Consolidated CDA (C-CDA)
4.0.0 - STU4 United States of America flag

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: Advance Directive Existence Observation

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveExistenceObservation Version: 4.0.0
Draft as of 2025-06-20 Computable Name: AdvanceDirectiveExistenceObservation
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.10.20.22.4.513:2025-05-01

This observation represents a simple observation indicating whether a person has any advance directive documents. When documents are available, a system can nest the needed references to the advance directive documents inside this Advance Directive Existence Observation.

Templates Used

Although open templates may contain any valid CDA content, the following templates are specifically called out by this template:

Optional EntryRelationships: AdvanceDirectiveObservation

Usages:

Changes since version 3.0.0:

  • New Content

    • Formal Views of Template Content

    Description of Template, Differentials, Snapshots and how the different presentations work.

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, no-obs-if-existence-false
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Fixed Value: OBS
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... sdtcCategory 0..* CD Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS
    .... @code 1..1 cs Fixed Value: completed
    ... effectiveTime C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @value 0..1 ts value should be used instead of low/high
    ... value 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... author 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... entryRelationship 0..* EntryRelationship
    .... @typeCode 1..1 cs Fixed Value: REFR
    .... observation 1..1 AdvanceDirectiveObservation

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.sdtcCategorypreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
    Observation.valuerequiredAnswerSetWithYesNoAndUnknowns .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16

    Constraints

    IdGradePath(s)DetailsRequirements
    no-obs-if-existence-falseerrorObservationIf 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')
    should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-onlyerrorObservation.effectiveTimeInterval fields SHALL NOT be present
    : (low | high | width | center).empty()
    value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, no-obs-if-existence-false
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    Binding: ObservationType (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... derivationExpr 0..1 ST
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs Binding: MediaType (example)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Fixed Value: completed
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
    ... methodCode 0..* CE Binding: ObservationMethod (example)
    ... targetSiteCode 0..* CD
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... participant 0..* Participant2
    ... entryRelationship 0..* EntryRelationship
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: REFR
    .... @inversionInd 0..1 bl
    .... @contextConductionInd 0..1 bl
    .... @negationInd 0..1 bl
    .... sequenceNumber 0..1 INT
    .... seperatableInd 0..1 BL
    .... act 0..1 Act
    .... encounter 0..1 Encounter
    .... observation 1..1 AdvanceDirectiveObservation
    .... observationMedia 0..1 ObservationMedia
    .... organizer 0..1 Organizer
    .... procedure 0..1 Procedure
    .... regionOfInterest 0..1 RegionOfInterest
    .... substanceAdministration 0..1 SubstanceAdministration
    .... supply 0..1 Supply
    ... reference 0..* Reference
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... referenceRange 0..* InfrastructureRoot
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    .... observationRange 1..1 ObservationRange
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.templateId:advance-directive-exist-obs.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.classCoderequiredFixed Value: OBS
    http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
    Observation.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
    Observation.sdtcCategorypreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
    Observation.codeexampleObservationType
    http://terminology.hl7.org/ValueSet/v3-ObservationType
    Observation.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Observation.text.mediaTypeexampleMediaType
    http://terminology.hl7.org/ValueSet/v3-MediaType
    Observation.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Observation.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Observation.statusCode.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Observation.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Observation.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Observation.valuerequiredAnswerSetWithYesNoAndUnknowns .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16
    Observation.interpretationCoderequiredCDAObservationInterpretation
    http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
    Observation.methodCodeexampleObservationMethod
    http://terminology.hl7.org/ValueSet/v3-ObservationMethod
    Observation.entryRelationship.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.entryRelationship.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.entryRelationship.typeCoderequiredFixed Value: REFR
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Observation.referenceRange.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.referenceRange.typeCoderequiredFixed Value: REFV
    http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

    Constraints

    IdGradePath(s)DetailsRequirements
    II-1errorObservation.typeId, Observation.entryRelationship.typeId, Observation.referenceRange.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    no-obs-if-existence-falseerrorObservationIf 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')
    should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-onlyerrorObservation.effectiveTimeInterval fields SHALL NOT be present
    : (low | high | width | center).empty()
    value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, no-obs-if-existence-false
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    Binding: ObservationType (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... derivationExpr 0..1 ST
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs Binding: MediaType (example)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Fixed Value: completed
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
    ... methodCode 0..* CE Binding: ObservationMethod (example)
    ... targetSiteCode 0..* CD
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... participant 0..* Participant2
    ... entryRelationship 0..* EntryRelationship
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: REFR
    .... @inversionInd 0..1 bl
    .... @contextConductionInd 0..1 bl
    .... @negationInd 0..1 bl
    .... sequenceNumber 0..1 INT
    .... seperatableInd 0..1 BL
    .... act 0..1 Act
    .... encounter 0..1 Encounter
    .... observation 1..1 AdvanceDirectiveObservation
    .... observationMedia 0..1 ObservationMedia
    .... organizer 0..1 Organizer
    .... procedure 0..1 Procedure
    .... regionOfInterest 0..1 RegionOfInterest
    .... substanceAdministration 0..1 SubstanceAdministration
    .... supply 0..1 Supply
    ... reference 0..* Reference
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... referenceRange 0..* InfrastructureRoot
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    .... observationRange 1..1 ObservationRange
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.templateId:advance-directive-exist-obs.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.classCoderequiredFixed Value: OBS
    http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
    Observation.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
    Observation.sdtcCategorypreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
    Observation.codeexampleObservationType
    http://terminology.hl7.org/ValueSet/v3-ObservationType
    Observation.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Observation.text.mediaTypeexampleMediaType
    http://terminology.hl7.org/ValueSet/v3-MediaType
    Observation.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Observation.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Observation.statusCode.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Observation.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Observation.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Observation.valuerequiredAnswerSetWithYesNoAndUnknowns .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16
    Observation.interpretationCoderequiredCDAObservationInterpretation
    http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
    Observation.methodCodeexampleObservationMethod
    http://terminology.hl7.org/ValueSet/v3-ObservationMethod
    Observation.entryRelationship.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.entryRelationship.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.entryRelationship.typeCoderequiredFixed Value: REFR
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Observation.referenceRange.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.referenceRange.typeCoderequiredFixed Value: REFV
    http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

    Constraints

    IdGradePath(s)DetailsRequirements
    II-1errorObservation.typeId, Observation.entryRelationship.typeId, Observation.referenceRange.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    no-obs-if-existence-falseerrorObservationIf 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')
    should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-onlyerrorObservation.effectiveTimeInterval fields SHALL NOT be present
    : (low | high | width | center).empty()
    value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')

    This structure is derived from Observation

    Summary

    Mandatory: 13 elements(1 nested mandatory element)
    Fixed: 4 elements

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 2 is sliced based on the values of Observation.templateId

    Differential View

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, no-obs-if-existence-false
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Fixed Value: OBS
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... sdtcCategory 0..* CD Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS
    .... @code 1..1 cs Fixed Value: completed
    ... effectiveTime C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @value 0..1 ts value should be used instead of low/high
    ... value 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... author 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... entryRelationship 0..* EntryRelationship
    .... @typeCode 1..1 cs Fixed Value: REFR
    .... observation 1..1 AdvanceDirectiveObservation

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.sdtcCategorypreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
    Observation.valuerequiredAnswerSetWithYesNoAndUnknowns .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16

    Constraints

    IdGradePath(s)DetailsRequirements
    no-obs-if-existence-falseerrorObservationIf 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')
    should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-onlyerrorObservation.effectiveTimeInterval fields SHALL NOT be present
    : (low | high | width | center).empty()
    value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, no-obs-if-existence-false
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    Binding: ObservationType (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... derivationExpr 0..1 ST
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs Binding: MediaType (example)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Fixed Value: completed
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
    ... methodCode 0..* CE Binding: ObservationMethod (example)
    ... targetSiteCode 0..* CD
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... participant 0..* Participant2
    ... entryRelationship 0..* EntryRelationship
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: REFR
    .... @inversionInd 0..1 bl
    .... @contextConductionInd 0..1 bl
    .... @negationInd 0..1 bl
    .... sequenceNumber 0..1 INT
    .... seperatableInd 0..1 BL
    .... act 0..1 Act
    .... encounter 0..1 Encounter
    .... observation 1..1 AdvanceDirectiveObservation
    .... observationMedia 0..1 ObservationMedia
    .... organizer 0..1 Organizer
    .... procedure 0..1 Procedure
    .... regionOfInterest 0..1 RegionOfInterest
    .... substanceAdministration 0..1 SubstanceAdministration
    .... supply 0..1 Supply
    ... reference 0..* Reference
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... referenceRange 0..* InfrastructureRoot
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    .... observationRange 1..1 ObservationRange
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.templateId:advance-directive-exist-obs.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.classCoderequiredFixed Value: OBS
    http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
    Observation.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
    Observation.sdtcCategorypreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
    Observation.codeexampleObservationType
    http://terminology.hl7.org/ValueSet/v3-ObservationType
    Observation.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Observation.text.mediaTypeexampleMediaType
    http://terminology.hl7.org/ValueSet/v3-MediaType
    Observation.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Observation.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Observation.statusCode.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Observation.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Observation.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Observation.valuerequiredAnswerSetWithYesNoAndUnknowns .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16
    Observation.interpretationCoderequiredCDAObservationInterpretation
    http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
    Observation.methodCodeexampleObservationMethod
    http://terminology.hl7.org/ValueSet/v3-ObservationMethod
    Observation.entryRelationship.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.entryRelationship.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.entryRelationship.typeCoderequiredFixed Value: REFR
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Observation.referenceRange.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.referenceRange.typeCoderequiredFixed Value: REFV
    http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

    Constraints

    IdGradePath(s)DetailsRequirements
    II-1errorObservation.typeId, Observation.entryRelationship.typeId, Observation.referenceRange.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    no-obs-if-existence-falseerrorObservationIf 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')
    should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-onlyerrorObservation.effectiveTimeInterval fields SHALL NOT be present
    : (low | high | width | center).empty()
    value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, no-obs-if-existence-false
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    Binding: ObservationType (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... derivationExpr 0..1 ST
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs Binding: MediaType (example)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Fixed Value: completed
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
    ... methodCode 0..* CE Binding: ObservationMethod (example)
    ... targetSiteCode 0..* CD
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... participant 0..* Participant2
    ... entryRelationship 0..* EntryRelationship
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: REFR
    .... @inversionInd 0..1 bl
    .... @contextConductionInd 0..1 bl
    .... @negationInd 0..1 bl
    .... sequenceNumber 0..1 INT
    .... seperatableInd 0..1 BL
    .... act 0..1 Act
    .... encounter 0..1 Encounter
    .... observation 1..1 AdvanceDirectiveObservation
    .... observationMedia 0..1 ObservationMedia
    .... organizer 0..1 Organizer
    .... procedure 0..1 Procedure
    .... regionOfInterest 0..1 RegionOfInterest
    .... substanceAdministration 0..1 SubstanceAdministration
    .... supply 0..1 Supply
    ... reference 0..* Reference
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... referenceRange 0..* InfrastructureRoot
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    .... observationRange 1..1 ObservationRange
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.templateId:advance-directive-exist-obs.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.classCoderequiredFixed Value: OBS
    http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
    Observation.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
    Observation.sdtcCategorypreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
    Observation.codeexampleObservationType
    http://terminology.hl7.org/ValueSet/v3-ObservationType
    Observation.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Observation.text.mediaTypeexampleMediaType
    http://terminology.hl7.org/ValueSet/v3-MediaType
    Observation.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Observation.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Observation.statusCode.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Observation.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Observation.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Observation.valuerequiredAnswerSetWithYesNoAndUnknowns .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.16
    Observation.interpretationCoderequiredCDAObservationInterpretation
    http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
    Observation.methodCodeexampleObservationMethod
    http://terminology.hl7.org/ValueSet/v3-ObservationMethod
    Observation.entryRelationship.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.entryRelationship.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.entryRelationship.typeCoderequiredFixed Value: REFR
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Observation.referenceRange.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.referenceRange.typeCoderequiredFixed Value: REFV
    http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

    Constraints

    IdGradePath(s)DetailsRequirements
    II-1errorObservation.typeId, Observation.entryRelationship.typeId, Observation.referenceRange.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    no-obs-if-existence-falseerrorObservationIf 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')
    should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-onlyerrorObservation.effectiveTimeInterval fields SHALL NOT be present
    : (low | high | width | center).empty()
    value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')

    This structure is derived from Observation

    Summary

    Mandatory: 13 elements(1 nested mandatory element)
    Fixed: 4 elements

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 2 is sliced based on the values of Observation.templateId

     

    Other representations of profile: CSV, Excel