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

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

Logical Model: NoteActivity - Detailed Descriptions

Draft as of 2024-05-18

Definitions for the NoteActivity logical model.

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

0. Act
Logical ContainerClinicalDocument (CDA Class)
ValidationInstance of this type are validated by templateId
XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
2. Act.templateId
Control1..?
SlicingThis element introduces a set of slices on Act.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ root
  • value @ extension
  • 4. Act.templateId:note-activity
    Slice Namenote-activity
    Control1..1
    6. Act.templateId:note-activity.root
    Control1..?
    Pattern Value2.16.840.1.113883.10.20.22.4.202
    8. Act.templateId:note-activity.extension
    Control1..?
    Pattern Value2016-11-01
    10. Act.classCode
    Comments

    SHALL contain exactly one [1..1] @classCode="ACT" Act (CONF:3250-16899).

    Fixed ValueACT
    12. Act.moodCode
    Comments

    SHALL contain exactly one [1..1] @moodCode="EVN" Event (CONF:3250-16900).

    Fixed ValueEVN
    14. Act.code
    Comments

    SHALL contain exactly one [1..1] code (CONF:3250-16895).

    Invariantsshould-translation: SHOULD contain translation (translation.exists())
    16. Act.code.code
    Comments

    This code SHALL contain exactly one [1..1] @code="34109-9" Note (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3250-16940).

    Control1..?
    Pattern Value34109-9
    18. Act.code.codeSystem
    Comments

    This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" LOINC (CONF:3250-16941).

    Control1..?
    Pattern Value2.16.840.1.113883.6.1
    20. Act.code.translation
    ShortIf the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Comments

    This code SHOULD contain zero or more [0..*] translation, which SHOULD be selected from ValueSet Note Types urn:oid:2.16.840.1.113883.11.20.9.68 DYNAMIC (CONF:3250-16939).

    BindingThe codes SHOULD be taken from Note Types .
    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68)
    22. Act.text
    ShortSHOULD reference the portion of section narrative text corresponding to this entry
    Comments

    SHALL contain exactly one [1..1] text (CONF:3250-16896).

    Control1..?
    Invariants3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). (mediaType.exists() implies (representation = 'B64' and xmlText.exists()))
    24. Act.text.mediaType
    ShortIf the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Comments

    This text MAY contain zero or one [0..1] @mediaType, which SHOULD be selected from ValueSet SupportedFileFormats urn:oid:2.16.840.1.113883.11.20.7.1 DYNAMIC (CONF:3250-16906).

    BindingThe codes SHOULD be taken from SupportedFileFormats .
    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1)
    26. Act.text.reference
    Comments

    This text SHALL contain exactly one [1..1] reference (CONF:3250-16897).

    Control1..?
    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
    28. Act.text.reference.nullFlavor
    ShortThe note activity must reference human-readable content in the narrative, so this reference must not be null.
    Comments

    This reference SHALL NOT contain [0..0] @nullFlavor (CONF:3250-16920).

    Control0..0
    30. Act.text.reference.value
    Comments

    This reference SHALL contain exactly one [1..1] @value (CONF:3250-16898).

    Control1..?
    32. Act.statusCode
    ShortIndicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Comments

    SHALL contain exactly one [1..1] statusCode (CONF:3250-16916).

    Control1..?
    34. Act.effectiveTime
    ShortThe effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Comments

    SHALL contain exactly one [1..1] effectiveTime (CONF:3250-16903).

    Control1..?
    Invariantsshould-value-att: SHOULD contain @value (value.exists())
    36. Act.effectiveTime.value
    Comments

    This effectiveTime SHOULD contain zero or one [0..1] @value (CONF:3250-16917).

    38. Act.author
    ShortRepresents the person(s) who wrote the note.
    Comments

    SHALL contain at least one [1..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:3250-16913).

    Control1..?
    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
    40. Act.participant
    Comments

    MAY contain zero or more [0..*] participant (CONF:3250-16923) such that it

    SlicingThis element introduces a set of slices on Act.participant. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ typeCode
    • 42. Act.participant:legalAuthenticator
      Slice NamelegalAuthenticator
      ShortRepresents the person(s) legally responsible for the contents of the note.
      Control0..*
      44. Act.participant:legalAuthenticator.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="LA" Legal Authenticator (CONF:3250-16925).

      Fixed ValueLA
      46. Act.participant:legalAuthenticator.time
      ShortIndicates the time of signing the note.
      Comments

      SHALL contain exactly one [1..1] US Realm Date and Time (Interval) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.3) (CONF:3250-16926).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS(US Realm Date and Time - Interval)
      48. Act.participant:legalAuthenticator.participantRole
      Comments

      SHALL contain exactly one [1..1] participantRole (CONF:3250-16924).

      Invariants3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). ()
      50. Act.participant:legalAuthenticator.participantRole.id
      ShortThis may be the ID of the note author. If so, no additional information in this participant is required.
      Comments

      This participantRole SHALL contain at least one [1..*] id (CONF:3250-16927).

      Control1..?
      52. Act.participant:legalAuthenticator.participantRole.playingEntity
      Comments

      This participantRole MAY contain zero or one [0..1] playingEntity (CONF:3250-16928).

      54. Act.participant:legalAuthenticator.participantRole.playingEntity.name
      Comments

      The playingEntity, if present, SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:3250-16929).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/PN(US Realm Person Name (PN.US.FIELDED))
      56. Act.entryRelationship
      Comments

      SHOULD contain zero or more [0..*] entryRelationship (CONF:3250-16907) such that it

      SlicingThis element introduces a set of slices on Act.entryRelationship. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • exists @ encounter
      • 58. Act.entryRelationship:encounter
        Slice Nameencounter
        ShortLinks the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
        Control0..*
        60. Act.entryRelationship:encounter.typeCode
        Comments

        SHALL contain exactly one [1..1] @typeCode="COMP" (CONF:3250-16921).

        Fixed ValueCOMP
        62. Act.entryRelationship:encounter.inversionInd
        Comments

        SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3250-16922).

        Control1..?
        Fixed Valuetrue
        64. Act.entryRelationship:encounter.negationInd
        ShortTo communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
        Comments

        MAY contain zero or one [0..1] @negationInd (CONF:3250-16931).

        66. Act.entryRelationship:encounter.encounter
        Comments

        SHALL contain exactly one [1..1] encounter (CONF:3250-16908).

        Control1..?
        68. Act.entryRelationship:encounter.encounter.id
        Comments

        This encounter SHALL contain at least one [1..*] id (CONF:3250-16909).

        Control1..?
        Invariants3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). ()
        70. Act.reference
        Comments

        MAY contain zero or more [0..*] reference (CONF:3250-16910) such that it

        SlicingThis element introduces a set of slices on Act.reference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • exists @ externalDocument
        • 72. Act.reference:externalDocument
          Slice NameexternalDocument
          ShortRepresents an unstructured C-CDA document containing the original contents of the note in the original format.
          Control0..*
          74. Act.reference:externalDocument.externalDocument
          Comments

          SHALL contain exactly one [1..1] externalDocument (CONF:3250-16911).

          Control1..?
          Invariantsshould-code: SHOULD contain code (code.exists())
          76. Act.reference:externalDocument.externalDocument.id
          Comments

          This externalDocument SHALL contain exactly one [1..1] id (CONF:3250-16915).

          Control1..1
          78. Act.reference:externalDocument.externalDocument.code
          Comments

          This externalDocument SHOULD contain zero or one [0..1] code (CONF:3250-16918).

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

          0. Act
          Definition

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


          Base definition for all types defined in FHIR type system.

          ShortBase for all types and resources
          Control10..1*
          Is Modifierfalse
          Logical ContainerClinicalDocument (CDA Class)
          ValidationInstance of this type are validated by templateId
          XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
          Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
          2. Act.templateId
          Definition

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

          Control1..*
          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
          SlicingThis element introduces a set of slices on Act.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ root
          • value @ extension
          • 4. Act.templateId:note-activity
            Slice Namenote-activity
            Definition

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

            Control1..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
            6. Act.templateId:note-activity.root
            Definition

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

            Control1..1
            Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelRoot
            Pattern Value2.16.840.1.113883.10.20.22.4.202
            8. Act.templateId:note-activity.extension
            Definition

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

            Control1..1
            Typestring(st: Character String)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelExtension
            Pattern Value2016-11-01
            10. Act.classCode
            Comments

            SHALL contain exactly one [1..1] @classCode="ACT" Act (CONF:3250-16899).

            Control1..1
            BindingThe codes SHALL be taken from XActClassDocumentEntryAct (2.0.0)
            (required to http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0)
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            Fixed ValueACT
            12. Act.moodCode
            Comments

            SHALL contain exactly one [1..1] @moodCode="EVN" Event (CONF:3250-16900).

            Control1..1
            BindingThe codes SHALL be taken from XDocumentActMood (2.0.0)
            (required to http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0)
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            Fixed ValueEVN
            14. Act.code
            Comments

            SHALL contain exactly one [1..1] code (CONF:3250-16895).

            Control1..1
            BindingFor example codes, see v3 Code System ActCode
            (example to http://terminology.hl7.org/ValueSet/v3-ActCode)
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
            Invariantsshould-translation: SHOULD contain translation (translation.exists())
            16. Act.code.code
            Definition

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

            Comments

            This code SHALL contain exactly one [1..1] @code="34109-9" Note (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3250-16940).

            Control1..1
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelCode
            Pattern Value34109-9
            18. Act.code.codeSystem
            Definition

            Specifies the code system that defines the code.

            Comments

            This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" LOINC (CONF:3250-16941).

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

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

            ShortIf the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
            Comments

            This code SHOULD contain zero or more [0..*] translation, which SHOULD be selected from ValueSet Note Types urn:oid:2.16.840.1.113883.11.20.9.68 DYNAMIC (CONF:3250-16939).

            Control0..*
            BindingThe codes SHOULD be taken from Note Types .
            (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68)
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
            XML FormatThe type of this property is determined using the " xsi:typeattribute.
            LabelTranslation
            22. Act.text
            ShortSHOULD reference the portion of section narrative text corresponding to this entry
            Comments

            SHALL contain exactly one [1..1] text (CONF:3250-16896).

            Control1..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
            Invariants3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). (mediaType.exists() implies (representation = 'B64' and xmlText.exists()))
            24. Act.text.mediaType
            Definition

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

            ShortIf the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
            Comments

            This text MAY contain zero or one [0..1] @mediaType, which SHOULD be selected from ValueSet SupportedFileFormats urn:oid:2.16.840.1.113883.11.20.7.1 DYNAMIC (CONF:3250-16906).

            Control0..1
            BindingThe codes SHOULD be taken from SupportedFileFormats .
            (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1)
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelMedia Type
            26. Act.text.reference
            Definition

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

            Comments

            This text SHALL contain exactly one [1..1] reference (CONF:3250-16897).

            Control1..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
            LabelReference
            Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
            28. Act.text.reference.nullFlavor
            Definition

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

            ShortThe note activity must reference human-readable content in the narrative, so this reference must not be null.
            Comments

            This reference SHALL NOT contain [0..0] @nullFlavor (CONF:3250-16920).

            Control0..0
            BindingThe codes SHALL be taken from CDANullFlavor
            (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelExceptional Value Detail
            30. Act.text.reference.value
            Comments

            This reference SHALL contain exactly one [1..1] @value (CONF:3250-16898).

            Control1..1
            Typeurl(url: Universal Resource Locator)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            32. Act.statusCode
            ShortIndicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
            Comments

            SHALL contain exactly one [1..1] statusCode (CONF:3250-16916).

            Control1..1
            BindingThe codes SHALL be taken from ActStatus
            (required to http://terminology.hl7.org/ValueSet/v3-ActStatus)
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
            34. Act.effectiveTime
            ShortThe effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
            Comments

            SHALL contain exactly one [1..1] effectiveTime (CONF:3250-16903).

            Control1..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
            Invariantsshould-value-att: SHOULD contain @value (value.exists())
            36. Act.effectiveTime.value
            Definition

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

            Comments

            This effectiveTime SHOULD contain zero or one [0..1] @value (CONF:3250-16917).

            Control0..1
            TypedateTime(ts: Point in Time)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Date FormatYYYYMMDDHHMMSS.UUUU[+|-ZZzz]
            XML FormatIn the XML format, this property is represented as an attribute.
            38. Act.author
            Definition

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

            ShortRepresents the person(s) who wrote the note.
            Comments

            SHALL contain at least one [1..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:3250-16913).

            Control1..*
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
            Is Modifierfalse
            40. Act.participant
            Comments

            MAY contain zero or more [0..*] participant (CONF:3250-16923) such that it

            Control0..*
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
            SlicingThis element introduces a set of slices on Act.participant. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ typeCode
            • 42. Act.participant:legalAuthenticator
              Slice NamelegalAuthenticator
              ShortRepresents the person(s) legally responsible for the contents of the note.
              Control0..*
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
              44. Act.participant:legalAuthenticator.typeCode
              Comments

              SHALL contain exactly one [1..1] @typeCode="LA" Legal Authenticator (CONF:3250-16925).

              Control1..1
              BindingThe codes SHALL be taken from CDAParticipationType
              (required to http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType)
              Typecode(cs: Coded Simple Value)
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              XML FormatIn the XML format, this property is represented as an attribute.
              Fixed ValueLA
              46. Act.participant:legalAuthenticator.time
              Definition

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

              ShortIndicates the time of signing the note.
              Comments

              SHALL contain exactly one [1..1] US Realm Date and Time (Interval) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.3) (CONF:3250-16926).

              Control1..1
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS(US Realm Date and Time - Interval)
              Is Modifierfalse
              Invariantsivl-ts-center: Center cannot co-exist with low or high (center.empty() or (low.empty() and high.empty()))
              ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day. (value.exists() implies value.toString().length() >= 10)
              ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component. (value.exists() implies value.toString().length() > 10)
              48. Act.participant:legalAuthenticator.participantRole
              Comments

              SHALL contain exactly one [1..1] participantRole (CONF:3250-16924).

              Control1..1
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/ParticipantRole
              Invariants3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). ()
              50. Act.participant:legalAuthenticator.participantRole.id
              ShortThis may be the ID of the note author. If so, no additional information in this participant is required.
              Comments

              This participantRole SHALL contain at least one [1..*] id (CONF:3250-16927).

              Control1..*
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
              52. Act.participant:legalAuthenticator.participantRole.playingEntity
              Comments

              This participantRole MAY contain zero or one [0..1] playingEntity (CONF:3250-16928).

              Control0..1
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/PlayingEntity
              54. Act.participant:legalAuthenticator.participantRole.playingEntity.name
              Definition

              A name for a person. A sequence of name parts, such as given name or family name, prefix, suffix, etc. Examples for person name values are "Jim Bob Walton, Jr.", "Adam Everyman", etc. A person name may be as simple as a character string or may consist of several person name parts, such as, "Jim", "Bob", "Walton", and "Jr.". PN differs from EN because the qualifier type cannot include LS (Legal Status).

              ShortBase for all types and resources
              Comments

              The playingEntity, if present, SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:3250-16929).

              Control1..*
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/PN(US Realm Person Name (PN.US.FIELDED))
              Is Modifierfalse
              Invariantspn-no-ls: No PN name part may have a qualifier of LS. ((item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty())
              81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). (conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists())
              81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372). (item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty())
              56. Act.entryRelationship
              Comments

              SHOULD contain zero or more [0..*] entryRelationship (CONF:3250-16907) such that it

              Control0..*
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/EntryRelationship
              SlicingThis element introduces a set of slices on Act.entryRelationship. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • exists @ encounter
              • 58. Act.entryRelationship:encounter
                Slice Nameencounter
                ShortLinks the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
                Control0..*
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/EntryRelationship
                60. Act.entryRelationship:encounter.typeCode
                Comments

                SHALL contain exactly one [1..1] @typeCode="COMP" (CONF:3250-16921).

                Control1..1
                BindingThe codes SHALL be taken from x_ActRelationshipEntryRelationship
                (required to http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship)
                Typecode(cs: Coded Simple Value)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed ValueCOMP
                62. Act.entryRelationship:encounter.inversionInd
                Definition

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

                Comments

                SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3250-16922).

                Control1..1
                Typeboolean(bl: Boolean)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed Valuetrue
                64. Act.entryRelationship:encounter.negationInd
                ShortTo communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
                Comments

                MAY contain zero or one [0..1] @negationInd (CONF:3250-16931).

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

                SHALL contain exactly one [1..1] encounter (CONF:3250-16908).

                Control1..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/Encounter
                68. Act.entryRelationship:encounter.encounter.classCode
                Control1..1
                BindingThe codes SHALL be taken from CDAActClass
                (required to http://hl7.org/cda/stds/core/ValueSet/CDAActClass)
                Typecode(cs: Coded Simple Value)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed ValueENC
                70. Act.entryRelationship:encounter.encounter.moodCode
                Control1..1
                BindingThe codes SHALL be taken from XDocumentEncounterMood (2.0.0)
                (required to http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0)
                Typecode(cs: Coded Simple Value)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                72. Act.entryRelationship:encounter.encounter.id
                Definition

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

                ShortLogical id of this artifact
                Comments

                This encounter SHALL contain at least one [1..*] id (CONF:3250-16909).


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

                Control10..*1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/IIid
                Is Modifierfalse
                Invariants3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). ()
                74. Act.reference
                Comments

                MAY contain zero or more [0..*] reference (CONF:3250-16910) such that it

                Control0..*
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                SlicingThis element introduces a set of slices on Act.reference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • exists @ externalDocument
                • 76. Act.reference:externalDocument
                  Slice NameexternalDocument
                  ShortRepresents an unstructured C-CDA document containing the original contents of the note in the original format.
                  Control0..*
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                  78. Act.reference:externalDocument.typeCode
                  Control1..1
                  BindingThe codes SHALL be taken from x_ActRelationshipExternalReference
                  (required to http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference)
                  Typecode(cs: Coded Simple Value)
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  80. Act.reference:externalDocument.externalDocument
                  Comments

                  SHALL contain exactly one [1..1] externalDocument (CONF:3250-16911).

                  Control1..1
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalDocument
                  Invariantsshould-code: SHOULD contain code (code.exists())
                  82. Act.reference:externalDocument.externalDocument.id
                  Comments

                  This externalDocument SHALL contain exactly one [1..1] id (CONF:3250-16915).

                  Control1..1
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                  84. Act.reference:externalDocument.externalDocument.code
                  Comments

                  This externalDocument SHOULD contain zero or one [0..1] code (CONF:3250-16918).

                  Control0..1
                  BindingFor example codes, see FHIRDocumentTypeCodes
                  (example to http://hl7.org/fhir/ValueSet/doc-typecodes)
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD

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

                  0. Act
                  Definition

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

                  ShortBase for all types and resources
                  Control1..1
                  Is Modifierfalse
                  Logical ContainerClinicalDocument (CDA Class)
                  ValidationInstance of this type are validated by templateId
                  XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
                  Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
                  2. Act.nullFlavor
                  Definition

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

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

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

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

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

                  Control0..1
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                  8. Act.typeId.nullFlavor
                  Definition

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

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

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

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

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

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

                  Identifies the type as an HL7 Registered model

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

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

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

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

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

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

                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                    22. Act.templateId:note-activity.nullFlavor
                    Definition

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

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

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

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

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

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

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

                    Control1..1
                    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelRoot
                    Pattern Value2.16.840.1.113883.10.20.22.4.202
                    30. Act.templateId:note-activity.extension
                    Definition

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

                    Control1..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelExtension
                    Pattern Value2016-11-01
                    32. Act.classCode
                    Comments

                    SHALL contain exactly one [1..1] @classCode="ACT" Act (CONF:3250-16899).

                    Control1..1
                    BindingThe codes SHALL be taken from XActClassDocumentEntryAct (2.0.0)
                    (required to http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Fixed ValueACT
                    34. Act.moodCode
                    Comments

                    SHALL contain exactly one [1..1] @moodCode="EVN" Event (CONF:3250-16900).

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

                    SHALL contain exactly one [1..1] code (CONF:3250-16895).

                    Control1..1
                    BindingFor example codes, see v3 Code System ActCode
                    (example to http://terminology.hl7.org/ValueSet/v3-ActCode)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                    Invariantsshould-translation: SHOULD contain translation (translation.exists())
                    42. Act.code.nullFlavor
                    Definition

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

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

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

                    Comments

                    This code SHALL contain exactly one [1..1] @code="34109-9" Note (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3250-16940).

                    Control1..1
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode
                    Pattern Value34109-9
                    46. Act.code.codeSystem
                    Definition

                    Specifies the code system that defines the code.

                    Comments

                    This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" LOINC (CONF:3250-16941).

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

                    The common name of the coding system.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

                    ShortIf the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
                    Comments

                    This code SHOULD contain zero or more [0..*] translation, which SHOULD be selected from ValueSet Note Types urn:oid:2.16.840.1.113883.11.20.9.68 DYNAMIC (CONF:3250-16939).

                    Control0..*
                    BindingThe codes SHOULD be taken from Note Types .
                    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                    XML FormatThe type of this property is determined using the " xsi:typeattribute.
                    LabelTranslation
                    64. Act.text
                    ShortSHOULD reference the portion of section narrative text corresponding to this entry
                    Comments

                    SHALL contain exactly one [1..1] text (CONF:3250-16896).

                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                    Invariants3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). (mediaType.exists() implies (representation = 'B64' and xmlText.exists()))
                    66. Act.text.nullFlavor
                    Definition

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

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

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

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

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

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

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

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

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

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

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

                    ShortIf the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
                    Comments

                    This text MAY contain zero or one [0..1] @mediaType, which SHOULD be selected from ValueSet SupportedFileFormats urn:oid:2.16.840.1.113883.11.20.7.1 DYNAMIC (CONF:3250-16906).

                    Control0..1
                    BindingThe codes SHOULD be taken from SupportedFileFormats .
                    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelMedia Type
                    78. Act.text.representation
                    Control0..1
                    BindingThe codes SHALL be taken from CDABinaryDataEncoding
                    (required to http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    80. Act.text.xmlText
                    Definition

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

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

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

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

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

                    Comments

                    This text SHALL contain exactly one [1..1] reference (CONF:3250-16897).

                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
                    LabelReference
                    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
                    84. Act.text.reference.nullFlavor
                    Definition

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

                    ShortThe note activity must reference human-readable content in the narrative, so this reference must not be null.
                    Comments

                    This reference SHALL NOT contain [0..0] @nullFlavor (CONF:3250-16920).

                    Control0..0
                    BindingThe codes SHALL be taken from CDANullFlavor
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelExceptional Value Detail
                    86. Act.text.reference.value
                    Comments

                    This reference SHALL contain exactly one [1..1] @value (CONF:3250-16898).

                    Control1..1
                    Typeurl(url: Universal Resource Locator)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    88. Act.text.reference.useablePeriod
                    Definition

                    Specifies the periods of time during which the telecommunication address can be used. For a telephone number, this can indicate the time of day in which the party can be reached on that telephone. For a web address, it may specify a time range in which the web content is promised to be available under the given address.

                    Control0..*
                    TypeChoice of: http://hl7.org/cda/stds/core/StructureDefinition/IVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/EIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/PIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/SXPR-TS
                    Default Typehttp://hl7.org/cda/stds/core/StructureDefinition/SXPR-TS
                    XML FormatThe type of this property is determined using the " xsi:typeattribute.
                    LabelUseable Period
                    90. Act.text.reference.use
                    Definition

                    One or more codes advising a system or user which telecommunication address in a set of like addresses to select for a given telecommunication need.

                    Control0..*
                    BindingThe codes SHALL be taken from TelecommunicationAddressUse (2.0.0)
                    (required to http://terminology.hl7.org/ValueSet/v3-TelecommunicationAddressUse|2.0.0)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelUse Code
                    92. Act.text.thumbnail
                    Definition

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

                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                    LabelThumbnail
                    94. Act.statusCode
                    ShortIndicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
                    Comments

                    SHALL contain exactly one [1..1] statusCode (CONF:3250-16916).

                    Control1..1
                    BindingThe codes SHALL be taken from ActStatus
                    (required to http://terminology.hl7.org/ValueSet/v3-ActStatus)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                    96. Act.effectiveTime
                    ShortThe effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
                    Comments

                    SHALL contain exactly one [1..1] effectiveTime (CONF:3250-16903).

                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
                    Invariantsshould-value-att: SHOULD contain @value (value.exists())
                    98. Act.effectiveTime.nullFlavor
                    Definition

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

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

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

                    Comments

                    This effectiveTime SHOULD contain zero or one [0..1] @value (CONF:3250-16917).

                    Control0..1
                    TypedateTime(ts: Point in Time)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Date FormatYYYYMMDDHHMMSS.UUUU[+|-ZZzz]
                    XML FormatIn the XML format, this property is represented as an attribute.
                    102. Act.effectiveTime.operator
                    Definition

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

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

                    This is the low limit of the interval.

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

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

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

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

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

                    This is the high limit of the interval.

                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
                    LabelHigh Boundary
                    112. Act.priorityCode
                    Control0..1
                    BindingFor example codes, see ActPriority
                    (example to http://terminology.hl7.org/ValueSet/v3-ActPriority)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                    114. Act.languageCode
                    Control0..1
                    BindingThe codes SHALL be taken from AllLanguages
                    (required to http://hl7.org/fhir/ValueSet/all-languages)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                    116. Act.subject
                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Subject
                    118. Act.specimen
                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Specimen
                    120. Act.performer
                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Performer2
                    122. Act.author
                    Definition

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

                    ShortRepresents the person(s) who wrote the note.
                    Comments

                    SHALL contain at least one [1..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:3250-16913).

                    Control1..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
                    Is Modifierfalse
                    124. Act.informant
                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Informant
                    126. Act.participant
                    Comments

                    MAY contain zero or more [0..*] participant (CONF:3250-16923) such that it

                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
                    SlicingThis element introduces a set of slices on Act.participant. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ typeCode
                    • 128. Act.participant:legalAuthenticator
                      Slice NamelegalAuthenticator
                      ShortRepresents the person(s) legally responsible for the contents of the note.
                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
                      130. Act.participant:legalAuthenticator.nullFlavor
                      Definition

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

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

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

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                      134. Act.participant:legalAuthenticator.typeId
                      Definition

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

                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      136. Act.participant:legalAuthenticator.typeId.nullFlavor
                      Definition

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

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

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

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

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

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

                      Identifies the type as an HL7 Registered model

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

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

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

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

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      148. Act.participant:legalAuthenticator.typeCode
                      Comments

                      SHALL contain exactly one [1..1] @typeCode="LA" Legal Authenticator (CONF:3250-16925).

                      Control1..1
                      BindingThe codes SHALL be taken from CDAParticipationType
                      (required to http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType)
                      Typecode(cs: Coded Simple Value)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Fixed ValueLA
                      150. Act.participant:legalAuthenticator.contextControlCode
                      Control0..1
                      BindingThe codes SHALL be taken from CDAContextControl
                      (required to http://hl7.org/cda/stds/core/ValueSet/CDAContextControl)
                      Typecode(cs: Coded Simple Value)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Fixed ValueOP
                      152. Act.participant:legalAuthenticator.sdtcFunctionCode
                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                      XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namefunctionCode.
                      154. Act.participant:legalAuthenticator.time
                      Definition

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

                      ShortIndicates the time of signing the note.
                      Comments

                      SHALL contain exactly one [1..1] US Realm Date and Time (Interval) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.3) (CONF:3250-16926).

                      Control1..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS(US Realm Date and Time - Interval)
                      Is Modifierfalse
                      Invariantsivl-ts-center: Center cannot co-exist with low or high (center.empty() or (low.empty() and high.empty()))
                      ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day. (value.exists() implies value.toString().length() >= 10)
                      ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component. (value.exists() implies value.toString().length() > 10)
                      156. Act.participant:legalAuthenticator.awarenessCode
                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                      158. Act.participant:legalAuthenticator.participantRole
                      Comments

                      SHALL contain exactly one [1..1] participantRole (CONF:3250-16924).

                      Control1..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/ParticipantRole
                      Invariants3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). ()
                      160. Act.participant:legalAuthenticator.participantRole.nullFlavor
                      Definition

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

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

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

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                      164. Act.participant:legalAuthenticator.participantRole.typeId
                      Definition

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

                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      166. Act.participant:legalAuthenticator.participantRole.typeId.nullFlavor
                      Definition

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

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

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

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

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

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

                      Identifies the type as an HL7 Registered model

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

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

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

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

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      178. Act.participant:legalAuthenticator.participantRole.classCode
                      Control0..1
                      BindingThe codes SHALL be taken from CDARoleClassRoot
                      (required to http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot)
                      Typecode(cs: Coded Simple Value)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Default ValueROL
                      180. Act.participant:legalAuthenticator.participantRole.id
                      ShortThis may be the ID of the note author. If so, no additional information in this participant is required.
                      Comments

                      This participantRole SHALL contain at least one [1..*] id (CONF:3250-16927).

                      Control1..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      182. Act.participant:legalAuthenticator.participantRole.sdtcIdentifiedBy
                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/IdentifiedBy
                      XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameidentifiedBy.
                      184. Act.participant:legalAuthenticator.participantRole.code
                      Control0..1
                      BindingFor example codes, see CDARoleCode
                      (example to http://hl7.org/cda/stds/core/ValueSet/CDARoleCode)
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                      186. Act.participant:legalAuthenticator.participantRole.addr
                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/AD
                      188. Act.participant:legalAuthenticator.participantRole.telecom
                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
                      190. Act.participant:legalAuthenticator.participantRole.playingDevice
                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Device
                      192. Act.participant:legalAuthenticator.participantRole.playingEntity
                      Comments

                      This participantRole MAY contain zero or one [0..1] playingEntity (CONF:3250-16928).

                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/PlayingEntity
                      194. Act.participant:legalAuthenticator.participantRole.playingEntity.nullFlavor
                      Definition

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

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

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

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                      198. Act.participant:legalAuthenticator.participantRole.playingEntity.typeId
                      Definition

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

                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      200. Act.participant:legalAuthenticator.participantRole.playingEntity.typeId.nullFlavor
                      Definition

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

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

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

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

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

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

                      Identifies the type as an HL7 Registered model

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

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

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

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

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      212. Act.participant:legalAuthenticator.participantRole.playingEntity.classCode
                      Control0..1
                      BindingThe codes SHALL be taken from EntityClassRoot
                      (required to http://terminology.hl7.org/ValueSet/v3-EntityClassRoot)
                      Typecode(cs: Coded Simple Value)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Default ValueENT
                      214. Act.participant:legalAuthenticator.participantRole.playingEntity.determinerCode
                      Control0..1
                      BindingThe codes SHALL be taken from EntityDeterminer
                      (required to http://terminology.hl7.org/ValueSet/v3-EntityDeterminer)
                      Typecode(cs: Coded Simple Value)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Fixed ValueINSTANCE
                      216. Act.participant:legalAuthenticator.participantRole.playingEntity.code
                      Control0..1
                      BindingFor example codes, see CDAEntityCode
                      (example to http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode)
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                      218. Act.participant:legalAuthenticator.participantRole.playingEntity.quantity
                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/PQ
                      220. Act.participant:legalAuthenticator.participantRole.playingEntity.name
                      Definition

                      A name for a person. A sequence of name parts, such as given name or family name, prefix, suffix, etc. Examples for person name values are "Jim Bob Walton, Jr.", "Adam Everyman", etc. A person name may be as simple as a character string or may consist of several person name parts, such as, "Jim", "Bob", "Walton", and "Jr.". PN differs from EN because the qualifier type cannot include LS (Legal Status).

                      ShortBase for all types and resources
                      Comments

                      The playingEntity, if present, SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:3250-16929).

                      Control1..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/PN(US Realm Person Name (PN.US.FIELDED))
                      Is Modifierfalse
                      Invariantspn-no-ls: No PN name part may have a qualifier of LS. ((item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty())
                      81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). (conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists())
                      81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372). (item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty())
                      222. Act.participant:legalAuthenticator.participantRole.playingEntity.sdtcBirthTime
                      Definition

                      The purpose of this extension is to allow the recording of the subscriber or member of a health plan in cases where the health plan eligibility system has different information on file than the provider does for the patient.

                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/TS
                      XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namebirthTime.
                      224. Act.participant:legalAuthenticator.participantRole.playingEntity.desc
                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                      226. Act.participant:legalAuthenticator.participantRole.scopingEntity
                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Entity
                      228. Act.entryRelationship
                      Comments

                      SHOULD contain zero or more [0..*] entryRelationship (CONF:3250-16907) such that it

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/EntryRelationship
                      SlicingThis element introduces a set of slices on Act.entryRelationship. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • exists @ encounter
                      • 230. Act.entryRelationship:encounter
                        Slice Nameencounter
                        ShortLinks the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/EntryRelationship
                        232. Act.entryRelationship:encounter.nullFlavor
                        Definition

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

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

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

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                        236. Act.entryRelationship:encounter.typeId
                        Definition

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

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        238. Act.entryRelationship:encounter.typeId.nullFlavor
                        Definition

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

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

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

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

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

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

                        Identifies the type as an HL7 Registered model

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

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

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

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

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        250. Act.entryRelationship:encounter.typeCode
                        Comments

                        SHALL contain exactly one [1..1] @typeCode="COMP" (CONF:3250-16921).

                        Control1..1
                        BindingThe codes SHALL be taken from x_ActRelationshipEntryRelationship
                        (required to http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed ValueCOMP
                        252. Act.entryRelationship:encounter.inversionInd
                        Definition

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

                        Comments

                        SHALL contain exactly one [1..1] @inversionInd="true" (CONF:3250-16922).

                        Control1..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed Valuetrue
                        254. Act.entryRelationship:encounter.contextConductionInd
                        Definition

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

                        Control0..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Default Valuetrue
                        256. Act.entryRelationship:encounter.negationInd
                        ShortTo communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
                        Comments

                        MAY contain zero or one [0..1] @negationInd (CONF:3250-16931).

                        Control0..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        258. Act.entryRelationship:encounter.sequenceNumber
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/INT
                        260. Act.entryRelationship:encounter.seperatableInd
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/BL
                        262. Act.entryRelationship:encounter.act
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act
                        264. Act.entryRelationship:encounter.encounter
                        Comments

                        SHALL contain exactly one [1..1] encounter (CONF:3250-16908).

                        Control1..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Encounter
                        266. Act.entryRelationship:encounter.encounter.nullFlavor
                        Definition

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

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

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

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                        270. Act.entryRelationship:encounter.encounter.typeId
                        Definition

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

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        272. Act.entryRelationship:encounter.encounter.typeId.nullFlavor
                        Definition

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

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

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

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

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

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

                        Identifies the type as an HL7 Registered model

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

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

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

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

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        284. Act.entryRelationship:encounter.encounter.classCode
                        Control1..1
                        BindingThe codes SHALL be taken from CDAActClass
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDAActClass)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed ValueENC
                        286. Act.entryRelationship:encounter.encounter.moodCode
                        Control1..1
                        BindingThe codes SHALL be taken from XDocumentEncounterMood (2.0.0)
                        (required to http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        288. Act.entryRelationship:encounter.encounter.id
                        Comments

                        This encounter SHALL contain at least one [1..*] id (CONF:3250-16909).

                        Control1..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        Invariants3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). ()
                        290. Act.entryRelationship:encounter.encounter.code
                        Control0..1
                        BindingFor example codes, see ActEncounterCode
                        (example to http://terminology.hl7.org/ValueSet/v3-ActEncounterCode)
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                        292. Act.entryRelationship:encounter.encounter.text
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                        294. Act.entryRelationship:encounter.encounter.statusCode
                        Control0..1
                        BindingThe codes SHALL be taken from ActStatus
                        (required to http://terminology.hl7.org/ValueSet/v3-ActStatus)
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                        296. Act.entryRelationship:encounter.encounter.effectiveTime
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
                        298. Act.entryRelationship:encounter.encounter.sdtcDischargeDispositionCode
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namedischargeDispositionCode.
                        300. Act.entryRelationship:encounter.encounter.priorityCode
                        Control0..1
                        BindingFor example codes, see ActPriority
                        (example to http://terminology.hl7.org/ValueSet/v3-ActPriority)
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        302. Act.entryRelationship:encounter.encounter.subject
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Subject
                        304. Act.entryRelationship:encounter.encounter.specimen
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Specimen
                        306. Act.entryRelationship:encounter.encounter.performer
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Performer2
                        308. Act.entryRelationship:encounter.encounter.author
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author
                        310. Act.entryRelationship:encounter.encounter.informant
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Informant
                        312. Act.entryRelationship:encounter.encounter.participant
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
                        314. Act.entryRelationship:encounter.encounter.entryRelationship
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/EntryRelationship
                        316. Act.entryRelationship:encounter.encounter.reference
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                        318. Act.entryRelationship:encounter.encounter.precondition
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition
                        320. Act.entryRelationship:encounter.encounter.sdtcPrecondition2
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition2
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameprecondition2.
                        322. Act.entryRelationship:encounter.encounter.sdtcInFulfillmentOf1
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/InFulfillmentOf1
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameinFulfillmentOf1.
                        324. Act.entryRelationship:encounter.observation
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation
                        326. Act.entryRelationship:encounter.observationMedia
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ObservationMedia
                        328. Act.entryRelationship:encounter.organizer
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Organizer
                        330. Act.entryRelationship:encounter.procedure
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Procedure
                        332. Act.entryRelationship:encounter.regionOfInterest
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/RegionOfInterest
                        334. Act.entryRelationship:encounter.substanceAdministration
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/SubstanceAdministration
                        336. Act.entryRelationship:encounter.supply
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Supply
                        338. Act.reference
                        Comments

                        MAY contain zero or more [0..*] reference (CONF:3250-16910) such that it

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                        SlicingThis element introduces a set of slices on Act.reference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • exists @ externalDocument
                        • 340. Act.reference:externalDocument
                          Slice NameexternalDocument
                          ShortRepresents an unstructured C-CDA document containing the original contents of the note in the original format.
                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                          342. Act.reference:externalDocument.nullFlavor
                          Definition

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

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

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

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                          346. Act.reference:externalDocument.typeId
                          Definition

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

                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          348. Act.reference:externalDocument.typeId.nullFlavor
                          Definition

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

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

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

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

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

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

                          Identifies the type as an HL7 Registered model

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

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

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

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

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          360. Act.reference:externalDocument.typeCode
                          Control1..1
                          BindingThe codes SHALL be taken from x_ActRelationshipExternalReference
                          (required to http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          362. Act.reference:externalDocument.seperatableInd
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/BL
                          364. Act.reference:externalDocument.externalAct
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalAct
                          366. Act.reference:externalDocument.externalObservation
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalObservation
                          368. Act.reference:externalDocument.externalProcedure
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalProcedure
                          370. Act.reference:externalDocument.externalDocument
                          Comments

                          SHALL contain exactly one [1..1] externalDocument (CONF:3250-16911).

                          Control1..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalDocument
                          Invariantsshould-code: SHOULD contain code (code.exists())
                          372. Act.reference:externalDocument.externalDocument.nullFlavor
                          Definition

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

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

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

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                          376. Act.reference:externalDocument.externalDocument.typeId
                          Definition

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

                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          378. Act.reference:externalDocument.externalDocument.typeId.nullFlavor
                          Definition

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

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

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

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

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

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

                          Identifies the type as an HL7 Registered model

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

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

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

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

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          390. Act.reference:externalDocument.externalDocument.classCode
                          Control0..1
                          BindingThe codes SHALL be taken from ActClassDocument
                          (required to http://terminology.hl7.org/ValueSet/v3-ActClassDocument)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Default ValueDOC
                          392. Act.reference:externalDocument.externalDocument.moodCode
                          Control0..1
                          BindingThe codes SHALL be taken from CDAActMood
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDAActMood)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Fixed ValueEVN
                          394. Act.reference:externalDocument.externalDocument.id
                          Comments

                          This externalDocument SHALL contain exactly one [1..1] id (CONF:3250-16915).

                          Control1..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          396. Act.reference:externalDocument.externalDocument.code
                          Comments

                          This externalDocument SHOULD contain zero or one [0..1] code (CONF:3250-16918).

                          Control0..1
                          BindingFor example codes, see FHIRDocumentTypeCodes
                          (example to http://hl7.org/fhir/ValueSet/doc-typecodes)
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                          398. Act.reference:externalDocument.externalDocument.text
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                          400. Act.reference:externalDocument.externalDocument.setId
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          402. Act.reference:externalDocument.externalDocument.versionNumber
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/INT
                          404. Act.precondition
                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition
                          406. Act.sdtcPrecondition2
                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition2
                          XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameprecondition2.
                          408. Act.sdtcInFulfillmentOf1
                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/InFulfillmentOf1
                          XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameinFulfillmentOf1.