Validation Results for CCDA

Generated Fri Jun 20 08:55:22 PST 2025, FHIR version 5.0.0 for hl7.cda.us.ccda#4.0.0 (canonical = http://hl7.org/cda/us/ccda (history)). See Full QA Report & IP

Quality Checks
Publisher Version:	IG Publisher Version: v(unknown), which is out of date. The current version is v2.0.7 Download Latest
Publication Code:	n/a . PackageId = hl7.cda.us.ccda, Canonical = http://hl7.org/cda/us/ccda
Realm Check for n/a:	n/a
Language Info:	This IG has no language information
Publication Request:	package-id hl7.cda.us.ccda version 4.0.0 path http://hl7.org/cda/us/ccda/4.0.0 Pub-Mode milestone status trial-use Release-Label STU4 Sequence (Group) CCDA 4.0 (current: 'CCDA 3.0', others = 'CCDA 2.1','CCDA 4.0') desc Published version of C-CDA 4.0. This release enables exchange of USCDI v5. RelatedIgs (None Found) No Messages found - all good
Supressed Messages:	122 Suppressed Issues
Dependency Checks:	Package Version FHIR Canonical Web Base Comment hl7.cda.us.ccda 4.0.0 R5 http://hl7.org/cda/us/ccda hl7.terminology.r5 6.4.0 M R5 http://terminology.hl7.org http://terminology.hl7.org/6.4.0 hl7.fhir.uv.extensions.r5 5.2.0 M R5 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.2.0 hl7.fhir.uv.extensions.r5 5.2.0 M R5 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.2.0 see above hl7.cda.uv.core 2.0.1-sd M R5 http://hl7.org/cda/stds/core http://hl7.org/cda/stds/core/2.0.1-sd hl7.fhir.uv.extensions.r5 5.1.0 O R5 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.1.0 Latest Release is 5.2.0 hl7.terminology 5.2.0 O R4 http://terminology.hl7.org http://terminology.hl7.org/5.2.0 FHIR Version Mismatch. Latest Release is 6.4.0 hl7.fhir.uv.extensions.r4 1.0.0 O R4 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/1.0.0 FHIR Version Mismatch. Latest Release is 5.2.0 us.nlm.vsac 0.23.0 M R4 http://fhir.org/packages/us.nlm.vsac http://fhir.org/packages/us.nlm.vsac FHIR Version Mismatch us.cdc.phinvads 0.12.0 M R4 http://fhir.org/packages/us.cdc.phinvads http://fhir.org/packages/us.cdc.phinvads FHIR Version Mismatch hl7.fhir.us.core 8.0.0 M R4 http://hl7.org/fhir/us/core http://hl7.org/fhir/us/core/STU8 FHIR Version Mismatch hl7.terminology.r4 6.4.0 M R4 http://terminology.hl7.org http://terminology.hl7.org/6.4.0 FHIR Version Mismatch hl7.fhir.uv.extensions.r4 5.2.0 M R4 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.2.0 FHIR Version Mismatch hl7.fhir.uv.smart-app-launch 2.2.0 M R4 http://hl7.org/fhir/smart-app-launch http://hl7.org/fhir/smart-app-launch/STU2.2 FHIR Version Mismatch hl7.fhir.uv.extensions 5.1.0-snapshot1 O R5 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.1.0-snapshot1 Latest Release is 5.2.0 hl7.terminology.r5 5.3.0 O R5 http://terminology.hl7.org http://terminology.hl7.org/5.3.0 Latest Release is 6.4.0 hl7.terminology 5.5.0 O R4 http://terminology.hl7.org http://terminology.hl7.org/5.5.0 FHIR Version Mismatch. Latest Release is 6.4.0 hl7.fhir.uv.extensions.r4 1.0.0 O R4 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/1.0.0 see above. Latest Release is 5.2.0 us.nlm.vsac 0.23.0 M R4 http://fhir.org/packages/us.nlm.vsac http://fhir.org/packages/us.nlm.vsac see above hl7.fhir.uv.sdc 3.0.0 M R4 http://hl7.org/fhir/uv/sdc http://hl7.org/fhir/uv/sdc/STU3 FHIR Version Mismatch hl7.fhir.r4.examples 4.0.1 O R4 http://hl7.org/fhir http://hl7.org/fhir/R4 FHIR Version Mismatch. Latest Release is 5.0.0 us.cdc.phinvads 0.12.0 M R4 http://fhir.org/packages/us.cdc.phinvads http://fhir.org/packages/us.cdc.phinvads see above hl7.fhir.uv.extensions.r4 5.2.0 M R4 http://hl7.org/fhir/extensions http://hl7.org/fhir/extensions/5.2.0 see above Templates: hl7.cda.template#current -> hl7.base.template#current -> fhir.base.template#current. Tools: 0.5.0
Related IGs:	n/a
Dependent IGs:	no references
Global Profiles:	(none declared)
Terminology Server(s):	http://tx.fhir.org/r5, https://tx.fhir.org/r5 (details)
HTA Analysis:	no Non-HL7 references found
R5 Dependencies:	(none)
Draft Dependencies:	hl7.cda.uv.core#2.0.1-sd: CDANullFlavor (5212 uses), CDAActMood (144 uses), CDACompressionAlgorithm (142 uses), BinaryDataEncoding (142 uses), CDAActClassObservation (91 uses), CDASetOperator (75 uses), CDAObservationInterpretation (89 uses), CDAActRelationshipType (109 uses), CDAParticipationType (174 uses), CDAContextControl (129 uses), CDARoleClassRoot (17 uses), CDAEntityCode (23 uses), CDARoleCode (54 uses), CDAActClass (77 uses), CDAPostalAddressUse (14 uses), CDAInformationRecipientRole (13 uses), CDASignatureCode (26 uses), CDARoleClassAssociative (10 uses), CDAActMoodIntent (13 uses), CDAActSubstanceAdministrationCode (5 uses), CDAEntityNameUse (3 uses), CDARoleClassMutualRelationship (1 uses) hl7.fhir.r5.core#5.0.0: GuideParameterCode (15 uses), FHIRDocumentTypeCodes (7 uses), MedicationDispenseStatusCodes (2 uses), DiagnosticServiceSectionCodes (2 uses) hl7.fhir.uv.extensions.r5#5.2.0: DefaultType (141 uses) hl7.fhir.uv.tools.r5#0.5.0: LogicalTarget (227 uses), LogicalContainer (227 uses) hl7.terminology#5.5.0: ManufacturerModelNameExample (14 uses), SoftwareNameExample (14 uses)
Modifier Extensions:	(none)
Previous Version Comparison:	Comparison with version 3.0.0
IPA Comparison:	n/a
IPS Comparison:	n/a
Validation Flags:	On: autoLoad; Off: hintAboutNonMustSupport, anyExtensionsAllowed, checkAggregation, showReferenceMessages, noExperimentalContent, displayWarnings
Summary:	errors = 21, warn = 1, info = 0, broken links = 0, pinned = n/a. Show Message Ids

n/a Show Validation Information

input/examples/basic-industry-observation-example.xml Show Validation Information (2)

input/examples/basic-occupation-observation-example.xml Show Validation Information (2)

input/examples/care-team-member-schedule-observation-example.xml Show Validation Information (1)

input/examples/care-team-organizer-example.xml Show Validation Information (1)

input/examples/comment-activity-example.xml Show Validation Information (1)

input/examples/medication-free-text-sig-example.xml Show Validation Information (1)

input/examples/us-realm-address-example.xml Show Validation Information (0)

input/examples/us-realm-date-and-time-example.xml Show Validation Information (0)

input/examples/us-realm-date-and-time-ivl-example.xml Show Validation Information (0)

input/hl7.cda.us.ccda.xml Show Validation Information (1)

Suppressed Messages (Warnings, hints, broken links)

01 CDA Schematron generation parameters that are noted as unknown by the IG publisher

• Unknown Parameters: [value-set-limit=1000, parent-template-id=2.16.840.1.113883.10.20.22] (1 uses)

02 Deliberate decision around fixed/pattern which results in warnings

• http://hl7.org/fhir/StructureDefinition/ElementDefinition#eld-20 (86 uses)
• http://hl7.org/fhir/StructureDefinition/ElementDefinition#eld-24 (6297 uses)

03 IG Publisher issue - Grahame to fix: https://chat.fhir.org/#narrow/stream/198221-cda.2Fpublish/topic/Invariant.20expression.20error

• http://hl7.org/fhir/StructureDefinition/ElementDefinition#eld-21 (15 uses)

04 Inherent collections where collection is limited to a single value so the warning is fine

• %The left side is inherently a collection, and so the expression 'item.country.xmlText% (8 uses)
• %The left side is inherently a collection, and so the expression 'value.code% (1 uses)
• %The left side is inherently a collection, and so the expression 'value.unit% (8 uses)

05 Deprecated value set that is used by CDA and inherited by C-CDA

• Reference to deprecated ValueSet http://hl7.org/fhir/ValueSet/jurisdiction|5.0.0 (228 uses)

06 xsi:type information - firing on templates with constrained type, but still required in CDA

• xsi:type is unnecessary at this point (68 uses)

08 Each slice is optional, so the maximum still applies

• The slice definition for Observation.value has a maximum of 1 but the slices add up to a maximum of 2. Check that this is what is intended (3 uses)

11 These are template IDs that are embedded in other templates and are not an individual template. The validator can not find these templates and warns us about them.

• The CDA Template 2.16.840.1.113883.10.20.1.58 is not known (4 uses)
• The CDA Template 2.16.840.1.113883.10.20.21.3.1 is not known (2 uses)
• The CDA Template 2.16.840.1.113883.10.20.22.4.87 is not known (3 uses)
• The CDA Template 2.16.840.1.113883.10.20.22.4.88 is not known (1 uses)
• The CDA Template 2.16.840.1.113883.10.20.22.4.89 is not known (3 uses)
• The CDA Template 2.16.840.1.113883.10.20.22.4.90 is not known (1 uses)

12 Our examples may not enforce the text references

• Constraint failed: should-sdtctext-ref-value: 'SHOULD contain text/reference/@value'% (9 uses)
• Constraint failed: should-text-ref-value: 'SHOULD contain text/reference/@value'% (220 uses)

13 Our examples will not always contain an author

• Constraint failed: should-author: 'SHOULD contain author'% (39 uses)

14 Multiple template IDs are required so the validator throws a warning on the slices

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectivesSection% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/AllergiesAndIntolerancesSection% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/DisabilityStatusObservation% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/MentalStatusSection% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/NotesSection% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ProblemObservation% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ProblemSection% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ResultsSection% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/SensoryStatus% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/SocialHistoryObservation% (3 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/SubstanceOrDeviceAllergyIntoleranceObservation% (3 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/USRealmHeader% (13 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/VitalSignsSection% (2 uses)

15 In the example the OID matches two different code systems - nothing we can do about this in the guide itself.

• The OID '2.16.840.1.113883.6.101' matches multiple resources (http://nucc.org/provider-taxonomy|4.0.0(active), http://terminology.hl7.org/CodeSystem/v3-nuccProviderCodes|3.0.1(active)); http://nucc.org/provider-taxonomy was chosen as the most appropriate (75 uses)

16 Assigned Author slices that are detected multiple times

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ContinuityofCareDocumentCCD% (1 uses)
• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/DischargeSummary% (1 uses)

17 An extra element not specified by the template

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/GoalObservation% (3 uses)

18 Note Activity is not a defined slice in the template but can be included

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/ProceduresSection% (3 uses)

19 Goal Observation is not a defined slice in the template but can be included

• This element does not match any known slice defined in the profile http://hl7.org/cda/us/ccda/StructureDefinition/OutcomeObservation% (1 uses)

20 Template requires a retired code

• The code '421927004' is valid but is not active (1 uses)
• The code 'NP' is valid but is retired (9 uses)

21 Unknown code systems used in examples

• The OID '2.16.840.1.113883.1.11.19563' is not known, so the code can't be validated (7 uses)
• The OID '2.16.840.1.113883.12.112' is not known, so the code can't be validated (1 uses)
• The OID '2.16.840.1.113883.6.255.1336' is not known, so the code can't be validated (1 uses)

22 Different example code systems that have no codes so can not be validated

• A definition for CodeSystem 'http://terminology.hl7.org/CodeSystem/PHOccupationalDataForHealthODH' could not be found, so the code cannot be validated% (2 uses)
• A definition for CodeSystem 'https://www.nubc.org/CodeSystem/PatDischargeStatus' could not be found, so the code cannot be validated% (2 uses)
• A definition for CodeSystem 'urn:oid:2.16.840.1.113883.12.112' could not be found, so the code cannot be validated (1 uses)
• A definition for CodeSystem 'urn:oid:2.16.840.1.113883.6.255.1336' could not be found, so the code cannot be validated (1 uses)
• None of the codings provided are in the value set 'Industry NAICS Detail (ODH)' (http://phinvads.cdc.gov/fhir/ValueSet/2.16.840.1.114222.4.11.7900|1), and a coding from this value set is required% (1 uses)
• None of the codings provided are in the value set 'Occupation ONETSOC Detail (ODH)' (http://phinvads.cdc.gov/fhir/ValueSet/2.16.840.1.114222.4.11.7901|1), and a coding from this value set is required% (1 uses)

23 SHOULD constraints that we are intentionally not including

• %1098-7513% (3 uses)
• %4537-10007% (1 uses)
• %should-addr% (3 uses)
• %should-assignedPerson% (1 uses)
• %should-care-team-org% (1 uses)
• %should-effectiveTime% (2 uses)
• %should-entry% (1 uses)
• %should-health-status-obs% (1 uses)
• %should-id-npi% (2 uses)
• %should-legalAuthenticator% (1 uses)
• %should-maritalStatusCode% (1 uses)
• %should-npi% (7 uses)
• %should-nutritional-status-obs% (2 uses)
• %should-otext-ref-value% (6 uses)
• %should-performer% (1 uses)
• %should-post-procedure-dx% (1 uses)
• %should-preop-dx% (1 uses)
• %should-procedure-act-procedure% (1 uses)
• %should-proficiencyLevelCode% (1 uses)
• %should-relatedParticipant% (7 uses)
• %should-responsibleParty% (6 uses)
• %should-routeCode% (1 uses)
• %should-section-advance-directives% (1 uses)
• %should-section-discharge-dx% (1 uses)
• %should-section-functional-status% (1 uses)
• %should-section-hpi% (1 uses)
• %should-section-mental-status% (1 uses)
• %should-section-nutrition% (1 uses)
• %should-section-plan-of-treatment% (1 uses)
• %should-section-procedures% (2 uses)
• %should-smoking-status% (3 uses)
• %should-targetSiteCode% (1 uses)
• %should-telecom% (3 uses)
• %should-time% (1 uses)
• %should-translation% (1 uses)
• %should-us-code% (2 uses)
• %should-use% (3 uses)
• %should-value% (9 uses)
• %ts-should-minute% (7 uses)

24 ERROR - our examples use an element that makes sense but does not match the actual datatype name

• The QName 'urn:hl7-org:v3::addr' does not match the expected QName 'urn:hl7-org:v3::AD' (1 uses)
• The QName 'urn:hl7-org:v3::effectiveTime' does not match the expected QName 'urn:hl7-org:v3::IVL_TS' (1 uses)
• The QName 'urn:hl7-org:v3::time' does not match the expected QName 'urn:hl7-org:v3::TS' (1 uses)

25 ERROR the full document examples are there and do get validated but the validator is unable to resolve reference

• Unable to resolve resource with reference 'Binary/care-plan-complete-example' (1 uses)
• Unable to resolve resource with reference 'Binary/ccd-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/consultation-note-complete-example' (1 uses)
• Unable to resolve resource with reference 'Binary/discharge-summary-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/history-and-physical-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/operative-note-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/patient-generated-document-informationrecipient' (1 uses)
• Unable to resolve resource with reference 'Binary/procedure-note-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/progress-note-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/referral-note-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/transfer-summary-header-example' (1 uses)
• Unable to resolve resource with reference 'Binary/us-realm-header-example' (1 uses)

27 Duplicate anchor ids produced by publisher - see if this can be fixed in a future release of the template

• The html source has duplicate anchor Ids:% (227 uses)

28 Experimental value sets in THO

• The definition for the element 'Organizer.sdtcCategory' binds to the value set 'http://hl7.org/fhir/ValueSet/diagnostic-service-sections' which is experimental, but this structure is not labeled as experimental (2 uses)

29 Deprecated templates that are still referenced in section templatesMore actions

• The profile http://hl7.org/cda/us/ccda/StructureDefinition/SmokingStatusMeaningfulUse|4.0.0 is retired (1 uses)
• The profile http://hl7.org/cda/us/ccda/StructureDefinition/TobaccoUse|4.0.0 is retired (1 uses)

30 This is a guide that uses FHIR v5 that references guides that are FHIR v4

• The ImplementationGuide is based on FHIR version 5.0.0 but package hl7.fhir.us.core#8.0.0 is based on FHIR version 4.0.1. In general, this version mismatch should be avoided - some tools will try to make this work with variable degrees of success, but others will not even try (1 uses)
• The ImplementationGuide is based on FHIR version 5.0.0 but package us.cdc.phinvads#0.12.0 is based on FHIR version 4.0.1. In general, this version mismatch should be avoided - some tools will try to make this work with variable degrees of success, but others will not even try (1 uses)
• The ImplementationGuide is based on FHIR version 5.0.0 but package us.nlm.vsac#0.23.0 is based on FHIR version 4.0.1. In general, this version mismatch should be avoided - some tools will try to make this work with variable degrees of success, but others will not even try (1 uses)
• This IG is for FHIR version 5.0.0, while the package 'hl7.fhir.uv.smart-app-launch#2.2.0' is for FHIR version 4.0.1 (1 uses)
• This IG is for FHIR version 5.0.0, while the package 'hl7.terminology#5.2.0' is for FHIR version 4.0.1 (1 uses)
• This IG is version 5.0.0, while the IG 'hl7.fhir.us.core' is from version 4.0.1 (1 uses)
• This IG is version 5.0.0, while the IG 'us.cdc.phinvads' is from version 4.0.1 (1 uses)
• This IG is version 5.0.0, while the IG 'us.nlm.vsac' is from version 4.0.1 (1 uses)

31 Multiple version matches for values sets - should choose specific version

• There are multiple different potential matches for the url% (1884 uses)

v4-01 - referencing an example external document that doesn't exist

• No definition could be found for URL value 'AdvanceDirective.b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3.pdf' (2 uses)

v4-02 - We know that Languages is a proper subset of all-languages

• Unable to check if http://terminology.hl7.org/ValueSet/Languages is a proper subset of http://hl7.org/fhir/ValueSet/all-languages - base value set is too large to check (1 uses)

v4-03 - Either we have an error for a reference that doesn't resolve or we have an error that the reference does not exist.

• Act.text.reference: minimum required = 1, but only found 0% (1 uses)
• Observation.text.reference: minimum required = 1, but only found 0% (1 uses)
• Organizer.code.originalText.reference: minimum required = 1, but only found 0% (1 uses)
• SubstanceAdministration.text.reference: minimum required = 1, but only found 0% (1 uses)

Errors sorted by type

Reference_REF_CantResolve

Terminology_TX_NoValid_1_CC

Validation_VAL_Profile_Minimum