Consolidated CDA (C-CDA)
4.0.0 - STU4
Consolidated CDA (C-CDA)
4.0.0 - STU4
This page is part of the CCDA: Consolidated CDA Release (v4.0.0: CCDA 4.0) 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
//
Title: Continuity of Care Document (CCD)
Taken from C-CDA 2.1 example in companion guide
Updated for C-CDA R3.0 with a focus on header elements
- required/suggested sections are populated with nullFlavor="NI"
to demonstrate WHICH sections should be included, but they
all contain "No information" as this is an example of the header
********************************************************
Disclaimer: The data in this sample file is not intended to represent real patients, people or clinical events. The file depicts a fictional character's health data.
Any resemblance to a real person is coincidental. To illustrate as many data elements as possible, the clinical scenario may not be plausible. Dates and times also may not coorelate well from a temporal perspective.
This sample is designed to be used in conjunction with the HL7 CDA® R2 IG: C-CDA Templates for Clinical Notes Companion Guide, Release 4.
********************************************************
// *************** US REALM HEADER (V4) ***************
{
"resourceType" : "ClinicalDocument",
"realmCode" : [
{
"code" : "US"
}
],
"typeId" : {
"extension" : "POCD_HD000040",
"root" : "2.16.840.1.113883.1.3"
},
"templateId" : [
// CCD template ID
{
"extension" : "2024-05-01",
"root" : "2.16.840.1.113883.10.20.22.1.1"
},
{
"extension" : "2024-05-01",
"root" : "2.16.840.1.113883.10.20.22.1.2"
}
],
"id" : // Globally unique identifier for the document
{
"extension" : "TT988",
"root" : "2.16.840.1.113883.19.5.99999.1"
},
"code" : {
"code" : "34133-9",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "Summarization of Episode Note"
},
"title" : // Title of this document
{
"xmlText" : "Patient Summary"
},
"effectiveTime" : {
"value" : "2023-05-01T11:45:59-05:00"
},
"confidentialityCode" : {
"code" : "N",
"codeSystem" : "2.16.840.1.113883.5.25",
"codeSystemName" : "Confidentiality",
"displayName" : "normal"
},
"languageCode" : {
"code" : "en-US"
},
"setId" : {
"extension" : "sTT988",
"root" : "2.16.840.1.113883.19.5.99999.19"
},
"versionNumber" : // Version of this document
{
"value" : 1
},
"recordTarget" : [
{
"patientRole" : {
"id" : [
{
"extension" : "444222222",
"root" : "2.16.840.1.113883.4.1"
}
],
"addr" : [
// Example Social Security Number using the actual SSN OID.
// US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1
{
"use" : [
"HP"
],
"item" : [
{
"streetAddressLine" : // HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119
{
"xmlText" : "2222 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"HP"
],
"value" : "tel:+1(555)555-2003"
}
],
"patient" : // HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119
{
"name" : [
{
"use" : [
"L"
],
"item" : [
{
"given" : [
{
"xmlText" : "Eve"
}
]
},
{
"family" : [
// The "SP" is "Spouse" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43
{
"xmlText" : "Betterhalf",
"qualifier" : [
"SP"
]
}
]
}
]
}
],
"administrativeGenderCode" : {
"code" : "F",
"codeSystem" : "2.16.840.1.113883.5.1",
"codeSystemName" : "AdministrativeGender",
"displayName" : "Female"
},
"birthTime" : // Date of birth need only be precise to the day
{
"value" : "1975-05-01"
},
"maritalStatusCode" : {
"code" : "M",
"codeSystem" : "2.16.840.1.113883.5.2",
"codeSystemName" : "MaritalStatusCode",
"displayName" : "Married"
},
"religiousAffiliationCode" : {
"code" : "1013",
"codeSystem" : "2.16.840.1.113883.5.1076",
"codeSystemName" : "HL7 Religious Affiliation",
"displayName" : "Christian (non-Catholic, non-specific)"
},
"raceCode" : // CDC Race and Ethnicity code set contains the five minimum race and ethnicity
categories defined by OMB Standards
{
"code" : "2076-8",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "Native Hawaiian or Other Pacific Islander"
},
"sdtcRaceCode" : [
{
"code" : "2079-2",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "Native Hawaiian"
},
{
"code" : "1074-4",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "Spanish American Indian"
}
],
"ethnicGroupCode" : {
"code" : "2135-2",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "Hispanic or Latino"
},
"birthplace" : // If a patient has a guardian, the guardian's information would be included here.
// <guardian>
<code code="POWATT" displayName="Power of Attorney" codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode"/>
<addr use="HP">
<streetAddressLine>2222 Home Street</streetAddressLine>
<city>Beaverton</city>
<state>MD</state>
<postalCode>21014</postalCode>
<country>US</country>
</addr>
<telecom value="tel:+1(555)555-2016" use="MC"/>
<guardianPerson>
<name>
<given>Boris</given>
<given qualifier="CL">Bo</given>
<family>Betterhalf</family>
</name>
</guardianPerson>
</guardian>
{
"place" : {
"addr" : {
"item" : [
{
"streetAddressLine" : {
"xmlText" : "4444 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
}
},
"languageCommunication" : [
{
"languageCode" : {
"code" : "en"
},
"modeCode" : // "en" is ISO 639-1 alpha-2 code for "English"
{
"code" : "ESP",
"codeSystem" : "2.16.840.1.113883.5.60",
"codeSystemName" : "LanguageAbilityMode",
"displayName" : "Expressed spoken"
},
"proficiencyLevelCode" : {
"code" : "G",
"codeSystem" : "2.16.840.1.113883.5.61",
"codeSystemName" : "LanguageAbilityProficiency",
"displayName" : "Good"
},
"preferenceInd" : // Patient's preferred language
{
"value" : true
}
}
]
},
"providerOrganization" : {
"id" : [
{
"extension" : "219BX",
"root" : "1.1.1.1.1.1.1.1.2"
}
],
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsTogether Physician Group"
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+(555)-555-5000"
}
],
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Health Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
]
}
}
}
],
"author" : [
// The author represents the person who provides the content in the document
{
"templateId" : [
{
"extension" : "2019-10-01",
"root" : "2.16.840.1.113883.10.20.22.5.6"
}
],
"time" : {
"value" : "2023-05-01T11:45:59-05:00"
},
"assignedAuthor" : {
"id" : [
{
"extension" : "5555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine Physician"
},
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Patricia"
}
]
},
{
"given" : [
{
"xmlText" : "Patty",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Colon"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
},
"representedOrganization" : {
"id" : [
{
"extension" : "6555555556",
"root" : "2.16.840.1.113883.4.6"
},
{
"extension" : "999-99-7777",
"root" : "2.16.840.1.113883.4.2"
}
],
"name" : [
{
"item" : [
{
"xmlText" : "Good Health Hospital System"
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1000"
}
],
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "101 Somewhere"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "USA"
}
}
]
}
]
}
}
},
{
"time" : {
"value" : "2023-05-01T11:45:59-05:00"
},
"assignedAuthor" : {
"id" : [
{
"extension" : "8.3",
"root" : "1.2.840.114350.1.1"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "101 Somewhere"
}
},
{
"city" : {
"xmlText" : "Madison"
}
},
{
"state" : {
"xmlText" : "WI"
}
},
{
"postalCode" : {
"xmlText" : "53558"
}
},
{
"country" : {
"xmlText" : "USA"
}
}
]
}
],
"telecom" : [
{
"nullFlavor" : "NA"
}
],
"assignedAuthoringDevice" : {
"manufacturerModelName" : {
"xmlText" : "PMEHR - Version 8.3"
},
"softwareName" : {
"xmlText" : "PMEHR - Version 8.3"
}
},
"representedOrganization" : {
"id" : [
{
"extension" : "6500",
"root" : "1.2.840.114350.1.13.6289.1.7.2.688879"
}
],
"name" : [
{
"item" : [
{
"xmlText" : "Good Health Hospital System"
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1000"
}
],
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "101 Somewhere"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "USA"
}
}
]
}
]
}
}
}
],
"dataEnterer" : // This author represents an author that is a DEVICE. CCDs are often authored entirely by a device
// The dataEnterer transferred the content created by the author into the document
{
"assignedEntity" : {
"id" : [
{
"extension" : "333777777",
"root" : "2.16.840.1.113883.4.6"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1050"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Ellen"
}
]
},
{
"family" : [
{
"xmlText" : "Enter"
}
]
}
]
}
]
}
}
},
"informant" : [
// The informant represents any sources of information for document content.
// A number of examples are included to show how to represent different possible types of informants
who may be involved with providing information used to create this documentation.
{
"assignedEntity" : // A practitioner from another organization.
{
"id" : [
{
"extension" : "888888888",
"root" : "2.16.840.1.113883.4.6"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1003"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Harold"
}
]
},
{
"family" : [
{
"xmlText" : "Hippocrates"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
},
"representedOrganization" : {
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsApart Physician Group"
}
]
}
]
}
}
},
{
"assignedEntity" : // A practitioner from another organization.
{
"id" : [
{
"extension" : "222223333",
"root" : "2.16.840.1.113883.4.6"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1025 Health Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1025"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Ramsey"
}
]
},
{
"family" : [
{
"xmlText" : "Reaction"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
},
"representedOrganization" : {
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsApart Physician Group"
}
]
}
]
}
}
},
{
"assignedEntity" : // A practitioner from another organization.
{
"id" : [
{
"extension" : "333444444",
"root" : "2.16.840.1.113883.4.6"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1017 Health Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1017"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "William"
}
]
},
{
"given" : [
{
"xmlText" : "Bill",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Beaker"
}
]
}
]
}
]
},
"representedOrganization" : {
"name" : [
{
"item" : [
{
"xmlText" : "Good Health Laboratory"
}
]
}
]
}
}
},
{
"assignedEntity" : // A practitioner from another organization.
{
"id" : [
{
"extension" : "333222222",
"root" : "2.16.840.1.113883.4.6"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1016 Health Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1016"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Susan"
}
]
},
{
"family" : [
{
"xmlText" : "Script"
}
]
},
{
"suffix" : [
{
"xmlText" : "Pharm.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
},
"representedOrganization" : {
"name" : [
{
"item" : [
{
"xmlText" : "People's Pharmacy"
}
]
}
]
}
}
},
{
"assignedEntity" : // A practitioner from another organization.
{
"id" : [
{
"extension" : "222334444",
"root" : "2.16.840.1.113883.4.6"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1027 Health Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1027"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Patrick"
}
]
},
{
"family" : [
{
"xmlText" : "Pump"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
},
"representedOrganization" : {
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsApart Physician Group"
}
]
}
]
}
}
},
{
"relatedEntity" : // A related person.
{
"classCode" : "PRS",
"code" : // classCode "PRS" represents a person with personal relationship with the patient
{
"code" : "SPS",
"codeSystem" : "2.16.840.1.113883.1.11.19563",
"codeSystemName" : "Personal Relationship Role Type Value Set",
"displayName" : "SPOUSE"
},
"relatedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Boris"
}
]
},
{
"given" : [
{
"xmlText" : "Bo",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Betterhalf"
}
]
}
]
}
]
}
}
}
],
"custodian" : // The custodian represents the organization charged with maintaining the original source document
{
"assignedCustodian" : {
"representedCustodianOrganization" : {
"id" : [
{
"extension" : "321CX",
"root" : "2.16.840.1.113883.4.6"
}
],
"name" : {
"item" : [
{
"xmlText" : "Good Health Hospital HIE"
}
]
},
"telecom" : {
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1009"
},
"addr" : {
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1009 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
}
}
},
"informationRecipient" : [
// The informationRecipient represents the intended recipient of the document
{
"intendedRecipient" : {
"informationRecipient" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Sara"
}
]
},
{
"family" : [
{
"xmlText" : "Specialize"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
},
"receivedOrganization" : {
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsApart Physician Group"
}
]
}
]
}
}
}
],
"legalAuthenticator" : // The legalAuthenticator represents the individual who is responsible for the document
{
"time" : {
"value" : "2015-06-25T15:00:00-05:00"
},
"signatureCode" : {
"code" : "S"
},
"assignedEntity" : {
"id" : [
{
"extension" : "5555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine Physician"
},
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Wilma"
}
]
},
{
"family" : [
{
"xmlText" : "Colon"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
},
"authenticator" : [
// The authenticator represents the individual attesting to the accuracy of information in the document
{
"time" : {
"value" : "2015-06-25T15:00:00-05:00"
},
"signatureCode" : {
"code" : "S"
},
"assignedEntity" : {
"id" : [
{
"extension" : "5555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine Physician"
},
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Wilma"
}
]
},
{
"family" : [
{
"xmlText" : "Colon"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
}
],
"participant" : [
// The participant represents supporting entities
{
"typeCode" : "IND",
"associatedEntity" : // typeCode "IND" represents an individual
{
"classCode" : "NOK",
"addr" : [
// classCode "NOK" represents the patient's next of kin
{
"use" : [
"HP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "2222 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"MC"
],
"value" : "tel:+1(555)555-2016"
}
],
"associatedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Boris"
}
]
},
{
"given" : [
{
"xmlText" : "Bo",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Betterhalf"
}
]
}
]
}
]
}
}
},
{
"typeCode" : "IND",
"associatedEntity" : {
"classCode" : "ECON",
"addr" : [
// classCode "ECON" represents an emergency contact
{
"use" : [
"HP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "2222 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"MC"
],
"value" : "tel:+1(555)555-2016"
}
],
"associatedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Boris"
}
]
},
{
"given" : [
{
"xmlText" : "Bo",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Betterhalf"
}
]
}
]
}
]
}
}
},
{
"typeCode" : "IND",
"templateId" : [
{
"extension" : "2023-05-01",
"root" : "2.16.840.1.113883.10.20.22.5.8"
}
],
"associatedEntity" : // This associatedEntity SHALL contain exactly one [1..1] @classCode="PRS" Person (CodeSystem: HL7RoleCode urn:oid:2.16.840.1.113883.5.111) (CONF:4537-33076).
{
"classCode" : "PRS",
"code" : // This associatedEntity/code represents the person's relationship to the patient (Personal And Legal Relationship Role Type Value Set)
{
"code" : "MTH",
"codeSystem" : "2.16.840.1.113883.5.111"
},
"addr" : [
// OPTIONAL ADDRESS
{
"use" : [
"HP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "2222 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "97867"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
// OPTIONAL TELECOM
{
"use" : [
"MC"
],
"value" : "tel:+1(555)555-2008"
}
],
"associatedPerson" : {
"name" : [
// SHALL REQUIRED US Realm Person Name Format
{
"item" : [
{
"given" : [
{
"xmlText" : "Boris"
}
]
},
{
"given" : [
{
"xmlText" : "Bo",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Betterhalf"
}
]
}
]
}
]
}
}
}
],
"documentationOf" : [
// Entities playing multiple roles are recorded in multiple participants
// NEW TEMPLATED PARTICIPANT FOR USCDI RELATED PERSON RELATIONSHIP AND NAME
The participant represents a related person
{
"serviceEvent" : {
"classCode" : "PCPR",
"effectiveTime" : // The effectiveTime reflects the provision of care summarized in the document.
In this scenario, the provision of care summarized is the lifetime for the patient
// Note, that by limitting the scope of the document to only the most recent encounter
The providers listed as performing care services would only include providers involved
in that most recent encounter.
// Best practive for including documentation of a patient's care team members is to
use the Care Teams Section.
// The high value represents when the summarized provision of care being ended.
In this scenario, when chart summary was created
{
"low" : {
"value" : "1975-05-01"
},
"high" : // The low value represents when the summarized provision of care began.
In this scenario, the patient's date of birth
{
"value" : "2016-04-12"
}
},
"performer" : [
{
"typeCode" : "PRF",
"functionCode" : {
"code" : "ATTPHYS",
"codeSystem" : "2.16.840.1.113883.5.88",
"codeSystemName" : "ParticipationFunction",
"displayName" : "attending physician",
"originalText" : {
"xmlText" : "Attending Physician"
}
},
"assignedEntity" : {
"classCode" : "ASSIGNED",
"id" : [
{
"extension" : "811111111",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine Physician"
},
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "8333 Clairemont Mesa Blvd."
}
},
{
"city" : {
"xmlText" : "Bel Air"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1-410-555-5544"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Wilma"
}
]
},
{
"family" : [
{
"xmlText" : "Colon"
}
]
}
]
}
]
},
"representedOrganization" : {
"classCode" : "ORG",
"name" : [
{
"item" : [
{
"xmlText" : "Good Health Hospital"
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1-410-555-5544"
}
],
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "8333 Clairemont Mesa Blvd."
}
},
{
"city" : {
"xmlText" : "Bel Air"
}
},
{
"state" : {
"xmlText" : "MD"
}
},
{
"postalCode" : {
"xmlText" : "21014"
}
}
]
}
]
}
}
}
]
}
}
],
"component" : {
"structuredBody" : // All sections are set to nullFlavor / text = No information,
as this is a header example, not a complete body example
{
"component" : [
// ******************** ENCOUNTERS ************************
{
"section" : {
"nullFlavor" : "NI",
"templateId" : [
// *** Encounters section (entries required) (V3) ***
{
"extension" : "2015-08-01",
"root" : "2.16.840.1.113883.10.20.22.2.22.1"
}
],
"code" : {
"code" : "46240-8",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "History of encounters"
},
"title" : {
"xmlText" : "ENCOUNTERS"
},
"text" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"
}
},
{
"section" : {
"nullFlavor" : "NI",
"templateId" : [
// ** Social History Section (V3) **
{
"extension" : "2015-08-01",
"root" : "2.16.840.1.113883.10.20.22.2.17"
}
],
"code" : {
"code" : "29762-2",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "Social History"
},
"title" : {
"xmlText" : "SOCIAL HISTORY"
},
"text" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"
}
},
{
"section" : {
"nullFlavor" : "NI",
"templateId" : [
// *** Allergies and Intolerances Section (entries required) (V3) ***
{
"extension" : "2015-08-01",
"root" : "2.16.840.1.113883.10.20.22.2.6.1"
}
],
"code" : {
"code" : "48765-2",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC"
},
"title" : {
"xmlText" : "ALLERGIES AND ADVERSE REACTIONS"
},
"text" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"
}
},
{
"section" : {
"nullFlavor" : "NI",
"templateId" : [
// *** Problem Section (entries required) (V3) ***
{
"extension" : "2015-08-01",
"root" : "2.16.840.1.113883.10.20.22.2.5.1"
}
],
"code" : {
"code" : "11450-4",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "PROBLEM LIST"
},
"title" : {
"xmlText" : "PROBLEMS"
},
"text" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"
}
},
{
"section" : {
"nullFlavor" : "NI",
"templateId" : [
// *** Medications Section (entries required) (V2) ***
{
"extension" : "2014-06-09",
"root" : "2.16.840.1.113883.10.20.22.2.1.1"
}
],
"code" : {
"code" : "10160-0",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "HISTORY OF MEDICATION USE"
},
"title" : {
"xmlText" : "MEDICATIONS"
},
"text" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"
}
},
{
"section" : {
"nullFlavor" : "NI",
"templateId" : [
// Results Section (entries required) (V3)
{
"extension" : "2015-08-01",
"root" : "2.16.840.1.113883.10.20.22.2.3.1"
}
],
"code" : {
"code" : "30954-2",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "RESULTS"
},
"title" : {
"xmlText" : "RESULTS"
},
"text" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"
}
},
{
"section" : {
"nullFlavor" : "NI",
"templateId" : [
// ** Vital Signs Section (entries required) (V3) **
{
"extension" : "2015-08-01",
"root" : "2.16.840.1.113883.10.20.22.2.4.1"
}
],
"code" : {
"code" : "8716-3",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "VITAL SIGNS"
},
"title" : {
"xmlText" : "VITAL SIGNS"
},
"text" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>"
}
}
]
}
}
}
IG © 2019+ Health Level Seven. Package hl7.cda.us.ccda#4.0.0 based on FHIR 5.0.0. Generated 2025-06-20
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