumber		0..1	IVL_INT
languageCode		0..1	CS	Binding: AllLanguages (required)
value		1..1	CD	NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: Gender Identity USCDI core (required) Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
@nullFlavor		0..1	cs	To represent additional Gender Identities, set nullFlavor="OTH". To represent "choose not to disclose", set nullFlavor="ASKU". Binding: CDANullFlavor (required) Additional Bindings Purpose Documentation Asked but Unknown and Other Preferred Binding Recommended nullFlavors
@code		0..1	cs
@codeSystem		0..1	oid, uuid, ruid
@codeSystemName		0..1	st
@codeSystemVersion		0..1	st
@displayName		0..1	st
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
originalText		0..1	ED
qualifier		0..*	CR
translation		0..*	CD
interpretationCode		0..*	CE	Binding: ObservationInterpretation (required)
methodCode		0..*	CE	Binding: ObservationMethod (example)
targetSiteCode		0..*	CD
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	AuthorParticipation	Base for all types and resources
informant		0..*	Informant
participant		0..*	Participant2
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	EntryReference	Base for all types and resources
encounter		0..1	Encounter
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
referenceRange		0..*	InfrastructureRoot
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		0..1	cs	Binding: ActRelationshipType (2.0.0) (required) Fixed Value: REFV
observationRange		1..1	ObservationRange
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.nullFlavor	required	CDANullFlavor
Observation.typeId.nullFlavor	required	CDANullFlavor
Observation.templateId:social-history-obs.nullFlavor	required	CDANullFlavor
Observation.templateId:gender-identity-obs.nullFlavor	required	CDANullFlavor
Observation.classCode	required	Fixed Value: OBS
Observation.moodCode	required	Fixed Value: EVN
Observation.code	preferred	SocialHistoryType
Observation.code.nullFlavor	required	CDANullFlavor
Observation.text.nullFlavor	required	CDANullFlavor
Observation.text.compression	required	CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm
Observation.text.mediaType	example	MediaType
Observation.text.representation	required	BinaryDataEncoding
Observation.statusCode	required	ActStatus
Observation.statusCode.nullFlavor	required	CDANullFlavor
Observation.effectiveTime.nullFlavor	required	CDANullFlavor
Observation.effectiveTime.operator	required	SetOperator
Observation.priorityCode	example	ActPriority
Observation.languageCode	required	AllLanguages
Observation.value	required	GenderIdentityUSCDICore
Observation.value.nullFlavor	required	CDANullFlavor
Observation.interpretationCode	required	ObservationInterpretation
Observation.methodCode	example	ObservationMethod
Observation.entryRelationship:social-history-entry-sprt-obs.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeId.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeCode	required	Fixed Value: SPRT
Observation.entryRelationship:social-history-entry-sprt-act.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-act.typeId.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-act.typeCode	required	Fixed Value: SPRT
Observation.referenceRange.nullFlavor	required	CDANullFlavor
Observation.referenceRange.typeId.nullFlavor	required	CDANullFlavor
Observation.referenceRange.typeCode	required	Fixed Value: REFV

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation, Observation.entryRelationship:social-history-entry-sprt-obs.observation, Observation.entryRelationship:social-history-entry-sprt-act.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

This structure is derived from SocialHistoryObservation

Summary

Mandatory: 7 elements

Differential View

This structure is derived from SocialHistoryObservation

Name	Flags	Card.	Type	Description & Constraints
Observation		1..1	SocialHistoryObservation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1, templateId, templateId, classCode, moodCode, id, code, text, statusCode, effectiveTime, value, author, entryRelationship, entryRelationship, entryRelationship Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class)
templateId		2..*	II
templateId:gender-identity-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.34.3.45
@extension		1..1	st	Required Pattern: 2023-05-01
@classCode		1..1	cs
@moodCode		1..1	cs
code		1..1	CD
@code		1..1	cs	Required Pattern: 76691-5
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
statusCode		1..1	CS
@code		1..1	cs
effectiveTime		1..1	IVL_TS	The effectiveTime represents the relevant time of the observation. A patient's "gender identity" may change and using effectiveTime/low and effectiveTime/high defines the time during which the patient had identified as specified.
low		1..1	IVXB_TS
high		0..1	IVXB_TS
value		1..1	CD	NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: Gender Identity USCDI core (required)
@nullFlavor		0..1	cs	To represent additional Gender Identities, set nullFlavor="OTH". To represent "choose not to disclose", set nullFlavor="ASKU". Binding: CDANullFlavor (required) Additional Bindings Purpose Documentation Asked but Unknown and Other Preferred Binding Recommended nullFlavors
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.value	required	GenderIdentityUSCDICore
Observation.value.nullFlavor	required	CDANullFlavor

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	SocialHistoryObservation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1, templateId, templateId, classCode, moodCode, id, code, text, statusCode, effectiveTime, value, author, entryRelationship, entryRelationship, entryRelationship Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class)
Slices for templateId		2..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
templateId:gender-identity-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.34.3.45
@extension		1..1	st	Required Pattern: 2023-05-01
@classCode		1..1	cs	Binding: ActClassObservation (2.0.0) (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred)
@code		1..1	cs	Required Pattern: 76691-5
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
statusCode		1..1	CS	Binding: ActStatus (required)
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS	The effectiveTime represents the relevant time of the observation. A patient's "gender identity" may change and using effectiveTime/low and effectiveTime/high defines the time during which the patient had identified as specified.
low		1..1	IVXB_TS
high		0..1	IVXB_TS
value		1..1	CD	NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: Gender Identity USCDI core (required) Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
@nullFlavor		0..1	cs	To represent additional Gender Identities, set nullFlavor="OTH". To represent "choose not to disclose", set nullFlavor="ASKU". Binding: CDANullFlavor (required) Additional Bindings Purpose Documentation Asked but Unknown and Other Preferred Binding Recommended nullFlavors
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
act	C	1..1	EntryReference	Base for all types and resources
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.classCode	required	Fixed Value: OBS
Observation.moodCode	required	Fixed Value: EVN
Observation.code	preferred	SocialHistoryType
Observation.statusCode	required	ActStatus
Observation.value	required	GenderIdentityUSCDICore
Observation.value.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeCode	required	Fixed Value: SPRT
Observation.entryRelationship:social-history-entry-sprt-act.typeCode	required	Fixed Value: SPRT

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation, Observation.entryRelationship:social-history-entry-sprt-obs.observation, Observation.entryRelationship:social-history-entry-sprt-act.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	SocialHistoryObservation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1, templateId, templateId, classCode, moodCode, id, code, text, statusCode, effectiveTime, value, author, entryRelationship, entryRelationship, entryRelationship Base for all types and resources Instances of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
Slices for templateId		2..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:social-history-obs		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.38
@extension		1..1	st	Required Pattern: 2022-06-01
templateId:gender-identity-obs		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.34.3.45
@extension		1..1	st	Required Pattern: 2023-05-01
@classCode		1..1	cs	Binding: ActClassObservation (2.0.0) (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl
id		1..*	II
code	C	1..1	CD	Binding: Social History Type (preferred)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Required Pattern: 76691-5
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
@codeSystemName		0..1	st
@codeSystemVersion		0..1	st
@displayName		0..1	st
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
originalText		0..1	ED
qualifier		0..*	CR
translation		0..*	CD
derivationExpr		0..1	ST
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	Binding: MediaType (example)
@representation		0..1	cs	Binding: Binary Data Encoding Value Set (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL
thumbnail		0..1	ED
statusCode		1..1	CS	Binding: ActStatus (required)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Fixed Value: completed
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
effectiveTime		1..1	IVL_TS	The effectiveTime represents the relevant time of the observation. A patient's "gender identity" may change and using effectiveTime/low and effectiveTime/high defines the time during which the patient had identified as specified.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
@operator		0..1	cs	Binding: SetOperator (required)
low		1..1	IVXB_TS
center		0..1	TS
width		0..1	PQ
high		0..1	IVXB_TS
priorityCode		0..1	CE	Binding: ActPriority (example)
repeatNumber		0..1	IVL_INT
languageCode		0..1	CS	Binding: AllLanguages (required)
value		1..1	CD	NOTE for PQ values: The base CDA R2.0 standard requires @unit to be drawn from UCUM, and best practice is to use case sensitive UCUM units Binding: Gender Identity USCDI core (required) Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Binding Social Determinant of Health Observations
@nullFlavor		0..1	cs	To represent additional Gender Identities, set nullFlavor="OTH". To represent "choose not to disclose", set nullFlavor="ASKU". Binding: CDANullFlavor (required) Additional Bindings Purpose Documentation Asked but Unknown and Other Preferred Binding Recommended nullFlavors
@code		0..1	cs
@codeSystem		0..1	oid, uuid, ruid
@codeSystemName		0..1	st
@codeSystemVersion		0..1	st
@displayName		0..1	st
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
originalText		0..1	ED
qualifier		0..*	CR
translation		0..*	CD
interpretationCode		0..*	CE	Binding: ObservationInterpretation (required)
methodCode		0..*	CE	Binding: ObservationMethod (example)
targetSiteCode		0..*	CD
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	AuthorParticipation	Base for all types and resources
informant		0..*	Informant
participant		0..*	Participant2
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:act, profile:observation
entryRelationship:social-history-entry-sprt-obs		0..*	EntryRelationship	When an Assessment Scale Observation is contained in a Social History Observation instance that is a Social Determinant of Health Social History Observation, that Assessment Scale Observation MAY contain Assessment Scale Supporting Observations that contain LOINC question and answer pairs from SDOH screening instruments.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:social-history-entry-sprt-act		0..*	EntryRelationship	When an Entry Reference is contained in a Social History Template instance that is a Social Determinant of Health Social History, that Entry Reference **MAY** reference an Assessment Scale Observation elsewhere in the document that represent LOINC question and answer pairs from SDOH screening instruments.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	EntryReference	Base for all types and resources
encounter		0..1	Encounter
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
referenceRange		0..*	InfrastructureRoot
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		0..1	cs	Binding: ActRelationshipType (2.0.0) (required) Fixed Value: REFV
observationRange		1..1	ObservationRange
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.nullFlavor	required	CDANullFlavor
Observation.typeId.nullFlavor	required	CDANullFlavor
Observation.templateId:social-history-obs.nullFlavor	required	CDANullFlavor
Observation.templateId:gender-identity-obs.nullFlavor	required	CDANullFlavor
Observation.classCode	required	Fixed Value: OBS
Observation.moodCode	required	Fixed Value: EVN
Observation.code	preferred	SocialHistoryType
Observation.code.nullFlavor	required	CDANullFlavor
Observation.text.nullFlavor	required	CDANullFlavor
Observation.text.compression	required	CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm
Observation.text.mediaType	example	MediaType
Observation.text.representation	required	BinaryDataEncoding
Observation.statusCode	required	ActStatus
Observation.statusCode.nullFlavor	required	CDANullFlavor
Observation.effectiveTime.nullFlavor	required	CDANullFlavor
Observation.effectiveTime.operator	required	SetOperator
Observation.priorityCode	example	ActPriority
Observation.languageCode	required	AllLanguages
Observation.value	required	GenderIdentityUSCDICore
Observation.value.nullFlavor	required	CDANullFlavor
Observation.interpretationCode	required	ObservationInterpretation
Observation.methodCode	example	ObservationMethod
Observation.entryRelationship:social-history-entry-sprt-obs.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeId.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-obs.typeCode	required	Fixed Value: SPRT
Observation.entryRelationship:social-history-entry-sprt-act.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-act.typeId.nullFlavor	required	CDANullFlavor
Observation.entryRelationship:social-history-entry-sprt-act.typeCode	required	Fixed Value: SPRT
Observation.referenceRange.nullFlavor	required	CDANullFlavor
Observation.referenceRange.typeId.nullFlavor	required	CDANullFlavor
Observation.referenceRange.typeCode	required	Fixed Value: REFV

Constraints

Id	Grade	Path(s)	Details	Requirements
4515-8555	error	Observation	If Observation/value is a physical quantity (xsi:type="PQ"): This value SHALL contain exactly one [1..1] @unit, which SHOULD be selected from ValueSet UnitsOfMeasureCaseSensitive urn:oid:2.16.840.1.113883.1.11.12839 DYNAMIC. Note: Base CDA requires that all @unit values SHALL be drawn from UCUM. :
4515-32956	warning	Observation.code	If @codeSystem is not LOINC, then this code **SHALL** contain at least one [1..*] translation, which **SHOULD** be selected from CodeSystem LOINC (urn:oid:2.16.840.1.113883.6.1) (CONF:4515-32956). : codeSystem = '2.16.840.1.113883.6.1' or translation.where(codeSystem = '2.16.840.1.113883.6.1').exists()
should-sh-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation, Observation.entryRelationship:social-history-entry-sprt-obs.observation, Observation.entryRelationship:social-history-entry-sprt-act.act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-value	warning	Observation	SHOULD contain value : value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

This structure is derived from SocialHistoryObservation

Summary

Mandatory: 7 elements

Other representations of profile: CSV, Excel