Consolidated CDA (C-CDA)
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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. For a full list of available versions, see the Directory of published versions

Logical Model: AdvanceDirectiveExistenceObservation - Detailed Descriptions

Draft as of 2025-06-20

Definitions for the AdvanceDirectiveExistenceObservation logical model.

Guidance on how to interpret the contents of this table can be foundhere

0. Observation
Definition

Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.


Base definition for all types defined in FHIR type system.

ShortBase for all types and resources
Control10..1*
Is Modifierfalse
Logical ContainerClinicalDocument (CDA Class)
ValidationInstance of this type are validated by templateId
XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
no-obs-if-existence-false: If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. ((entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001'))
2. Observation.nullFlavor
Definition

If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

Control0..1
BindingThe codes SHALL be taken from CDANullFlavor
(required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
Typecode(cs: Coded Simple Value)
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
LabelExceptional Value Detail
4. Observation.realmCode
Definition

When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

Control0..*
Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
6. Observation.typeId
Definition

When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

Control0..1
Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
InvariantsII-1: An II instance must have either a root or an nullFlavor. (root.exists() or nullFlavor.exists())
8. Observation.typeId.nullFlavor
Definition

If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

Control0..1
BindingThe codes SHALL be taken from CDANullFlavor
(required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
Typecode(cs: Coded Simple Value)
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
LabelExceptional Value Detail
10. Observation.typeId.assigningAuthorityName
Definition

A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

Control0..1
Typestring(st: Character String)
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
LabelAssigning Authority Name
12. Observation.typeId.displayable
Definition

Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

Control0..1
Typeboolean(bl: Boolean)
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
LabelDisplayable
14. Observation.typeId.root
Definition

Identifies the type as an HL7 Registered model

Control1..1
Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
LabelRoot
Fixed Value2.16.840.1.113883.1.3
16. Observation.typeId.extension
Definition

A character string as a unique identifier within the scope of the identifier root.

Control1..1
Typestring(st: Character String)
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
XML FormatIn the XML format, this property is represented as an attribute.
LabelExtension
18. Observation.templateId
Definition

When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

Control1..*
Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
SlicingThis element introduces a set of slices on Observation.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ root
  • value @ extension
  • 20. Observation.templateId:advance-directive-exist-obs
    Slice Nameadvance-directive-exist-obs
    Definition

    When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

    Control1..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
    22. Observation.templateId:advance-directive-exist-obs.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    24. Observation.templateId:advance-directive-exist-obs.assigningAuthorityName
    Definition

    A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelAssigning Authority Name
    26. Observation.templateId:advance-directive-exist-obs.displayable
    Definition

    Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

    Control0..1
    Typeboolean(bl: Boolean)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelDisplayable
    28. Observation.templateId:advance-directive-exist-obs.root
    Definition

    A unique identifier that guarantees the global uniqueness of the instance identifier. The root alone may be the entire instance identifier.

    Control1..1
    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelRoot
    Pattern Value2.16.840.1.113883.10.20.22.4.513
    30. Observation.templateId:advance-directive-exist-obs.extension
    Definition

    A character string as a unique identifier within the scope of the identifier root.

    Control1..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExtension
    Pattern Value2025-05-01
    32. Observation.classCode
    Comments

    SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC).

    Control1..1
    BindingThe codes SHALL be taken from CDAActClassObservation
    (required to http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed ValueOBS
    34. Observation.moodCode
    Comments

    SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC).

    Control1..1
    BindingThe codes SHALL be taken from XActMoodDocumentObservation (2.0.0)
    (required to http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed ValueEVN
    36. Observation.negationInd
    Control0..1
    Typeboolean(bl: Boolean)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    38. Observation.id
    Definition

    The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

    ShortLogical id of this artifact
    Comments

    SHALL contain at least one [1..*] id.


    Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

    Control10..*1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IIid
    Is Modifierfalse
    40. Observation.sdtcCategory
    Control0..*
    BindingThe codes SHOULD be taken from Advance Healthcare Directive Categories LOINC .
    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
    XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namecategory.
    42. Observation.code
    Definition

    Describes what was observed. Sometimes this is called the observation "name".

    ShortAdvance directive/living will completedType of observation (code / type)
    Comments

    All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

    Control1..1
    This element is affected by the following invariants: obs-7
    BindingFor example codes, see ObservationTypehttp://hl7.org/fhir/ValueSet/observation-codes
    (example to http://terminology.hl7.org/ValueSet/v3-ObservationType)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CDCodeableConcept
    Is Modifierfalse
    XML FormatThe type of this property is determined using the xsi:typeattribute.
    Requirements

    Knowing what kind of observation is being made is essential to understanding the observation.

    Alternate NamesName
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. Observation.code.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    46. Observation.code.code
    Definition

    The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.

    Control1..1
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCode
    Pattern Value45473-6
    48. Observation.code.codeSystem
    Definition

    Specifies the code system that defines the code.

    ShortLOINC
    Control1..1
    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCode System
    Pattern Value2.16.840.1.113883.6.1
    50. Observation.code.codeSystemName
    Definition

    The common name of the coding system.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCode System Name
    52. Observation.code.codeSystemVersion
    Definition

    If applicable, a version descriptor defined specifically for the given code system.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCode System Version
    54. Observation.code.displayName
    Definition

    A name or title for the code, under which the sending system shows the code value to its users.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelDisplay Name
    56. Observation.code.sdtcValueSet
    Definition

    The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.

    Control0..1
    Typestring(oid: ISO Object Identifier)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSet.
    58. Observation.code.sdtcValueSetVersion
    Definition

    The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSetVersion.
    60. Observation.code.originalText
    Definition

    The text or phrase used as the basis for the coding.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
    LabelOriginal Text
    62. Observation.code.qualifier
    Definition

    Specifies additional codes that increase the specificity of the the primary code.

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CR
    LabelQualifier
    64. Observation.code.translation
    Definition

    A set of other concept descriptors that translate this concept descriptor into other code systems.

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
    XML FormatThe type of this property is determined using the xsi:typeattribute.
    LabelTranslation
    66. Observation.derivationExpr
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ST
    68. Observation.text
    Definition

    A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

    ShortSHOULD reference the portion of section narrative text corresponding to this entryText summary of the resource, for human interpretation
    Comments

    Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

    Control10..1
    This element is affected by the following invariants: dom-6
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/EDNarrative
    Is Modifierfalse
    XML FormatThe type of this property is determined using the xsi:typeattribute.
    Alternate Namesnarrative, html, xhtml, display
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    70. Observation.text.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    72. Observation.text.compression
    Definition

    Indicates whether the raw byte data is compressed, and what compression algorithm was used.

    Control0..1
    BindingThe codes SHALL be taken from CDACompressionAlgorithm
    (required to http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCompression
    74. Observation.text.integrityCheck
    Definition

    The integrity check is a short binary value representing a cryptographically strong checksum that is calculated over the binary data. The purpose of this property, when communicated with a reference is for anyone to validate later whether the reference still resolved to the same data that the reference resolved to when the encapsulated data value with reference was created.

    Control0..1
    Typebase64Binary(bin: Binary Data)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelIntegrity Check
    76. Observation.text.integrityCheckAlgorithm
    Definition

    Specifies the algorithm used to compute the integrityCheck value. The cryptographically strong checksum algorithm Secure Hash Algorithm-1 (SHA-1) is currently the industry standard. It has superseded the MD5 algorithm only a couple of years ago, when certain flaws in the security of MD5 were discovered. Currently the SHA-1 hash algorithm is the default choice for the integrity check algorithm. Note that SHA-256 is also entering widespread usage.

    Control0..1
    BindingThe codes SHALL be taken from IntegrityCheckAlgorithm (2.0.0)
    (required to http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelIntegrity Check Algorithm
    78. Observation.text.language
    Definition

    For character based information the language property specifies the human language of the text.

    Control0..1
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelLanguage
    80. Observation.text.mediaType
    Definition

    Identifies the type of the encapsulated data and identifies a method to interpret or render the data.

    Control0..1
    BindingFor example codes, see MediaType
    (example to http://terminology.hl7.org/ValueSet/v3-MediaType)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelMedia Type
    82. Observation.text.representation
    Control0..1
    BindingThe codes SHALL be taken from CDABinaryDataEncoding
    (required to http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    84. Observation.text.xmlText
    Definition

    Data that is primarily intended for human interpretation or for further machine processing is outside the scope of HL7. This includes unformatted or formatted written language, multimedia data, or structured information as defined by a different standard (e.g., XML-signatures.)

    ShortAllows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    Comments

    This element is represented in XML as textual content. The actual name "xmlText" will not appear in a CDA instance.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as unadorned text.
    86. Observation.text.reference
    Definition

    A telecommunication address (TEL), such as a URL for HTTP or FTP, which will resolve to precisely the same binary data that could as well have been provided as inline data.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
    LabelReference
    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
    88. Observation.text.thumbnail
    Definition

    An abbreviated rendition of the full data. A thumbnail requires significantly fewer resources than the full data, while still maintaining some distinctive similarity with the full data. A thumbnail is typically used with by-reference encapsulated data. It allows a user to select data more efficiently before actually downloading through the reference.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
    LabelThumbnail
    90. Observation.statusCode
    Comments

    SHALL contain exactly one [1..1] statusCode.

    Control1..1
    BindingThe codes SHALL be taken from ActStatus
    (required to http://terminology.hl7.org/ValueSet/v3-ActStatus)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
    92. Observation.statusCode.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    94. Observation.statusCode.code
    Definition

    The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.

    Comments

    This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC).

    Control1..1
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCode
    Fixed Valuecompleted
    96. Observation.statusCode.codeSystem
    Definition

    Specifies the code system that defines the code.

    Control0..0
    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCode System
    98. Observation.statusCode.codeSystemName
    Definition

    The common name of the coding system.

    Control0..0
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCode System Name
    100. Observation.statusCode.codeSystemVersion
    Definition

    If applicable, a version descriptor defined specifically for the given code system.

    Control0..0
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelCode System Version
    102. Observation.statusCode.displayName
    Definition

    A name or title for the code, under which the sending system shows the code value to its users.

    Control0..0
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelDisplay Name
    104. Observation.statusCode.sdtcValueSet
    Definition

    The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.

    Control0..1
    Typestring(oid: ISO Object Identifier)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSet.
    106. Observation.statusCode.sdtcValueSetVersion
    Definition

    The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSetVersion.
    108. Observation.statusCode.originalText
    Definition

    The text or phrase used as the basis for the coding.

    Control0..0
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
    LabelOriginal Text
    110. Observation.statusCode.qualifier
    Definition

    Specifies additional codes that increase the specificity of the the primary code.

    Control0..0
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CR
    LabelQualifier
    112. Observation.statusCode.translation
    Definition

    A set of other concept descriptors that translate this concept descriptor into other code systems.

    Control0..0
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
    XML FormatThe type of this property is determined using the xsi:typeattribute.
    LabelTranslation
    114. Observation.effectiveTime
    ShortNote: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Comments

    SHALL contain exactly one [1..1] effectiveTime.

    Control1..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
    Invariantsvalue-only: Interval fields SHALL NOT be present ((low | high | width | center).empty())
    116. Observation.effectiveTime.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    118. Observation.effectiveTime.value
    Definition

    A quantity specifying a point on the axis of natural time. A point in time is most often represented as a calendar expression.

    Shortvalue should be used instead of low/high
    Control0..1
    TypedateTime(ts: Point in Time)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Date FormatYYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    XML FormatIn the XML format, this property is represented as an attribute.
    120. Observation.effectiveTime.operator
    Definition

    A code specifying whether the set component is included (union) or excluded (set-difference) from the set, or other set operations with the current set component and the set as constructed from the representation stream up to the current point.

    Control0..1
    BindingThe codes SHALL be taken from CDASetOperator
    (required to http://hl7.org/cda/stds/core/ValueSet/CDASetOperator)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Default ValueI
    122. Observation.effectiveTime.low
    Definition

    This is the low limit of the interval.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
    LabelLow Boundary
    124. Observation.effectiveTime.center
    Definition

    The arithmetic mean of the interval (low plus high divided by 2). The purpose of distinguishing the center as a semantic property is for conversions of intervals from and to point values.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/TS
    LabelCentral Value
    126. Observation.effectiveTime.width
    Definition

    The difference between high and low boundary. The purpose of distinguishing a width property is to handle all cases of incomplete information symmetrically. In any interval representation only two of the three properties high, low, and width need to be stated and the third can be derived.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/PQ
    LabelWidth
    128. Observation.effectiveTime.high
    Definition

    This is the high limit of the interval.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
    LabelHigh Boundary
    130. Observation.priorityCode
    Control0..1
    BindingFor example codes, see ActPriority
    (example to http://terminology.hl7.org/ValueSet/v3-ActPriority)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
    132. Observation.repeatNumber
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-INT
    134. Observation.languageCode
    Control0..1
    BindingThe codes SHALL be taken from AllLanguages
    (required to http://hl7.org/fhir/ValueSet/all-languages)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
    136. Observation.value
    Control1..1
    BindingThe codes SHALL be taken from Answer Set with Yes No and Unknowns .
    (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
    XML FormatThe type of this property is determined using the xsi:typeattribute.
    138. Observation.interpretationCode
    Control0..*
    BindingThe codes SHALL be taken from CDAObservationInterpretation
    (required to http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
    140. Observation.methodCode
    Control0..*
    BindingFor example codes, see ObservationMethod
    (example to http://terminology.hl7.org/ValueSet/v3-ObservationMethod)
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
    142. Observation.targetSiteCode
    Definition

    Drawn from concept domain ActSite

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
    144. Observation.subject
    Definition

    The patient, or group of patients, location, device, organization, procedure or practitioner this observation is about and into whose or what record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the focus element or the code itself specifies the actual focus of the observation.

    ShortWho and/or what the observation is about
    Comments

    One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated. The subject of an Observation may in some cases be a procedure. This supports the regulatory inspection use case where observations are captured during inspections of a procedure that is being performed (independent of any particular patient or whether patient related at all).

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/SubjectReference(Patient, Group, Device, Location, Organization, Procedure, Practitioner, Medication, Substance, BiologicallyDerivedProduct, NutritionProduct)
    Is Modifierfalse
    Requirements

    Observations have no value if you don't know who or what they're about.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    146. Observation.specimen
    Definition

    The specimen that was used when this observation was made.

    ShortSpecimen used for this observation
    Comments

    Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

    Control0..*1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/SpecimenReference(Specimen, Group)
    Is Modifierfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    obs-9: If Observation.specimen is a reference to Group, the group can only have specimens ((reference.resolve().exists() and reference.resolve() is Group) implies reference.resolve().member.entity.resolve().all($this is Specimen))
    148. Observation.performer
    Definition

    Who was responsible for asserting the observed value as "true".

    ShortWho is responsible for the observation
    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Performer2Reference(Practitioner, PractitionerRole, Organization, CareTeam, Patient, RelatedPerson)
    Is Modifierfalse
    Requirements

    May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    150. Observation.author
    Comments

    SHALL contain exactly [1..1] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119).

    Control1..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Provenance - Author Participation)
    152. Observation.informant
    ShortMAY contain zero or one [0..1] informant
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Informant
    154. Observation.participant
    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
    156. Observation.entryRelationship
    Comments

    MAY contain zero or more [0..*] entryRelationship.

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/EntryRelationship
    158. Observation.entryRelationship.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    160. Observation.entryRelationship.realmCode
    Definition

    When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
    162. Observation.entryRelationship.typeId
    Definition

    When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
    InvariantsII-1: An II instance must have either a root or an nullFlavor. (root.exists() or nullFlavor.exists())
    164. Observation.entryRelationship.typeId.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    166. Observation.entryRelationship.typeId.assigningAuthorityName
    Definition

    A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelAssigning Authority Name
    168. Observation.entryRelationship.typeId.displayable
    Definition

    Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

    Control0..1
    Typeboolean(bl: Boolean)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelDisplayable
    170. Observation.entryRelationship.typeId.root
    Definition

    Identifies the type as an HL7 Registered model

    Control1..1
    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelRoot
    Fixed Value2.16.840.1.113883.1.3
    172. Observation.entryRelationship.typeId.extension
    Definition

    A character string as a unique identifier within the scope of the identifier root.

    Control1..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExtension
    174. Observation.entryRelationship.templateId
    Definition

    When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
    176. Observation.entryRelationship.typeCode
    Control1..1
    BindingThe codes SHALL be taken from x_ActRelationshipEntryRelationship
    (required to http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed ValueREFR
    178. Observation.entryRelationship.inversionInd
    Definition

    The entryRelationship.inversionInd can be set to "true" to indicate that the relationship should be interpreted as if the roles of the source and target entries were reversed.

    Control0..1
    Typeboolean(bl: Boolean)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    180. Observation.entryRelationship.contextConductionInd
    Definition

    The entryRelationship.contextConductionInd differs from the otherwise common use of this attribute in that in all other cases where this attribute is used, the value is fixed at "true", whereas here the value is defaulted to "true", and can be changed to "false" when referencing an entry in the same document. Setting the context conduction to false when referencing an entry in the same document keeps clear the fact that the referenced object retains its original context.

    Control0..1
    Typeboolean(bl: Boolean)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Default Valuetrue
    182. Observation.entryRelationship.negationInd
    Control0..1
    Typeboolean(bl: Boolean)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    184. Observation.entryRelationship.sequenceNumber
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/INT
    186. Observation.entryRelationship.seperatableInd
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/BL
    188. Observation.entryRelationship.act
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act
    190. Observation.entryRelationship.encounter
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Encounter
    192. Observation.entryRelationship.observation
    Comments

    SHALL contain exactly one [1..1] Advance Directive Observation (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2025-05-01).

    Control1..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Advance Directive Observation)
    194. Observation.entryRelationship.observationMedia
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ObservationMedia
    196. Observation.entryRelationship.organizer
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Organizer
    198. Observation.entryRelationship.procedure
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Procedure
    200. Observation.entryRelationship.regionOfInterest
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/RegionOfInterest
    202. Observation.entryRelationship.substanceAdministration
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/SubstanceAdministration
    204. Observation.entryRelationship.supply
    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Supply
    206. Observation.reference
    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
    208. Observation.precondition
    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition
    210. Observation.sdtcPrecondition2
    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition2
    XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameprecondition2.
    212. Observation.referenceRange
    Definition

    Relates an Observation to the ObservationRange class, where the expected range of values for a particular observation can be specified.


    Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two referenceRange elements would be used.

    ShortProvides guide for interpretation
    Comments

    Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/InfrastructureRootBackboneElement
    Is Modifierfalse
    Requirements

    Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    obs-3: Must have at least a low or a high or text (low.exists() or high.exists() or text.exists())
    214. Observation.referenceRange.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    216. Observation.referenceRange.realmCode
    Definition

    When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
    218. Observation.referenceRange.typeId
    Definition

    When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

    Control0..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
    InvariantsII-1: An II instance must have either a root or an nullFlavor. (root.exists() or nullFlavor.exists())
    220. Observation.referenceRange.typeId.nullFlavor
    Definition

    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

    Control0..1
    BindingThe codes SHALL be taken from CDANullFlavor
    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExceptional Value Detail
    222. Observation.referenceRange.typeId.assigningAuthorityName
    Definition

    A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

    Control0..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelAssigning Authority Name
    224. Observation.referenceRange.typeId.displayable
    Definition

    Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

    Control0..1
    Typeboolean(bl: Boolean)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelDisplayable
    226. Observation.referenceRange.typeId.root
    Definition

    Identifies the type as an HL7 Registered model

    Control1..1
    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelRoot
    Fixed Value2.16.840.1.113883.1.3
    228. Observation.referenceRange.typeId.extension
    Definition

    A character string as a unique identifier within the scope of the identifier root.

    Control1..1
    Typestring(st: Character String)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    LabelExtension
    230. Observation.referenceRange.templateId
    Definition

    When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
    232. Observation.referenceRange.typeCode
    Control0..1
    BindingThe codes SHALL be taken from CDAActRelationshipType
    (required to http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType)
    Typecode(cs: Coded Simple Value)
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    XML FormatIn the XML format, this property is represented as an attribute.
    Fixed ValueREFV
    234. Observation.referenceRange.observationRange
    Control1..1
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ObservationRange
    236. Observation.sdtcInFulfillmentOf1
    Control0..*
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/InFulfillmentOf1
    XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameinFulfillmentOf1.

    Guidance on how to interpret the contents of this table can be foundhere

    0. Observation
    Logical ContainerClinicalDocument (CDA Class)
    ValidationInstance of this type are validated by templateId
    XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
    Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
    no-obs-if-existence-false: If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. ((entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001'))
    2. Observation.templateId
    Control1..?
    SlicingThis element introduces a set of slices on Observation.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ root
    • value @ extension
    • 4. Observation.templateId:advance-directive-exist-obs
      Slice Nameadvance-directive-exist-obs
      Control1..1
      6. Observation.templateId:advance-directive-exist-obs.root
      Control1..?
      Pattern Value2.16.840.1.113883.10.20.22.4.513
      8. Observation.templateId:advance-directive-exist-obs.extension
      Control1..?
      Pattern Value2025-05-01
      10. Observation.classCode
      Comments

      SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC).

      Fixed ValueOBS
      12. Observation.moodCode
      Comments

      SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC).

      Fixed ValueEVN
      14. Observation.id
      Comments

      SHALL contain at least one [1..*] id.

      Control1..?
      16. Observation.sdtcCategory
      BindingThe codes SHOULD be taken from Advance Healthcare Directive Categories LOINC .
      (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
      18. Observation.code
      ShortAdvance directive/living will completed
      20. Observation.code.code
      Control1..?
      Pattern Value45473-6
      22. Observation.code.codeSystem
      ShortLOINC
      Control1..?
      Pattern Value2.16.840.1.113883.6.1
      24. Observation.text
      ShortSHOULD reference the portion of section narrative text corresponding to this entry
      Control1..?
      26. Observation.text.reference
      Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
      28. Observation.statusCode
      Comments

      SHALL contain exactly one [1..1] statusCode.

      Control1..?
      30. Observation.statusCode.code
      Comments

      This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC).

      Control1..?
      Fixed Valuecompleted
      32. Observation.effectiveTime
      ShortNote: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
      Comments

      SHALL contain exactly one [1..1] effectiveTime.

      Control1..?
      Invariantsvalue-only: Interval fields SHALL NOT be present ((low | high | width | center).empty())
      34. Observation.effectiveTime.value
      Shortvalue should be used instead of low/high
      36. Observation.value
      Control1..1
      BindingThe codes SHALL be taken from Answer Set with Yes No and Unknowns .
      (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16)
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD, http://hl7.org/cda/stds/core/StructureDefinition/EIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/CO, http://hl7.org/cda/stds/core/StructureDefinition/TEL, http://hl7.org/cda/stds/core/StructureDefinition/EN, http://hl7.org/cda/stds/core/StructureDefinition/BL, http://hl7.org/cda/stds/core/StructureDefinition/AD, http://hl7.org/cda/stds/core/StructureDefinition/PIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/RTO-PQ-PQ, http://hl7.org/cda/stds/core/StructureDefinition/SXPR-TS, http://hl7.org/cda/stds/core/StructureDefinition/ED, http://hl7.org/cda/stds/core/StructureDefinition/TS, http://hl7.org/cda/stds/core/StructureDefinition/II, http://hl7.org/cda/stds/core/StructureDefinition/ST, http://hl7.org/cda/stds/core/StructureDefinition/PQ, http://hl7.org/cda/stds/core/StructureDefinition/IVL-PQ, http://hl7.org/cda/stds/core/StructureDefinition/CE, http://hl7.org/cda/stds/core/StructureDefinition/MO, http://hl7.org/cda/stds/core/StructureDefinition/IVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/ANY, http://hl7.org/cda/stds/core/StructureDefinition/INT, http://hl7.org/cda/stds/core/StructureDefinition/REAL, http://hl7.org/cda/stds/core/StructureDefinition/CV, http://hl7.org/cda/stds/core/StructureDefinition/SC
      38. Observation.author
      Comments

      SHALL contain exactly [1..1] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119).

      Control1..1
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Provenance - Author Participation)
      40. Observation.informant
      ShortMAY contain zero or one [0..1] informant
      Control0..1
      42. Observation.entryRelationship
      Comments

      MAY contain zero or more [0..*] entryRelationship.

      44. Observation.entryRelationship.typeCode
      Fixed ValueREFR
      46. Observation.entryRelationship.observation
      Comments

      SHALL contain exactly one [1..1] Advance Directive Observation (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2025-05-01).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Advance Directive Observation)

      Guidance on how to interpret the contents of this table can be foundhere

      0. Observation
      Definition

      Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.

      ShortBase for all types and resources
      Control1..1
      Is Modifierfalse
      Logical ContainerClinicalDocument (CDA Class)
      ValidationInstance of this type are validated by templateId
      XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
      Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
      no-obs-if-existence-false: If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. ((entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001'))
      2. Observation.nullFlavor
      Definition

      If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

      Control0..1
      BindingThe codes SHALL be taken from CDANullFlavor
      (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
      Typecode(cs: Coded Simple Value)
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      LabelExceptional Value Detail
      4. Observation.realmCode
      Definition

      When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

      Control0..*
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
      6. Observation.typeId
      Definition

      When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

      Control0..1
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
      InvariantsII-1: An II instance must have either a root or an nullFlavor. (root.exists() or nullFlavor.exists())
      8. Observation.typeId.nullFlavor
      Definition

      If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

      Control0..1
      BindingThe codes SHALL be taken from CDANullFlavor
      (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
      Typecode(cs: Coded Simple Value)
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      LabelExceptional Value Detail
      10. Observation.typeId.assigningAuthorityName
      Definition

      A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

      Control0..1
      Typestring(st: Character String)
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      LabelAssigning Authority Name
      12. Observation.typeId.displayable
      Definition

      Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

      Control0..1
      Typeboolean(bl: Boolean)
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      LabelDisplayable
      14. Observation.typeId.root
      Definition

      Identifies the type as an HL7 Registered model

      Control1..1
      Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      LabelRoot
      Fixed Value2.16.840.1.113883.1.3
      16. Observation.typeId.extension
      Definition

      A character string as a unique identifier within the scope of the identifier root.

      Control1..1
      Typestring(st: Character String)
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      XML FormatIn the XML format, this property is represented as an attribute.
      LabelExtension
      18. Observation.templateId
      Definition

      When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

      Control1..*
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
      SlicingThis element introduces a set of slices on Observation.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ root
      • value @ extension
      • 20. Observation.templateId:advance-directive-exist-obs
        Slice Nameadvance-directive-exist-obs
        Definition

        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

        Control1..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
        22. Observation.templateId:advance-directive-exist-obs.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        24. Observation.templateId:advance-directive-exist-obs.assigningAuthorityName
        Definition

        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelAssigning Authority Name
        26. Observation.templateId:advance-directive-exist-obs.displayable
        Definition

        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

        Control0..1
        Typeboolean(bl: Boolean)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelDisplayable
        28. Observation.templateId:advance-directive-exist-obs.root
        Definition

        A unique identifier that guarantees the global uniqueness of the instance identifier. The root alone may be the entire instance identifier.

        Control1..1
        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelRoot
        Pattern Value2.16.840.1.113883.10.20.22.4.513
        30. Observation.templateId:advance-directive-exist-obs.extension
        Definition

        A character string as a unique identifier within the scope of the identifier root.

        Control1..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExtension
        Pattern Value2025-05-01
        32. Observation.classCode
        Comments

        SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC).

        Control1..1
        BindingThe codes SHALL be taken from CDAActClassObservation
        (required to http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Fixed ValueOBS
        34. Observation.moodCode
        Comments

        SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC).

        Control1..1
        BindingThe codes SHALL be taken from XActMoodDocumentObservation (2.0.0)
        (required to http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Fixed ValueEVN
        36. Observation.negationInd
        Control0..1
        Typeboolean(bl: Boolean)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        38. Observation.id
        Comments

        SHALL contain at least one [1..*] id.

        Control1..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
        40. Observation.sdtcCategory
        Control0..*
        BindingThe codes SHOULD be taken from Advance Healthcare Directive Categories LOINC .
        (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namecategory.
        42. Observation.code
        ShortAdvance directive/living will completed
        Control1..1
        BindingFor example codes, see ObservationType
        (example to http://terminology.hl7.org/ValueSet/v3-ObservationType)
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
        XML FormatThe type of this property is determined using the xsi:typeattribute.
        44. Observation.code.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        46. Observation.code.code
        Definition

        The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.

        Control1..1
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCode
        Pattern Value45473-6
        48. Observation.code.codeSystem
        Definition

        Specifies the code system that defines the code.

        ShortLOINC
        Control1..1
        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCode System
        Pattern Value2.16.840.1.113883.6.1
        50. Observation.code.codeSystemName
        Definition

        The common name of the coding system.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCode System Name
        52. Observation.code.codeSystemVersion
        Definition

        If applicable, a version descriptor defined specifically for the given code system.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCode System Version
        54. Observation.code.displayName
        Definition

        A name or title for the code, under which the sending system shows the code value to its users.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelDisplay Name
        56. Observation.code.sdtcValueSet
        Definition

        The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.

        Control0..1
        Typestring(oid: ISO Object Identifier)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSet.
        58. Observation.code.sdtcValueSetVersion
        Definition

        The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSetVersion.
        60. Observation.code.originalText
        Definition

        The text or phrase used as the basis for the coding.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
        LabelOriginal Text
        62. Observation.code.qualifier
        Definition

        Specifies additional codes that increase the specificity of the the primary code.

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CR
        LabelQualifier
        64. Observation.code.translation
        Definition

        A set of other concept descriptors that translate this concept descriptor into other code systems.

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
        XML FormatThe type of this property is determined using the xsi:typeattribute.
        LabelTranslation
        66. Observation.derivationExpr
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ST
        68. Observation.text
        ShortSHOULD reference the portion of section narrative text corresponding to this entry
        Control1..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
        XML FormatThe type of this property is determined using the xsi:typeattribute.
        70. Observation.text.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        72. Observation.text.compression
        Definition

        Indicates whether the raw byte data is compressed, and what compression algorithm was used.

        Control0..1
        BindingThe codes SHALL be taken from CDACompressionAlgorithm
        (required to http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCompression
        74. Observation.text.integrityCheck
        Definition

        The integrity check is a short binary value representing a cryptographically strong checksum that is calculated over the binary data. The purpose of this property, when communicated with a reference is for anyone to validate later whether the reference still resolved to the same data that the reference resolved to when the encapsulated data value with reference was created.

        Control0..1
        Typebase64Binary(bin: Binary Data)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelIntegrity Check
        76. Observation.text.integrityCheckAlgorithm
        Definition

        Specifies the algorithm used to compute the integrityCheck value. The cryptographically strong checksum algorithm Secure Hash Algorithm-1 (SHA-1) is currently the industry standard. It has superseded the MD5 algorithm only a couple of years ago, when certain flaws in the security of MD5 were discovered. Currently the SHA-1 hash algorithm is the default choice for the integrity check algorithm. Note that SHA-256 is also entering widespread usage.

        Control0..1
        BindingThe codes SHALL be taken from IntegrityCheckAlgorithm (2.0.0)
        (required to http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelIntegrity Check Algorithm
        78. Observation.text.language
        Definition

        For character based information the language property specifies the human language of the text.

        Control0..1
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelLanguage
        80. Observation.text.mediaType
        Definition

        Identifies the type of the encapsulated data and identifies a method to interpret or render the data.

        Control0..1
        BindingFor example codes, see MediaType
        (example to http://terminology.hl7.org/ValueSet/v3-MediaType)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelMedia Type
        82. Observation.text.representation
        Control0..1
        BindingThe codes SHALL be taken from CDABinaryDataEncoding
        (required to http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        84. Observation.text.xmlText
        Definition

        Data that is primarily intended for human interpretation or for further machine processing is outside the scope of HL7. This includes unformatted or formatted written language, multimedia data, or structured information as defined by a different standard (e.g., XML-signatures.)

        ShortAllows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
        Comments

        This element is represented in XML as textual content. The actual name "xmlText" will not appear in a CDA instance.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as unadorned text.
        86. Observation.text.reference
        Definition

        A telecommunication address (TEL), such as a URL for HTTP or FTP, which will resolve to precisely the same binary data that could as well have been provided as inline data.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
        LabelReference
        Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
        88. Observation.text.thumbnail
        Definition

        An abbreviated rendition of the full data. A thumbnail requires significantly fewer resources than the full data, while still maintaining some distinctive similarity with the full data. A thumbnail is typically used with by-reference encapsulated data. It allows a user to select data more efficiently before actually downloading through the reference.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
        LabelThumbnail
        90. Observation.statusCode
        Comments

        SHALL contain exactly one [1..1] statusCode.

        Control1..1
        BindingThe codes SHALL be taken from ActStatus
        (required to http://terminology.hl7.org/ValueSet/v3-ActStatus)
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
        92. Observation.statusCode.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        94. Observation.statusCode.code
        Definition

        The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.

        Comments

        This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC).

        Control1..1
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCode
        Fixed Valuecompleted
        96. Observation.statusCode.codeSystem
        Definition

        Specifies the code system that defines the code.

        Control0..0
        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCode System
        98. Observation.statusCode.codeSystemName
        Definition

        The common name of the coding system.

        Control0..0
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCode System Name
        100. Observation.statusCode.codeSystemVersion
        Definition

        If applicable, a version descriptor defined specifically for the given code system.

        Control0..0
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelCode System Version
        102. Observation.statusCode.displayName
        Definition

        A name or title for the code, under which the sending system shows the code value to its users.

        Control0..0
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelDisplay Name
        104. Observation.statusCode.sdtcValueSet
        Definition

        The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.

        Control0..1
        Typestring(oid: ISO Object Identifier)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSet.
        106. Observation.statusCode.sdtcValueSetVersion
        Definition

        The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSetVersion.
        108. Observation.statusCode.originalText
        Definition

        The text or phrase used as the basis for the coding.

        Control0..0
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
        LabelOriginal Text
        110. Observation.statusCode.qualifier
        Definition

        Specifies additional codes that increase the specificity of the the primary code.

        Control0..0
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CR
        LabelQualifier
        112. Observation.statusCode.translation
        Definition

        A set of other concept descriptors that translate this concept descriptor into other code systems.

        Control0..0
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
        XML FormatThe type of this property is determined using the xsi:typeattribute.
        LabelTranslation
        114. Observation.effectiveTime
        ShortNote: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
        Comments

        SHALL contain exactly one [1..1] effectiveTime.

        Control1..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
        Invariantsvalue-only: Interval fields SHALL NOT be present ((low | high | width | center).empty())
        116. Observation.effectiveTime.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        118. Observation.effectiveTime.value
        Definition

        A quantity specifying a point on the axis of natural time. A point in time is most often represented as a calendar expression.

        Shortvalue should be used instead of low/high
        Control0..1
        TypedateTime(ts: Point in Time)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Date FormatYYYYMMDDHHMMSS.UUUU[+|-ZZzz]
        XML FormatIn the XML format, this property is represented as an attribute.
        120. Observation.effectiveTime.operator
        Definition

        A code specifying whether the set component is included (union) or excluded (set-difference) from the set, or other set operations with the current set component and the set as constructed from the representation stream up to the current point.

        Control0..1
        BindingThe codes SHALL be taken from CDASetOperator
        (required to http://hl7.org/cda/stds/core/ValueSet/CDASetOperator)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Default ValueI
        122. Observation.effectiveTime.low
        Definition

        This is the low limit of the interval.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
        LabelLow Boundary
        124. Observation.effectiveTime.center
        Definition

        The arithmetic mean of the interval (low plus high divided by 2). The purpose of distinguishing the center as a semantic property is for conversions of intervals from and to point values.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/TS
        LabelCentral Value
        126. Observation.effectiveTime.width
        Definition

        The difference between high and low boundary. The purpose of distinguishing a width property is to handle all cases of incomplete information symmetrically. In any interval representation only two of the three properties high, low, and width need to be stated and the third can be derived.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PQ
        LabelWidth
        128. Observation.effectiveTime.high
        Definition

        This is the high limit of the interval.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
        LabelHigh Boundary
        130. Observation.priorityCode
        Control0..1
        BindingFor example codes, see ActPriority
        (example to http://terminology.hl7.org/ValueSet/v3-ActPriority)
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
        132. Observation.repeatNumber
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-INT
        134. Observation.languageCode
        Control0..1
        BindingThe codes SHALL be taken from AllLanguages
        (required to http://hl7.org/fhir/ValueSet/all-languages)
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
        136. Observation.value
        Control1..1
        BindingThe codes SHALL be taken from Answer Set with Yes No and Unknowns .
        (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16)
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
        XML FormatThe type of this property is determined using the xsi:typeattribute.
        138. Observation.interpretationCode
        Control0..*
        BindingThe codes SHALL be taken from CDAObservationInterpretation
        (required to http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation)
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
        140. Observation.methodCode
        Control0..*
        BindingFor example codes, see ObservationMethod
        (example to http://terminology.hl7.org/ValueSet/v3-ObservationMethod)
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
        142. Observation.targetSiteCode
        Definition

        Drawn from concept domain ActSite

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
        144. Observation.subject
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Subject
        146. Observation.specimen
        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Specimen
        148. Observation.performer
        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Performer2
        150. Observation.author
        Comments

        SHALL contain exactly [1..1] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119).

        Control1..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Provenance - Author Participation)
        152. Observation.informant
        ShortMAY contain zero or one [0..1] informant
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Informant
        154. Observation.participant
        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
        156. Observation.entryRelationship
        Comments

        MAY contain zero or more [0..*] entryRelationship.

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/EntryRelationship
        158. Observation.entryRelationship.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        160. Observation.entryRelationship.realmCode
        Definition

        When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
        162. Observation.entryRelationship.typeId
        Definition

        When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
        InvariantsII-1: An II instance must have either a root or an nullFlavor. (root.exists() or nullFlavor.exists())
        164. Observation.entryRelationship.typeId.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        166. Observation.entryRelationship.typeId.assigningAuthorityName
        Definition

        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelAssigning Authority Name
        168. Observation.entryRelationship.typeId.displayable
        Definition

        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

        Control0..1
        Typeboolean(bl: Boolean)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelDisplayable
        170. Observation.entryRelationship.typeId.root
        Definition

        Identifies the type as an HL7 Registered model

        Control1..1
        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelRoot
        Fixed Value2.16.840.1.113883.1.3
        172. Observation.entryRelationship.typeId.extension
        Definition

        A character string as a unique identifier within the scope of the identifier root.

        Control1..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExtension
        174. Observation.entryRelationship.templateId
        Definition

        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
        176. Observation.entryRelationship.typeCode
        Control1..1
        BindingThe codes SHALL be taken from x_ActRelationshipEntryRelationship
        (required to http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Fixed ValueREFR
        178. Observation.entryRelationship.inversionInd
        Definition

        The entryRelationship.inversionInd can be set to "true" to indicate that the relationship should be interpreted as if the roles of the source and target entries were reversed.

        Control0..1
        Typeboolean(bl: Boolean)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        180. Observation.entryRelationship.contextConductionInd
        Definition

        The entryRelationship.contextConductionInd differs from the otherwise common use of this attribute in that in all other cases where this attribute is used, the value is fixed at "true", whereas here the value is defaulted to "true", and can be changed to "false" when referencing an entry in the same document. Setting the context conduction to false when referencing an entry in the same document keeps clear the fact that the referenced object retains its original context.

        Control0..1
        Typeboolean(bl: Boolean)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Default Valuetrue
        182. Observation.entryRelationship.negationInd
        Control0..1
        Typeboolean(bl: Boolean)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        184. Observation.entryRelationship.sequenceNumber
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/INT
        186. Observation.entryRelationship.seperatableInd
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/BL
        188. Observation.entryRelationship.act
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act
        190. Observation.entryRelationship.encounter
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Encounter
        192. Observation.entryRelationship.observation
        Comments

        SHALL contain exactly one [1..1] Advance Directive Observation (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2025-05-01).

        Control1..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Advance Directive Observation)
        194. Observation.entryRelationship.observationMedia
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ObservationMedia
        196. Observation.entryRelationship.organizer
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Organizer
        198. Observation.entryRelationship.procedure
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Procedure
        200. Observation.entryRelationship.regionOfInterest
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/RegionOfInterest
        202. Observation.entryRelationship.substanceAdministration
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/SubstanceAdministration
        204. Observation.entryRelationship.supply
        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Supply
        206. Observation.reference
        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
        208. Observation.precondition
        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition
        210. Observation.sdtcPrecondition2
        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition2
        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameprecondition2.
        212. Observation.referenceRange
        Definition

        Relates an Observation to the ObservationRange class, where the expected range of values for a particular observation can be specified.

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/InfrastructureRoot
        214. Observation.referenceRange.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        216. Observation.referenceRange.realmCode
        Definition

        When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
        218. Observation.referenceRange.typeId
        Definition

        When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
        InvariantsII-1: An II instance must have either a root or an nullFlavor. (root.exists() or nullFlavor.exists())
        220. Observation.referenceRange.typeId.nullFlavor
        Definition

        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

        Control0..1
        BindingThe codes SHALL be taken from CDANullFlavor
        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExceptional Value Detail
        222. Observation.referenceRange.typeId.assigningAuthorityName
        Definition

        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

        Control0..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelAssigning Authority Name
        224. Observation.referenceRange.typeId.displayable
        Definition

        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

        Control0..1
        Typeboolean(bl: Boolean)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelDisplayable
        226. Observation.referenceRange.typeId.root
        Definition

        Identifies the type as an HL7 Registered model

        Control1..1
        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelRoot
        Fixed Value2.16.840.1.113883.1.3
        228. Observation.referenceRange.typeId.extension
        Definition

        A character string as a unique identifier within the scope of the identifier root.

        Control1..1
        Typestring(st: Character String)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        LabelExtension
        230. Observation.referenceRange.templateId
        Definition

        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
        232. Observation.referenceRange.typeCode
        Control0..1
        BindingThe codes SHALL be taken from CDAActRelationshipType
        (required to http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType)
        Typecode(cs: Coded Simple Value)
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        XML FormatIn the XML format, this property is represented as an attribute.
        Fixed ValueREFV
        234. Observation.referenceRange.observationRange
        Control1..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ObservationRange
        236. Observation.sdtcInFulfillmentOf1
        Control0..*
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/InFulfillmentOf1
        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameinFulfillmentOf1.