Consolidated CDA (C-CDA)
3.0.0 - STU3
Consolidated CDA (C-CDA)
3.0.0 - STU3
This page is part of the CCDA: Consolidated CDA Release (v3.0.0: CCDA 3.0) generated with FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
This content is an example of the US Realm Header for Patient Generated Document Logical Model and is not a FHIR Resource
<ClinicalDocument xmlns="urn:hl7-org:v3">
<realmCode code="US" />
<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3" />
<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2024-05-01" />
<templateId root="2.16.840.1.113883.10.20.29.1" extension="2024-05-01" />
<id root="2c1e0e12-b0ae-4456-a526-c11d5e69e77c" />
<code code="68831-7" displayName="Discharge summary note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>Patient Discharge Summary</title>
<effectiveTime value="201308151030-0800" />
<confidentialityCode code="N" displayName="normal" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality" />
<languageCode code="en-US" />
<recordTarget>
<patientRole>
<id extension="444222222" root="2.16.840.1.113883.4.1"/>
<!-- Example Social Security Number using the actual SSN OID. -->
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>2222 Home Street</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
</addr>
<telecom value="tel:+1(555)555-2003" use="HP"/>
<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
<patient>
<name use="L">
<given>Adam</given>
<family>Everyman</family>
</name>
<administrativeGenderCode code="M" displayName="Male" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender"/>
<birthTime value="19750501"/>
<religiousAffiliationCode code="1013" displayName="Christian (non-Catholic, non-specific)" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="HL7 Religious Affiliation"/>
<raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race & Ethnicity - CDC"/>
<ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race & Ethnicity - CDC"/>
<birthplace>
<place>
<addr use="H">
<streetAddressLine>4444 Home Street</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
</addr>
</place>
</birthplace>
<languageCommunication>
<languageCode code="en"/>
<!-- "en" is ISO 639-1 alpha-2 code for "English" -->
<modeCode code="ESP" displayName="Expressed spoken" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode"/>
<proficiencyLevelCode code="G" displayName="Good" codeSystem="2.16.840.1.113883.5.61" codeSystemName="LanguageAbilityProficiency"/>
<!-- Patient's preferred language -->
<preferenceInd value="true"/>
</languageCommunication>
</patient>
</patientRole>
</recordTarget>
<author>
<time value="201308151030-0800"/>
<assignedAuthor>
<id extension="5555555555" root="2.16.840.1.113883.4.6"/>
<code code="207QA0505X" displayName="Adult Medicine Physician" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>
<addr use="WP">
<streetAddressLine>1004 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1(555)555-1004"/>
<assignedPerson>
<name>
<given>Patricia</given>
<given qualifier="CL">Patty</given>
<family>Primary</family>
<suffix qualifier="AC">M.D.</suffix>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id extension="321CX" root="2.16.840.1.113883.4.6"/>
<name>Good Health HIE</name>
<telecom use="WP" value="tel:+1(555)555-1009"/>
<addr use="WP">
<streetAddressLine>1009 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<!-- The document is intended for multiple recipients, Adam himself and his PCP physician. -->
<informationRecipient>
<intendedRecipient>
<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying
a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
<id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234" />
<informationRecipient>
<name>
<given>Adam</given>
<family>Everyman</family>
</name>
</informationRecipient>
<receivedOrganization>
<!-- id using HL7 example OID. -->
<id extension="999.3" root="2.16.840.1.113883.19" />
<name>MyPersonalHealthRecord.Com</name>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<informationRecipient>
<intendedRecipient>
<!-- Unique/Trusted id using HL7 example OID. -->
<id extension="999.4" root="2.16.840.1.113883.19" />
<!-- The physician's NPI number -->
<id extension="1122334455" root="2.16.840.1.113883.4.6" />
<!-- The physician's Direct Address -->
<!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying
a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
<id extension="DrP@direct.sampleHISP2.com" root="2.16.123.123.12345.4321" />
<telecom use="WP" value="tel:(781)555-1212" />
<telecom use="WP" value="mailto:DrP@direct.sampleHISP2.com" />
<informationRecipient>
<name>
<prefix>Dr.</prefix>
<given>Patricia</given>
<family>Primary</family>
</name>
</informationRecipient>
<receivedOrganization>
<!-- Unique/Trusted id using HL7 example OID. -->
<id extension="999.2" root="2.16.840.1.113883.19" />
<!-- NPI for the organization -->
<id extension="1234567890" root="2.16.840.1.113883.4.6" />
<name>Good Health Internal Medicine</name>
<telecom use="WP" value="tel:(781)555-1212" />
<addr>
<streetAddressLine>100 Health Drive</streetAddressLine>
<city>Boston</city>
<state>MA</state>
<postalCode>02368</postalCode>
<country>USA</country>
</addr>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<legalAuthenticator>
<time value="20130801223615-0800"/>
<signatureCode code="S"/>
<assignedEntity>
<id extension="555555555" root="2.16.840.1.113883.4.6"/>
<code code="207QA0505X" displayName="Adult Medicine Physician" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>
<addr>
<streetAddressLine>1004 Healthcare Drive </streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1(555)-1004"/>
<assignedPerson>
<name>
<given>Patricia</given>
<given qualifier="CL">Patty</given>
<family>Primary</family>
<suffix qualifier="AC">M.D.</suffix>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<component>
<structuredBody>
<component>
<section>
<!-- Individual Body Section Contents -->
</section>
</component>
</structuredBody>
</component>
</ClinicalDocument>
IG © 2019+ Health Level Seven. Package hl7.cda.us.ccda#3.0.0 based on FHIR 5.0.0. Generated 2024-05-18
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