Consolidated CDA (C-CDA)
3.0.0 - STU3 United States of America flag

This page is part of the CCDA: Consolidated CDA Release (v3.0.0: CCDA 3.0) generated with FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

Logical Model: Advance Directive Observation

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation Version: 3.0.0
Draft as of 2024-05-18 Computable Name: AdvanceDirectiveObservation
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2022-02-14

Advance Directive Observations may include a variety of information called different “content types”. The set of Advance Directive Observations within an Advance Directive Organizer provides a summarization of relevant information available in an external Advance Healthcare Directive document or gathered as a result of a conversation with the patient or their healthcare agent (Advance Directive document or Portable Medical Order document).

The types of content in an advance directive could include, but are not limited to:

  • Healthcare agent consent
  • Resuscitation procedure preference
  • Intubation and Ventilation procedure preference
  • Antibiotics or other medication administration preference
  • Artificial nutrition or hydration administration preference
  • Diagnostic Testing procedure preference
  • Preferences relating to palliative care
  • Preferences relating to hospice care
  • Organ donation preference
  • Autopsy procedure preference
  • Burial or funeral preference
  • Care preference that is general in nature which the patient wants care providers to take into consideration, such as likes or dislikes related to the experience of receiving care
  • Information about a personal goal, such as seeing a grandchild born, attending a child’s wedding, finding care for a beloved pet, or dying in a certain place.

Preferences can be for or against certain procedures and are typically conditional based upon a certain health scenario taking place.

The type of content in a portable medical order could include but are not limited to procedures that can be ordered such as cardiopulmonary resuscitation, hospital transfer, full/selected/comfort care, antibiotics administration, artificial nutrition and hydration administration, dialysis, intubation, ventilation, and more.

Advance directives are effective when the individual is unable to communicate with their medical team themselves, due to a health crisis or emergency, and persist from execution until such time as the condition of the individual renders them appropriate for use. The effectiveTime/low tells when they went into effect (or will go into effect) and the high tells when they ceased or will cease to be in effect. If the starting effective time is not known, effectiveTime/low is UNK, but this would still be considered “Active”. At a minimum the starting effective time is the date signed. If effectiveTime/high contains a value of “NA” or it is not valued, the advance directive remains active until some action is taken to make it inactive, such as updating the document contents or revocation of the document itself. (Explicit use of nullFlavor=”NA” is the preferred approach for indicating an Advance Directive that is not time bounded.) That action may update the existing information with an effectiveTime/high or it may replace the open-ended entry with a new entry that includes the effectiveTime/high information. An advance directive is active so long as the effectiveTime/high has not been passed.

The author of the Advance Directive Observation is the person documenting that the directives were reviewed and verified to be accurate for provision of treatment and care. The verifier is the person who read the document and verified the advance directive information. The role of verifier and the role of author need not be fulfilled by the same person, so each role is documented separately. However, the author and the verifier often will be the same person in advance healthcare directive documents that are NOT portable medical orders. This template supports Context Conduction. The author of the organizer can be assumed to be the author of the Advance Directive Observations within the organizer unless explicitly overridden within the contained observation. When author identity confidence is high, implementers should explicitly assert conformance to the Provenance Author Participation template.

Advance Directive Observations that would appear in the context of an Advance Directive Organizer:

Information Content Type (as evidenced in an external document, or provided verbally during a patient encounter and not contained in an external document) How the Observation is used to represent this information for exchange
Existing advance healthcare directive document Observation.code = 75320
Observation.code.translation = 92183-3 (Form type)
Observation.value = a code from Advance Healthcare Directive Categories
Optional: entryRelationship to reference the external source document by identifier
Appointment of healthcare agents that are consented to by the patient. Observation.code = 75320
Observation.code.translation = 81335-2
Observation.value = a code from Healthcare Agent or Proxy Choices
If no healthcare agents are appointed, Observation.value/@nullflavor = a code from No Healthcare Agent Included Reason
Observation.participant is used to record an appointed healthcare agent. Each Advance Directive Observation of this type holds only one Healthcare Agent, necessitating that if a primary healthcare agent and a backup healthcare agent are designed two Advance Directive Observation entries are required.
Patient’s Treatment Intervention Preferences (also supports preconditional health scenarios), Care Experience Preferences, and Upon Death Preferences. When documenting that a patient has documented or expressed Treatment Intervention Preferences, Care Experience Preferences, or Upon Death Preferences, the person verifying the content in the referenced document is the performer of the observation and the observation.value tells what type of content was verified or discussed.
The documented preference is included as a reference to the Treatment Intervention Preference, Care Experience Preference or Upon Death Preference identified in the source document.
The verified current preference can be included as entryRelationships to a Treatment Intervention Preference or Care Experience Preference where the performer is the person verifying the information with the patient or the healthcare agent, the informant is the patient or healthcare agent, and the author is the person recording this documentation in the EHR.
Observation.code = 75320
Observation.code.translation = 95541-9 Care Experience Preference
81378-2 Personal Intervention Preference
81337-8 Upon Death Preferences
Observation.value = code from Advance Directive Content Type
Personal healthcare goals (also supports preconditional health scenarios) Observation.code = 75320
Observation.code.translation = 87528-6 Personal Health Goal
Observation.value = a code from Health Goals at End of Life Grouping
Practitioner Orders that are in place in a Portable Medical Order document. Observation.code = 75320
Observation.code.translation = Code should come from CPT or SNOMED CT codes.
Observation.value will be from a specialized value set including coded values appropriate for the specific order. Or if coded concepts are not available, Observation.value will be a Boolean where T = perform and F=do-not-perform

Advance Directive Observation that would not be contained in the context of an Advance Directive Organizer:

Information Content Type (as evidenced in an external document, or provided verbally during a patient encounter and not contained in an external document) How the Observation is used to represent this information for exchange
Advance Directive Observation authored by the organization creating the C-CDA document to show the Patient’s DNR Status. Observation.code = 75320
Observation.code.translation = 100822-6 Cardiopulmonary resuscitation orders
Observation.value will be LA33470-8 (Yes CPR) or LA33471-6 (No CPR)

Usage:

Formal Views of Template Content

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

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, 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)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
.... templateId:advance-directive-obs 1..1 II
..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.48
..... @extension 1..1 st Required Pattern: 2022-02-14
... @classCode 1..1 cs Fixed Value: OBS
... @moodCode 1..1 cs Fixed Value: EVN
... code C 1..1 CD should-translation: SHOULD contain translation
.... @code 1..1 cs Required Pattern: 75320-2
.... translation 0..* CD Binding: Advance Directives Categories . (preferred)
... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
.... reference C 0..1 TEL value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1 CS
.... @code 1..1 cs Fixed Value: completed
... effectiveTime 1..1 IVL_TS
.... low 1..1 IVXB_TS
.... high C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... value 1..1 CD Binding: Advance Directives Content Type . (required): Advance Directive Content Type

... author 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant SHOULD contain informant
... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
.... participant:verifier C 0..* Participant2 The participant "VRF" represents the clinician(s) who verified the patient advance directive.
should-time: SHOULD contain time
..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
...... templateId:primary 1..1 II
....... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.1.58
....... @extension 0..0
..... @typeCode 1..1 cs Fixed Value: VRF
..... time C 0..1 IVL_TS value-only: Interval fields SHALL not be present
...... @value 0..1 ts value should be used instead of low/high
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
...... addr 0..* USRealmAddress Base for all types and resources
...... playingEntity 1..1 PlayingEntity
....... name 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
.... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
..... @typeCode 1..1 cs Fixed Value: CST
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @classCode 1..1 cs Fixed Value: AGNT
...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
...... addr 0..1 USRealmAddress Base for all types and resources
...... telecom 0..* TEL
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
....... name 1..1 PN The name of the healthcare agent.
... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
.... reference:reference1 1..* Reference
..... @typeCode 1..1 cs Fixed Value: REFR
..... externalDocument 1..1 ExternalDocument
...... id 1..* II
...... code 1..1 CD Binding: Advance Directives Categories . (preferred)
...... text 0..1 ED
....... reference C 0..1 TEL The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.valuerequiredAdvanceDirectivesContentType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
value-onlyerrorObservation.participant:verifier.timeInterval 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 & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, 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)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
.... templateId:advance-directive-obs 1..1 II
..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.48
..... @extension 1..1 st Required Pattern: 2022-02-14
... @classCode 1..1 cs Binding: CDAActClassObservation (required)
Fixed Value: OBS
... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
Fixed Value: EVN
... code C 1..1 CD Binding: ObservationType (example)
should-translation: SHOULD contain translation
.... @code 1..1 cs Required Pattern: 75320-2
.... translation 0..* CD Binding: Advance Directives Categories . (preferred)
... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
.... reference C 0..1 TEL value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1 CS Binding: ActStatus (required)
.... @code 1..1 cs Fixed Value: completed
... effectiveTime 1..1 IVL_TS
.... low 1..1 IVXB_TS
.... high C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... value 1..1 CD Binding: Advance Directives Content Type . (required): Advance Directive Content Type


... author 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant SHOULD contain informant
... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
.... participant:verifier C 0..* Participant2 The participant "VRF" represents the clinician(s) who verified the patient advance directive.
should-time: SHOULD contain time
..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
...... templateId:primary 1..1 II
....... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.1.58
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: VRF
..... time C 0..1 IVL_TS value-only: Interval fields SHALL not be present
...... @value 0..1 ts value should be used instead of low/high
Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
...... addr C 0..* USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... playingEntity 1..1 PlayingEntity
....... name C 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
.... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: CST
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @classCode 1..1 cs Binding: CDARoleClassRoot (required)
Fixed Value: AGNT
...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
...... addr C 0..1 USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
....... name 1..1 PN The name of the healthcare agent.
... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
.... reference:reference1 1..* Reference
..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
Fixed Value: REFR
..... externalDocument 1..1 ExternalDocument
...... id 1..* II
...... code 1..1 CD Binding: Advance Directives Categories . (preferred)
...... text 0..1 ED
....... reference C 0..1 TEL The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
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.codeexampleObservationType
http://terminology.hl7.org/ValueSet/v3-ObservationType
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.statusCoderequiredActStatus
http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.valuerequiredAdvanceDirectivesContentType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
Observation.participant:verifier.typeCoderequiredFixed Value: VRF
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:custodian.typeCoderequiredFixed Value: CST
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:custodian.participantRole.classCoderequiredFixed Value: AGNT
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.typeCoderequiredFixed Value: REFR
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
81-7296errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addr**SHALL NOT** have mixed content except for white space (CONF:81-7296)
: item.xmlText.empty()
81-9371errorObservation.participant:verifier.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorObservation.participant:verifier.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
81-10024errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state'))
81-10025errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?'))
pn-no-lserrorObservation.participant:verifier.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
shall-cityerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain exactly one [1..1] city (CONF:81-7292).
: nullFlavor.exists() or item.city.count() = 1
shall-max-ad-partserrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL have at most one of each: state, city, postalCode, and country
: (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1)
shall-streetAddressLineerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
: nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4)
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-countrywarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain country
: nullFlavor.exists() or item.country.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
should-usewarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain @use
: nullFlavor.exists() or use.exists()
value-onlyerrorObservation.participant:verifier.timeInterval 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 & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, 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)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId 0..1 II
.... @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-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: 2.16.840.1.113883.10.20.22.4.48
..... @extension 1..1 st Required Pattern: 2022-02-14
... @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
... code C 1..1 CD Binding: ObservationType (example)
should-translation: SHOULD contain translation
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @code 1..1 cs Required Pattern: 75320-2
.... @codeSystem 0..1 oid, uuid, ruid
.... @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 Binding: Advance Directives Categories . (preferred)
... 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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
.... 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 1..1 IVL_TS
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
.... @operator 0..1 cs Binding: CDASetOperator (required)
.... low 1..1 IVXB_TS
.... center 0..1 TS
.... width 0..1 PQ
.... high C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... priorityCode 0..1 CE Binding: ActPriority (example)
... repeatNumber 0..1 IVL_INT
... languageCode 0..1 CS Binding: AllLanguages (required)
... value 1..1 CD Binding: Advance Directives Content Type . (required): Advance Directive Content Type


... 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 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant SHOULD contain informant
... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
.... participant:verifier C 0..* Participant2 The participant "VRF" represents the clinician(s) who verified the patient advance directive.
should-time: SHOULD contain time
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId 0..1 II
...... @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
...... templateId:primary 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: 2.16.840.1.113883.10.20.1.58
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: VRF
..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
Fixed Value: OP
..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
XML: functionCode (urn:hl7-org:sdtc)
..... time C 0..1 IVL_TS value-only: Interval fields SHALL not be present
...... @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
..... awarenessCode 0..1 CE
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId 0..1 II
....... @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
...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
...... id 0..* II
...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
XML: identifiedBy (urn:hl7-org:sdtc)
...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
...... addr C 0..* USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingDevice 0..1 Device
...... playingEntity 1..1 PlayingEntity
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... realmCode 0..* CS
....... typeId 0..1 II
........ @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
....... @classCode 0..1 cs Binding: EntityClassRoot (required)
....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
Fixed Value: INSTANCE
....... code 0..1 CE Binding: CDAEntityCode (example)
....... quantity 0..* PQ
....... name C 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
XML: birthTime (urn:hl7-org:sdtc)
....... desc 0..1 ED
...... scopingEntity 0..1 Entity
.... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId 0..1 II
...... @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: CDAParticipationType (required)
Fixed Value: CST
..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
Fixed Value: OP
..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
XML: functionCode (urn:hl7-org:sdtc)
..... time 0..1 IVL_TS
..... awarenessCode 0..1 CE
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId 0..1 II
....... @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
...... @classCode 1..1 cs Binding: CDARoleClassRoot (required)
Fixed Value: AGNT
...... id 0..* II
...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
XML: identifiedBy (urn:hl7-org:sdtc)
...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
...... addr C 0..1 USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingDevice 0..1 Device
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... realmCode 0..* CS
....... typeId 0..1 II
........ @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
....... @classCode 0..1 cs Binding: EntityClassRoot (required)
....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
Fixed Value: INSTANCE
....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
....... quantity 0..* PQ
....... name 1..1 PN The name of the healthcare agent.
....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
XML: birthTime (urn:hl7-org:sdtc)
....... desc 0..1 ED
...... scopingEntity 0..1 Entity
... entryRelationship 0..* EntryRelationship
... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
.... reference:reference1 1..* Reference
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId 0..1 II
...... @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_ActRelationshipExternalReference (required)
Fixed Value: REFR
..... seperatableInd 0..1 BL
..... externalAct 0..1 ExternalAct
..... externalObservation 0..1 ExternalObservation
..... externalProcedure 0..1 ExternalProcedure
..... externalDocument 1..1 ExternalDocument
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId 0..1 II
....... @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
...... @classCode 0..1 cs Binding: ActClassDocument (required)
...... @moodCode 0..1 cs Binding: CDAActMood (required)
Fixed Value: EVN
...... id 1..* II
...... code 1..1 CD Binding: Advance Directives Categories . (preferred)
...... text 0..1 ED
....... @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 The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
....... thumbnail 0..1 ED
...... setId 0..1 II
...... versionNumber 0..1 INT
... 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 0..1 II
..... @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-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.codeexampleObservationType
http://terminology.hl7.org/ValueSet/v3-ObservationType
Observation.code.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
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.valuerequiredAdvanceDirectivesContentType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
Observation.interpretationCoderequiredCDAObservationInterpretation
http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
Observation.methodCodeexampleObservationMethod
http://terminology.hl7.org/ValueSet/v3-ObservationMethod
Observation.participant:verifier.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.templateId:primary.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeCoderequiredFixed Value: VRF
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:verifier.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:verifier.time.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.time.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.participant:verifier.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.classCoderequiredCDARoleClassRoot
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:verifier.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:verifier.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:verifier.participantRole.playingEntity.codeexampleCDAEntityCode
http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
Observation.participant:custodian.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeCoderequiredFixed Value: CST
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:custodian.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:custodian.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.classCoderequiredFixed Value: AGNT
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:custodian.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeCoderequiredFixed Value: REFR
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Observation.reference:reference1.externalDocument.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.classCoderequiredActClassDocument
http://terminology.hl7.org/ValueSet/v3-ActClassDocument
Observation.reference:reference1.externalDocument.moodCoderequiredFixed Value: EVN
http://hl7.org/cda/stds/core/ValueSet/CDAActMood
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.reference:reference1.externalDocument.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.reference:reference1.externalDocument.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.reference:reference1.externalDocument.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.reference:reference1.externalDocument.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
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
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
81-7296errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addr**SHALL NOT** have mixed content except for white space (CONF:81-7296)
: item.xmlText.empty()
81-9371errorObservation.participant:verifier.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorObservation.participant:verifier.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
81-10024errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state'))
81-10025errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?'))
pn-no-lserrorObservation.participant:verifier.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
shall-cityerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain exactly one [1..1] city (CONF:81-7292).
: nullFlavor.exists() or item.city.count() = 1
shall-max-ad-partserrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL have at most one of each: state, city, postalCode, and country
: (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1)
shall-streetAddressLineerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
: nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4)
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-countrywarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain country
: nullFlavor.exists() or item.country.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
should-usewarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain @use
: nullFlavor.exists() or use.exists()
value-onlyerrorObservation.participant:verifier.timeInterval 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: 18 elements(8 nested mandatory elements)
Fixed: 7 elements
Prohibited: 1 element

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
  • The element 1 is sliced based on the value of Observation.participant
  • The element 1 is sliced based on the value of Observation.participant.templateId
  • The element 1 is sliced based on the value of Observation.reference

Differential View

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, 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)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
.... templateId:advance-directive-obs 1..1 II
..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.48
..... @extension 1..1 st Required Pattern: 2022-02-14
... @classCode 1..1 cs Fixed Value: OBS
... @moodCode 1..1 cs Fixed Value: EVN
... code C 1..1 CD should-translation: SHOULD contain translation
.... @code 1..1 cs Required Pattern: 75320-2
.... translation 0..* CD Binding: Advance Directives Categories . (preferred)
... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
.... reference C 0..1 TEL value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1 CS
.... @code 1..1 cs Fixed Value: completed
... effectiveTime 1..1 IVL_TS
.... low 1..1 IVXB_TS
.... high C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... value 1..1 CD Binding: Advance Directives Content Type . (required): Advance Directive Content Type

... author 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant SHOULD contain informant
... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
.... participant:verifier C 0..* Participant2 The participant "VRF" represents the clinician(s) who verified the patient advance directive.
should-time: SHOULD contain time
..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
...... templateId:primary 1..1 II
....... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.1.58
....... @extension 0..0
..... @typeCode 1..1 cs Fixed Value: VRF
..... time C 0..1 IVL_TS value-only: Interval fields SHALL not be present
...... @value 0..1 ts value should be used instead of low/high
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
...... addr 0..* USRealmAddress Base for all types and resources
...... playingEntity 1..1 PlayingEntity
....... name 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
.... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
..... @typeCode 1..1 cs Fixed Value: CST
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @classCode 1..1 cs Fixed Value: AGNT
...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
...... addr 0..1 USRealmAddress Base for all types and resources
...... telecom 0..* TEL
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
....... name 1..1 PN The name of the healthcare agent.
... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
.... reference:reference1 1..* Reference
..... @typeCode 1..1 cs Fixed Value: REFR
..... externalDocument 1..1 ExternalDocument
...... id 1..* II
...... code 1..1 CD Binding: Advance Directives Categories . (preferred)
...... text 0..1 ED
....... reference C 0..1 TEL The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.valuerequiredAdvanceDirectivesContentType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
value-onlyerrorObservation.participant:verifier.timeInterval 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 & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, 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)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
.... templateId:advance-directive-obs 1..1 II
..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.48
..... @extension 1..1 st Required Pattern: 2022-02-14
... @classCode 1..1 cs Binding: CDAActClassObservation (required)
Fixed Value: OBS
... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
Fixed Value: EVN
... code C 1..1 CD Binding: ObservationType (example)
should-translation: SHOULD contain translation
.... @code 1..1 cs Required Pattern: 75320-2
.... translation 0..* CD Binding: Advance Directives Categories . (preferred)
... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
.... reference C 0..1 TEL value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1 CS Binding: ActStatus (required)
.... @code 1..1 cs Fixed Value: completed
... effectiveTime 1..1 IVL_TS
.... low 1..1 IVXB_TS
.... high C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... value 1..1 CD Binding: Advance Directives Content Type . (required): Advance Directive Content Type


... author 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant SHOULD contain informant
... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
.... participant:verifier C 0..* Participant2 The participant "VRF" represents the clinician(s) who verified the patient advance directive.
should-time: SHOULD contain time
..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
...... templateId:primary 1..1 II
....... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.1.58
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: VRF
..... time C 0..1 IVL_TS value-only: Interval fields SHALL not be present
...... @value 0..1 ts value should be used instead of low/high
Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
...... addr C 0..* USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... playingEntity 1..1 PlayingEntity
....... name C 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
.... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: CST
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @classCode 1..1 cs Binding: CDARoleClassRoot (required)
Fixed Value: AGNT
...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
...... addr C 0..1 USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
....... name 1..1 PN The name of the healthcare agent.
... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
.... reference:reference1 1..* Reference
..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
Fixed Value: REFR
..... externalDocument 1..1 ExternalDocument
...... id 1..* II
...... code 1..1 CD Binding: Advance Directives Categories . (preferred)
...... text 0..1 ED
....... reference C 0..1 TEL The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
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.codeexampleObservationType
http://terminology.hl7.org/ValueSet/v3-ObservationType
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.statusCoderequiredActStatus
http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.valuerequiredAdvanceDirectivesContentType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
Observation.participant:verifier.typeCoderequiredFixed Value: VRF
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:custodian.typeCoderequiredFixed Value: CST
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:custodian.participantRole.classCoderequiredFixed Value: AGNT
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.typeCoderequiredFixed Value: REFR
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
81-7296errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addr**SHALL NOT** have mixed content except for white space (CONF:81-7296)
: item.xmlText.empty()
81-9371errorObservation.participant:verifier.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorObservation.participant:verifier.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
81-10024errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state'))
81-10025errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?'))
pn-no-lserrorObservation.participant:verifier.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
shall-cityerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain exactly one [1..1] city (CONF:81-7292).
: nullFlavor.exists() or item.city.count() = 1
shall-max-ad-partserrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL have at most one of each: state, city, postalCode, and country
: (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1)
shall-streetAddressLineerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
: nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4)
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-countrywarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain country
: nullFlavor.exists() or item.country.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
should-usewarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain @use
: nullFlavor.exists() or use.exists()
value-onlyerrorObservation.participant:verifier.timeInterval 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 & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, 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)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId 0..1 II
.... @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-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: 2.16.840.1.113883.10.20.22.4.48
..... @extension 1..1 st Required Pattern: 2022-02-14
... @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
... code C 1..1 CD Binding: ObservationType (example)
should-translation: SHOULD contain translation
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @code 1..1 cs Required Pattern: 75320-2
.... @codeSystem 0..1 oid, uuid, ruid
.... @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 Binding: Advance Directives Categories . (preferred)
... 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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
.... 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 1..1 IVL_TS
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
.... @operator 0..1 cs Binding: CDASetOperator (required)
.... low 1..1 IVXB_TS
.... center 0..1 TS
.... width 0..1 PQ
.... high C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... priorityCode 0..1 CE Binding: ActPriority (example)
... repeatNumber 0..1 IVL_INT
... languageCode 0..1 CS Binding: AllLanguages (required)
... value 1..1 CD Binding: Advance Directives Content Type . (required): Advance Directive Content Type


... 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 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant SHOULD contain informant
... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
.... participant:verifier C 0..* Participant2 The participant "VRF" represents the clinician(s) who verified the patient advance directive.
should-time: SHOULD contain time
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId 0..1 II
...... @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
...... templateId:primary 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: 2.16.840.1.113883.10.20.1.58
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: VRF
..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
Fixed Value: OP
..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
XML: functionCode (urn:hl7-org:sdtc)
..... time C 0..1 IVL_TS value-only: Interval fields SHALL not be present
...... @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
..... awarenessCode 0..1 CE
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId 0..1 II
....... @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
...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
...... id 0..* II
...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
XML: identifiedBy (urn:hl7-org:sdtc)
...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
...... addr C 0..* USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingDevice 0..1 Device
...... playingEntity 1..1 PlayingEntity
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... realmCode 0..* CS
....... typeId 0..1 II
........ @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
....... @classCode 0..1 cs Binding: EntityClassRoot (required)
....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
Fixed Value: INSTANCE
....... code 0..1 CE Binding: CDAEntityCode (example)
....... quantity 0..* PQ
....... name C 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
XML: birthTime (urn:hl7-org:sdtc)
....... desc 0..1 ED
...... scopingEntity 0..1 Entity
.... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId 0..1 II
...... @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: CDAParticipationType (required)
Fixed Value: CST
..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
Fixed Value: OP
..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
XML: functionCode (urn:hl7-org:sdtc)
..... time 0..1 IVL_TS
..... awarenessCode 0..1 CE
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId 0..1 II
....... @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
...... @classCode 1..1 cs Binding: CDARoleClassRoot (required)
Fixed Value: AGNT
...... id 0..* II
...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
XML: identifiedBy (urn:hl7-org:sdtc)
...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
...... addr C 0..1 USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingDevice 0..1 Device
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... realmCode 0..* CS
....... typeId 0..1 II
........ @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
....... @classCode 0..1 cs Binding: EntityClassRoot (required)
....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
Fixed Value: INSTANCE
....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
....... quantity 0..* PQ
....... name 1..1 PN The name of the healthcare agent.
....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
XML: birthTime (urn:hl7-org:sdtc)
....... desc 0..1 ED
...... scopingEntity 0..1 Entity
... entryRelationship 0..* EntryRelationship
... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
.... reference:reference1 1..* Reference
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId 0..1 II
...... @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_ActRelationshipExternalReference (required)
Fixed Value: REFR
..... seperatableInd 0..1 BL
..... externalAct 0..1 ExternalAct
..... externalObservation 0..1 ExternalObservation
..... externalProcedure 0..1 ExternalProcedure
..... externalDocument 1..1 ExternalDocument
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId 0..1 II
....... @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
...... @classCode 0..1 cs Binding: ActClassDocument (required)
...... @moodCode 0..1 cs Binding: CDAActMood (required)
Fixed Value: EVN
...... id 1..* II
...... code 1..1 CD Binding: Advance Directives Categories . (preferred)
...... text 0..1 ED
....... @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 The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
....... thumbnail 0..1 ED
...... setId 0..1 II
...... versionNumber 0..1 INT
... 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 0..1 II
..... @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-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.codeexampleObservationType
http://terminology.hl7.org/ValueSet/v3-ObservationType
Observation.code.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
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.valuerequiredAdvanceDirectivesContentType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1099.57
Observation.interpretationCoderequiredCDAObservationInterpretation
http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
Observation.methodCodeexampleObservationMethod
http://terminology.hl7.org/ValueSet/v3-ObservationMethod
Observation.participant:verifier.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.templateId:primary.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeCoderequiredFixed Value: VRF
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:verifier.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:verifier.time.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.time.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.participant:verifier.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.classCoderequiredCDARoleClassRoot
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:verifier.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:verifier.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:verifier.participantRole.playingEntity.codeexampleCDAEntityCode
http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
Observation.participant:custodian.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeCoderequiredFixed Value: CST
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:custodian.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:custodian.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.classCoderequiredFixed Value: AGNT
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:custodian.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeCoderequiredFixed Value: REFR
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Observation.reference:reference1.externalDocument.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.classCoderequiredActClassDocument
http://terminology.hl7.org/ValueSet/v3-ActClassDocument
Observation.reference:reference1.externalDocument.moodCoderequiredFixed Value: EVN
http://hl7.org/cda/stds/core/ValueSet/CDAActMood
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.reference:reference1.externalDocument.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.reference:reference1.externalDocument.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.reference:reference1.externalDocument.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.reference:reference1.externalDocument.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
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
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
81-7296errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addr**SHALL NOT** have mixed content except for white space (CONF:81-7296)
: item.xmlText.empty()
81-9371errorObservation.participant:verifier.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorObservation.participant:verifier.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
81-10024errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state'))
81-10025errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?'))
pn-no-lserrorObservation.participant:verifier.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
shall-cityerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain exactly one [1..1] city (CONF:81-7292).
: nullFlavor.exists() or item.city.count() = 1
shall-max-ad-partserrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL have at most one of each: state, city, postalCode, and country
: (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1)
shall-streetAddressLineerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
: nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4)
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-countrywarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain country
: nullFlavor.exists() or item.country.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
should-usewarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain @use
: nullFlavor.exists() or use.exists()
value-onlyerrorObservation.participant:verifier.timeInterval 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: 18 elements(8 nested mandatory elements)
Fixed: 7 elements
Prohibited: 1 element

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
  • The element 1 is sliced based on the value of Observation.participant
  • The element 1 is sliced based on the value of Observation.participant.templateId
  • The element 1 is sliced based on the value of Observation.reference

 

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