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. For a full list of available versions, see the Directory of published versions
This content is an example of the Care Plan Logical Model and is not a FHIR Resource
<?xml version="1.0" encoding="utf-8"?>
<?xml-stylesheet type="text/xsl" href="CDA.xsl"?>
<!--
Title: Care Plan
Based on: C-CDA_R2_Care_Plan.xml
Created by: Lantana Consulting Group, LLC
Updated for C-CDA R3.0 with a focus on header elements
********************************************************
Disclaimer: This sample file contains representative data elements to represent a Care Plan.
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.
The data in this sample file is not intended to represent real patients, people or clinical events.
This sample is designed to be used in conjunction with the C-CDA Clinical Notes Implementation Guide.
********************************************************
-->
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:sdtc="urn:hl7-org:sdtc">
<!-- ** CDA Header ** -->
<realmCode code="US"/>
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<!-- US Realm Header -->
<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2024-05-01"/>
<!-- Care Plan -->
<templateId root="2.16.840.1.113883.10.20.22.1.15" extension="2024-05-01"/>
<id root="db734647-fc99-424c-a864-7e3cda82e703"/>
<code code="81957-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Overall Plan of Care/Advance Care Directives panel"/>
<title>Good Health Hospital Care Plan</title>
<effectiveTime value="201308201120-0800"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
<languageCode code="en-US"/>
<!-- This document is the second document in the set (see setId for id for the set -->
<setId root="004bb033-b948-4f4c-b5bf-a8dbd7d8dd40"/>
<!-- See relatedDocument for the previous version in the set -->
<versionNumber value="2"/>
<!-- Patient (recordTarget) -->
<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>
<!-- The first name element represents what the patient is known as -->
<name use="L">
<given>Eve</given>
<!-- The "SP" is "Spouse" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
<family qualifier="SP">Betterhalf</family>
</name>
<!-- The second name element represents another name associated with the patient -->
<name use="SRCH">
<given>Eve</given>
<!-- The "BR" is "Birth" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
<family qualifier="BR">Everywoman</family>
</name>
<administrativeGenderCode code="F" displayName="Female" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender"/>
<!-- Date of birth need only be precise to the day -->
<birthTime value="19750501"/>
<maritalStatusCode code="M" displayName="Married" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode"/>
<religiousAffiliationCode code="1013" displayName="Christian (non-Catholic, non-specific)" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="HL7 Religious Affiliation"/>
<!-- CDC Race and Ethnicity code set contains the five minimum race and ethnicity categories defined by OMB Standards -->
<raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race & Ethnicity - CDC"/>
<!-- The raceCode extension is only used if raceCode is valued -->
<sdtc:raceCode code="2076-8" displayName="Native Hawaiian or Other Pacific Islander" 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"/>
<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>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
</addr>
<telecom value="tel:+1(555)555-2008" use="MC"/>
<guardianPerson>
<name>
<given>Boris</given>
<given qualifier="CL">Bo</given>
<family>Betterhalf</family>
</name>
</guardianPerson>
</guardian>
<birthplace>
<place>
<addr>
<streetAddressLine>4444 Home Street</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
</addr>
</place>
</birthplace>
<languageCommunication>
<languageCode code="en"/>
<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>
<providerOrganization>
<id extension="219BX" root="2.16.840.1.113883.4.6"/>
<name>The DoctorsTogether Physician Group</name>
<telecom use="WP" value="tel:+1(555)555-5000"/>
<addr use="WP">
<streetAddressLine>1007 Health Drive</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>
<!-- Author -->
<author>
<time value="201307301235-0800"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="77777777777" />
<code code="163W00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" displayName="Registered nurse"/>
<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>Nurse</given>
<family>Nightingale</family>
<suffix>RN</suffix>
</name>
</assignedPerson>
<representedOrganization>
<id root="2.16.840.1.113883.19.5"/>
<name>Good Health Hospital</name>
</representedOrganization>
</assignedAuthor>
</author>
<!-- Data Enterer -->
<dataEnterer>
<assignedEntity>
<id extension="333777777" root="2.16.840.1.113883.4.6"/>
<addr use="WP">
<streetAddressLine>1007 Healthcare Drive</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1(555)-1050"/>
<assignedPerson>
<name>
<given>Ellen</given>
<family>Enter</family>
</name>
</assignedPerson>
</assignedEntity>
</dataEnterer>
<!-- Informant -->
<informant>
<assignedEntity>
<id extension="888888888" root="2.16.840.1.113883.19.5"/>
<addr use="WP">
<streetAddressLine>1007 Healthcare Drive</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel:+1(555)-1003"/>
<assignedPerson>
<name>
<given>Harold</given>
<family>Hippocrates</family>
<suffix qualifier="AC">D.O.</suffix>
</name>
</assignedPerson>
</assignedEntity>
</informant>
<!-- Custodian -->
<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>
<informationRecipient>
<intendedRecipient>
<!-- Receiving Person Provider Id -->
<id root="a1cd2b74-c6de-44ee-b552-3adacb7983cc"/>
<!-- Receiving Medicare/Medicaid Provider Id-->
<id root="c72f64c2-b1db-444b-bbff-4d2e1d6bd659"/>
<!-- Receiving Person ID-->
<id root="fa883fee-b255-4465-8fb5-1d8135e39896"/>
<!-- Receiving Person Address-->
<addr use="WP">
<streetAddressLine>100 Better Health Rd.</streetAddressLine>
<city>Ann Arbor</city>
<state>MI</state>
<postalCode>97857</postalCode>
<country>US</country>
</addr>
<telecom use="WP" value="tel+1(555)555-1010"/>
<informationRecipient>
<!-- Receiving Person Name-->
<name>
<given>Nurse</given>
<family>Caresalot</family>
<suffix>RN</suffix>
</name>
</informationRecipient>
<receivedOrganization>
<!-- Receiving Organization Id-->
<id root="c4c416a7-aeeb-4dcc-9662-ab836ff4d265"/>
<!-- Receiving Organization Provider ID (NPI) -->
<id root="ab47f3c4-1267-4b9e-9a29-e966b5a861c8"/>
<!-- Receiving Organization Name -->
<name>Better Health Hospital</name>
<!-- Receiving Organization Address -->
<addr use="WP">
<streetAddressLine>100 Better Health Rd.</streetAddressLine>
<city>Ann Arbor</city>
<state>MI</state>
<postalCode>97857</postalCode>
<country>US</country>
</addr>
<!-- Receiving Care Setting Type Description: displayName. Receiving Care Setting Type Code: code -->
<standardIndustryClassCode displayName="Long Term Care Hospital" code="282E00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<!-- Legal Authenticator -->
<legalAuthenticator>
<time value="201307301235-0800"/>
<signatureCode code="S"/>
<sdtc:signatureText mediaType="text/xml" representation="B64">U2lnbmVkIGJ5IE51cnNlIE5pZ2h0aW5nYWxl</sdtc:signatureText>
<assignedEntity>
<id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/>
<code code="163W00000X" codeSystem="2.16.840.1.113883.6.101" displayName="Registered nurse"/>
<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>Nurse</given>
<family>Nightingale</family>
<suffix>RN</suffix>
</name>
</assignedPerson>
<representedOrganization>
<id root="2.16.840.1.113883.19.5"/>
<name>Good Health Hospital</name>
<!-- the orgnaization id and name -->
</representedOrganization>
</assignedEntity>
</legalAuthenticator>
<!-- This authenticator represents patient agreement or sign-off of the Care Plan-->
<authenticator>
<time value="201307301235-0800"/>
<signatureCode code="S"/>
<sdtc:signatureText mediaType="text/xml" representation="B64">U2lnbmVkIGJ5IEV2ZSBFdmVyeXdvbWFu</sdtc:signatureText>
<assignedEntity>
<id extension="444222222" root="2.16.840.1.113883.4.1"/>
<code code="ONESELF" displayName="Self" codeSystem="2.16.840.1.113883.5.111" codeSystemName="RoleCode"/>
<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"/>
<assignedPerson>
<name use="L">
<given>Eve</given>
<family qualifier="SP">Everywoman</family>
</name>
</assignedPerson>
</assignedEntity>
</authenticator>
<!-- This participant represents the person who reviewed the Care Plan. If the date in the time element is in the past, then this review has already taken place.
If the date in the time element is in the future, then this is the date of the next scheduled review. -->
<!-- This example shows a Care Plan Review that has already taken place -->
<participant typeCode="VRF">
<functionCode code="425268008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Review of Care Plan"/>
<time value="201308011024-0800"/>
<associatedEntity classCode="ASSIGNED">
<id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/>
<code code="163W00000X" codeSystem="2.16.840.1.113883.6.101" displayName="Registered nurse"/>
<associatedPerson nullFlavor="NA" />
</associatedEntity>
</participant>
<!-- This participant represents the person who reviewed the Care Plan. If the date in the time element is in the past, then this review has already taken place.
If the date in the time element is in the future, then this is the date of the next scheduled review. -->
<!-- This example shows a Scheduled Care Plan Review that is in the future -->
<participant typeCode="VRF">
<functionCode code="425268008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Review of Care Plan"/>
<time value="201310011230-0800"/>
<associatedEntity classCode="ASSIGNED">
<id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/>
<code code="SELF" displayName="self" codeSystem="2.16.840.1.113883.5.111"/>
<associatedPerson nullFlavor="NA" />
</associatedEntity>
</participant>
<!-- This participant identifies individuals who support the patient such as a relative or caregiver -->
<participant typeCode="IND">
<!-- Emergency Contact -->
<associatedEntity classCode="ECON">
<addr use="HP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Ann Arbor</city>
<state>MI</state>
<postalCode>97857</postalCode>
<country>US</country>
</addr>
<telecom value="tel:(999)555-1212" use="WP"/>
<associatedPerson>
<name>
<prefix>Mrs.</prefix>
<given>Martha</given>
<family>Jones</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<!-- This participant identifies individuals who support the patient such as a relative or caregiver -->
<participant typeCode="IND">
<!-- Caregiver -->
<associatedEntity classCode="CAREGIVER">
<addr use="HP">
<streetAddressLine>17 Daws Rd.</streetAddressLine>
<city>Ann Arbor</city>
<state>MI</state>
<postalCode>97857</postalCode>
<country>US</country>
</addr>
<telecom value="tel:(999)555-1212" use="WP"/>
<associatedPerson>
<name>
<prefix>Mrs.</prefix>
<given>Martha</given>
<family>Jones</family>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<documentationOf>
<serviceEvent classCode="PCPR">
<effectiveTime>
<low value="201307201030-0800"/>
<high value="201308151300-0800"/>
</effectiveTime>
<!-- The performer(s) represents the healthcare providers involved in the current or historical care of the patient.
The patient’s key healthcare providers would be listed here which would include the primary physician and any
active consulting physicians, therapists, counselors, and care team members. -->
<performer typeCode="PRF">
<time value="20130715223615-0800"/>
<assignedEntity>
<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)-1004"/>
<assignedPerson>
<name>
<given>Patricia</given>
<given qualifier="CL">Patty</given>
<family>Primary</family>
<suffix qualifier="AC">M.D.</suffix>
</name>
</assignedPerson>
</assignedEntity>
</performer>
</serviceEvent>
</documentationOf>
<!-- The Care Plan is continually evolving and dynamic. The Care Plan CDA instance
is NOT dynamic. Each time a Care Plan CDA is generated it represents a snapshot
in time of the Care Plan at that moment. Whenever a care provider or patient
generates a Care Plan, it should be noted through relatedDocument
whether the current Care Plan replaces or appends another Care Plan.
The relatedDocumentTypeCode indicates whether the current document is
an addendum to the ParentDocument (APND (append)) or the current document
is a replacement of the ParentDocument (RPLC (replace)). -->
<!-- This document is the second in a set - relatedDocument
describes the parent document-->
<relatedDocument typeCode="RPLC">
<parentDocument>
<id root="223769be-f6ee-4b04-a0ce-b56ae998c880"/>
<code code="CarePlan-x" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Care Plan"/>
<setId root="004bb033-b948-4f4c-b5bf-a8dbd7d8dd40"/>
<versionNumber value="1"/>
</parentDocument>
</relatedDocument>
<componentOf>
<encompassingEncounter>
<id extension="9937012" root="2.16.840.1.113883.19"/>
<code codeSystem="2.16.840.1.113883.5.4" code="IMP" displayName="Inpatient encounter"/>
<!-- captures that this is an inpatient encounter -->
<effectiveTime>
<low value="201306150930-0800"/>
<!-- No high value - this patient is still in hospital -->
</effectiveTime>
</encompassingEncounter>
</componentOf>
<!--
********************************************************
CDA Body
********************************************************
-->
<component>
<structuredBody>
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.58" extension="2015-08-01"/>
<code code="75310-3" displayName="Health Concerns Document" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>Health Concerns Section</title>
<text>...</text>
</section>
</component>
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.60"/>
<code code="61146-7" displayName="Goals" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>Goals Section</title>
<text>...</text>
</section>
</component>
<component>
<section nullFlavor="NI">
<templateId root="2.16.840.1.113883.10.20.22.2.61" />
<code code="11383-7" displayName="Patient Problem Outcome" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
<title>Health Status Evaluations/Outcomes Section</title>
<text>...</text>
</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
Links: Table of Contents |
QA Report
| Version History 
|
|
Propose a change