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

This page is part of the CCDA: Consolidated CDA Release (v4.0.0: CCDA 4.0) generated with FHIR (HL7ยฎ FHIRยฎ 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: 4.0.0
Draft as of 2025-06-20 Computable Name: AdvanceDirectiveObservation
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2025-05-01

The Advance Directive Observation template is nested within the Advance Directive Existence Observation, which indicates whether the individual has any advance directive documents. Each Advance Directive Observation template provides details about one type of advance directive document and may also include information about the documentโ€™s author, as well as any individuals who discussed and verified its contents with the patient or their designated healthcare agent.

The Advance Directive Observation template also can be nested within an Intervention Act to serve as documentation explaining why an intervention was planned/performed or not.

Usages:

Changes since version 3.0.0:

  • The resource metadata has changed (description)

    • Formal Views of Template Content

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

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-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: 2025-05-01
    ... @classCode 1..1 cs Fixed Value: OBS
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... code C 1..1 CD Advance Directive
    Constraints: should-translation
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS
    .... @code 1..1 cs Fixed Value: completed
    ... effectiveTime 1..1 IVL_TS
    .... low 1..1 IVXB_TS
    .... high C 1..1 IVXB_TS Constraints: 1198-32449
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... author 0..* AuthorParticipation
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-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 Constraints: value-only
    ...... @value 0..1 ts value should be used instead of low/high
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ...... addr 0..* USRealmAddress
    ...... playingEntity 1..1 PlayingEntity
    ....... name 1..1 USRealmPersonNamePNUSFIELDED
    .... 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 Constraints: should-code, should-addr, should-telecom
    ...... @classCode 1..1 cs Fixed Value: AGNT
    ...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
    ...... addr 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-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 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... id 1..* II
    ...... code 1..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (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).
    Constraints: 1198-8699
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.code.translationpreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
    Observation.valuepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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.codepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41

    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 & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-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: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ... code C 1..1 CD Advance Directive
    Binding: ObservationType (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (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 Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Fixed Value: completed
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime 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 Constraints: 1198-32449
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... 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
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
    ...... 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 Constraints: value-only
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    ...... @operator 0..1 cs Binding: CDASetOperator (required)
    ...... low 0..1 IVXB_TS
    ...... center 0..1 TS
    ...... width 0..1 PQ
    ...... high 0..1 IVXB_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 0..* USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 1..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @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 1..1 USRealmPersonNamePNUSFIELDED
    ....... 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 C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: 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 Constraints: should-code, should-addr, should-telecom
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @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 C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_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 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 Healthcare Directive Document Types Grouper . (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).
    Constraints: 1198-8699
    ....... thumbnail 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... referenceRange 0..* InfrastructureRoot
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    .... observationRange 1..1 ObservationRange
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.templateId:advance-directive-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.translationpreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    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.valuepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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.codepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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'
    II-1errorObservation.typeId, Observation.participant:verifier.typeId, Observation.participant:verifier.participantRole.typeId, Observation.participant:verifier.participantRole.playingEntity.typeId, Observation.participant:custodian.typeId, Observation.participant:custodian.participantRole.typeId, Observation.participant:custodian.participantRole.playingEntity.typeId, Observation.reference:reference1.typeId, Observation.reference:reference1.externalDocument.typeId, Observation.referenceRange.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    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 & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-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: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ... code C 1..1 CD Advance Directive
    Binding: ObservationType (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (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 Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Fixed Value: completed
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime 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 Constraints: 1198-32449
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... 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
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
    ...... 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 Constraints: value-only
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    ...... @operator 0..1 cs Binding: CDASetOperator (required)
    ...... low 0..1 IVXB_TS
    ...... center 0..1 TS
    ...... width 0..1 PQ
    ...... high 0..1 IVXB_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 0..* USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 1..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @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 1..1 USRealmPersonNamePNUSFIELDED
    ....... 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 C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: 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 Constraints: should-code, should-addr, should-telecom
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @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 C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_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 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 Healthcare Directive Document Types Grouper . (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).
    Constraints: 1198-8699
    ....... thumbnail 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... referenceRange 0..* InfrastructureRoot
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    .... observationRange 1..1 ObservationRange
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.templateId:advance-directive-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.translationpreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    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.valuepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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.codepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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'
    II-1errorObservation.typeId, Observation.participant:verifier.typeId, Observation.participant:verifier.participantRole.typeId, Observation.participant:verifier.participantRole.playingEntity.typeId, Observation.participant:custodian.typeId, Observation.participant:custodian.participantRole.typeId, Observation.participant:custodian.participantRole.playingEntity.typeId, Observation.reference:reference1.typeId, Observation.reference:reference1.externalDocument.typeId, Observation.referenceRange.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    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('#')

    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 & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-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: 2025-05-01
    ... @classCode 1..1 cs Fixed Value: OBS
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... code C 1..1 CD Advance Directive
    Constraints: should-translation
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS
    .... @code 1..1 cs Fixed Value: completed
    ... effectiveTime 1..1 IVL_TS
    .... low 1..1 IVXB_TS
    .... high C 1..1 IVXB_TS Constraints: 1198-32449
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... author 0..* AuthorParticipation
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-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 Constraints: value-only
    ...... @value 0..1 ts value should be used instead of low/high
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ...... addr 0..* USRealmAddress
    ...... playingEntity 1..1 PlayingEntity
    ....... name 1..1 USRealmPersonNamePNUSFIELDED
    .... 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 Constraints: should-code, should-addr, should-telecom
    ...... @classCode 1..1 cs Fixed Value: AGNT
    ...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
    ...... addr 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-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 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... id 1..* II
    ...... code 1..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (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).
    Constraints: 1198-8699
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Observation.code.translationpreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
    Observation.valuepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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.codepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41

    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 & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-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: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ... code C 1..1 CD Advance Directive
    Binding: ObservationType (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (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 Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Fixed Value: completed
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime 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 Constraints: 1198-32449
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... 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
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
    ...... 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 Constraints: value-only
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    ...... @operator 0..1 cs Binding: CDASetOperator (required)
    ...... low 0..1 IVXB_TS
    ...... center 0..1 TS
    ...... width 0..1 PQ
    ...... high 0..1 IVXB_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 0..* USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 1..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @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 1..1 USRealmPersonNamePNUSFIELDED
    ....... 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 C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: 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 Constraints: should-code, should-addr, should-telecom
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @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 C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_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 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 Healthcare Directive Document Types Grouper . (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).
    Constraints: 1198-8699
    ....... thumbnail 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... referenceRange 0..* InfrastructureRoot
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    .... observationRange 1..1 ObservationRange
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.templateId:advance-directive-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.translationpreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    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.valuepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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.codepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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'
    II-1errorObservation.typeId, Observation.participant:verifier.typeId, Observation.participant:verifier.participantRole.typeId, Observation.participant:verifier.participantRole.playingEntity.typeId, Observation.participant:custodian.typeId, Observation.participant:custodian.participantRole.typeId, Observation.participant:custodian.participantRole.playingEntity.typeId, Observation.reference:reference1.typeId, Observation.reference:reference1.externalDocument.typeId, Observation.referenceRange.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    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('#')

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-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: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ... code C 1..1 CD Advance Directive
    Binding: ObservationType (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (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 Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Fixed Value: completed
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime 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 Constraints: 1198-32449
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... 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
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
    ...... 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 Constraints: value-only
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    ...... @operator 0..1 cs Binding: CDASetOperator (required)
    ...... low 0..1 IVXB_TS
    ...... center 0..1 TS
    ...... width 0..1 PQ
    ...... high 0..1 IVXB_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 0..* USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 1..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @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 1..1 USRealmPersonNamePNUSFIELDED
    ....... 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 C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: 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 Constraints: should-code, should-addr, should-telecom
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @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 C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_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 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @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 Healthcare Directive Document Types Grouper . (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).
    Constraints: 1198-8699
    ....... thumbnail 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... referenceRange 0..* InfrastructureRoot
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... realmCode 0..* CS
    .... typeId C 0..1 II Constraints: II-1
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ..... @extension 1..1 st
    .... templateId 0..* II
    .... @typeCode 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    .... observationRange 1..1 ObservationRange
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Observation.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Observation.templateId:advance-directive-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.translationpreferredAdvanceHealthcareDirectiveCategoriesLOINC .
    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.valuepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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.codepreferredAdvanceHealthcareDirectiveDocumentTypesGrouper .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41
    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'
    II-1errorObservation.typeId, Observation.participant:verifier.typeId, Observation.participant:verifier.participantRole.typeId, Observation.participant:verifier.participantRole.playingEntity.typeId, Observation.participant:custodian.typeId, Observation.participant:custodian.participantRole.typeId, Observation.participant:custodian.participantRole.playingEntity.typeId, Observation.reference:reference1.typeId, Observation.reference:reference1.externalDocument.typeId, Observation.referenceRange.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    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('#')

    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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