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

This page is part of the CCDA: Consolidated CDA Release (v4.0.0: CCDA 4.0) generated with FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

Logical Model: Problem Concern Act

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/ProblemConcernAct Version: 4.0.0
Draft as of 2025-06-20 Computable Name: ProblemConcernAct
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.10.20.22.4.3:2024-05-01

This template reflects an ongoing concern on behalf of the provider that placed the concern on a patient's problem list. So long as the underlying condition is of concern to the provider (i.e., as long as the condition, whether active or resolved, is of ongoing concern and interest to the provider), the statusCode is "active". Only when the underlying condition is no longer of concern is the statusCode set to "completed". The effectiveTime reflects the time that the underlying condition was felt to be a concern; it may or may not correspond to the effectiveTime of the condition (e.g., even five years later, the clinician may remain concerned about a prior heart attack).

The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.

The effectiveTime/low of the Problem Concern Act asserts when the concern became active. The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).

A Problem Concern Act can contain one Problem Observation (templateId 2.16.840.1.113883.10.20.22.4.4). The Problem Observation is a discrete observation of a condition, and therefore will have a statusCode of "completed". For instance, a Concern may contain a Problem Observation of "chest pain" that is still ongoing:

  • Problem Concern 1 — Problem Observation: Chest Pain (effectiveTime.high is empty) Or a Concern may contain a Problem Observation of "chest pain" that is still worrisome but the problem happened in the past:
  • Problem Concern 1 — Problem Observation: Chest Pain (effectiveTime.high is present and in the past) Many systems display the nested Problem Observation with the most recent author time stamp, and provide a mechanism for viewing prior observations.

Templates Used

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

Required EntryRelationships: ProblemObservation

Optional EntryRelationships: PriorityPreference

Usages:

Changes since version 3.0.0:

  • The resource metadata has changed (description)

    • Formal Views of Template Content

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

    This structure is derived from Act

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:problem-concern-act 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.3
    ..... @extension 1..1 st Required Pattern: 2024-05-01
    ... @classCode 1..1 cs Fixed Value: ACT
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... code 1..1 CD
    .... @code 1..1 cs Required Pattern: CONC
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.6
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.
    .... @nullFlavor 0..0
    .... @code 1..1 cs Binding: ProblemAct statusCode . (required)
    ... effectiveTime 1..1 IVL_TS
    .... low 1..1 IVXB_TS The effectiveTime/low of the Problem Concern Act asserts when the concern became active.
    .... high 0..1 IVXB_TS The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).
    ... author 0..* AuthorParticipation
    ... Slices for entryRelationship 1..* EntryRelationship The following entryRelationship represents the importance of the concern to a provider.
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:problem 1..1 EntryRelationship
    ..... @typeCode 1..1 cs Fixed Value: SUBJ
    ..... observation 1..1 ProblemObservation
    .... entryRelationship:priority 0..* EntryRelationship
    ..... @typeCode 1..1 cs Fixed Value: REFR
    ..... observation 1..1 PriorityPreference

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Act.statusCode.coderequiredProblemActStatusCode .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.19

    Constraints

    IdGradePath(s)DetailsRequirements
    should-authorwarningActSHOULD contain author
    : author.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-starts-octothorpeerrorAct.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:problem-concern-act 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.3
    ..... @extension 1..1 st Required Pattern: 2024-05-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... code 1..1 CD Binding: v3 Code System ActCode (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: CONC
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.6
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs Binding: MediaType (example)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.
    Binding: ActStatus (required)
    .... @code 1..1 cs Binding: ProblemAct statusCode . (required)
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime 1..1 IVL_TS
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 1..1 IVXB_TS The effectiveTime/low of the Problem Concern Act asserts when the concern became active.
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 0..* AuthorParticipation
    ... informant 0..* Informant
    ... participant 0..* Participant2
    ... Slices for entryRelationship 1..* EntryRelationship The following entryRelationship represents the importance of the concern to a provider.
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:problem 1..1 EntryRelationship
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: SUBJ
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 ProblemObservation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    .... entryRelationship:priority 0..* EntryRelationship
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: REFR
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 PriorityPreference
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... reference 0..* Reference
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.templateId:problem-concern-act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.classCoderequiredFixed Value: ACT
    http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
    Act.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
    Act.codeexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    Act.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Act.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Act.text.mediaTypeexampleMediaType
    http://terminology.hl7.org/ValueSet/v3-MediaType
    Act.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Act.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.statusCode.coderequiredProblemActStatusCode .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.19
    Act.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Act.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Act.entryRelationship:problem.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:problem.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:problem.typeCoderequiredFixed Value: SUBJ
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Act.entryRelationship:priority.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:priority.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:priority.typeCoderequiredFixed Value: REFR
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship

    Constraints

    IdGradePath(s)DetailsRequirements
    II-1errorAct.typeId, Act.entryRelationship:problem.typeId, Act.entryRelationship:priority.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    should-authorwarningActSHOULD contain author
    : author.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-starts-octothorpeerrorAct.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:problem-concern-act 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.3
    ..... @extension 1..1 st Required Pattern: 2024-05-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... code 1..1 CD Binding: v3 Code System ActCode (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: CONC
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.6
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs Binding: MediaType (example)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.
    Binding: ActStatus (required)
    .... @code 1..1 cs Binding: ProblemAct statusCode . (required)
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime 1..1 IVL_TS
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 1..1 IVXB_TS The effectiveTime/low of the Problem Concern Act asserts when the concern became active.
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 0..* AuthorParticipation
    ... informant 0..* Informant
    ... participant 0..* Participant2
    ... Slices for entryRelationship 1..* EntryRelationship The following entryRelationship represents the importance of the concern to a provider.
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:problem 1..1 EntryRelationship
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: SUBJ
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 ProblemObservation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    .... entryRelationship:priority 0..* EntryRelationship
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: REFR
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 PriorityPreference
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... reference 0..* Reference
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.templateId:problem-concern-act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.classCoderequiredFixed Value: ACT
    http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
    Act.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
    Act.codeexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    Act.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Act.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Act.text.mediaTypeexampleMediaType
    http://terminology.hl7.org/ValueSet/v3-MediaType
    Act.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Act.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.statusCode.coderequiredProblemActStatusCode .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.19
    Act.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Act.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Act.entryRelationship:problem.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:problem.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:problem.typeCoderequiredFixed Value: SUBJ
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Act.entryRelationship:priority.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:priority.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:priority.typeCoderequiredFixed Value: REFR
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship

    Constraints

    IdGradePath(s)DetailsRequirements
    II-1errorAct.typeId, Act.entryRelationship:problem.typeId, Act.entryRelationship:priority.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    should-authorwarningActSHOULD contain author
    : author.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-starts-octothorpeerrorAct.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')

    This structure is derived from Act

    Summary

    Mandatory: 14 elements(1 nested mandatory element)
    Fixed: 4 elements
    Prohibited: 1 element

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 2 is sliced based on the values of Act.templateId
    • The element 1 is sliced based on the value of Act.entryRelationship

    Differential View

    This structure is derived from Act

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:problem-concern-act 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.3
    ..... @extension 1..1 st Required Pattern: 2024-05-01
    ... @classCode 1..1 cs Fixed Value: ACT
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... code 1..1 CD
    .... @code 1..1 cs Required Pattern: CONC
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.6
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.
    .... @nullFlavor 0..0
    .... @code 1..1 cs Binding: ProblemAct statusCode . (required)
    ... effectiveTime 1..1 IVL_TS
    .... low 1..1 IVXB_TS The effectiveTime/low of the Problem Concern Act asserts when the concern became active.
    .... high 0..1 IVXB_TS The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).
    ... author 0..* AuthorParticipation
    ... Slices for entryRelationship 1..* EntryRelationship The following entryRelationship represents the importance of the concern to a provider.
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:problem 1..1 EntryRelationship
    ..... @typeCode 1..1 cs Fixed Value: SUBJ
    ..... observation 1..1 ProblemObservation
    .... entryRelationship:priority 0..* EntryRelationship
    ..... @typeCode 1..1 cs Fixed Value: REFR
    ..... observation 1..1 PriorityPreference

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Act.statusCode.coderequiredProblemActStatusCode .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.19

    Constraints

    IdGradePath(s)DetailsRequirements
    should-authorwarningActSHOULD contain author
    : author.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-starts-octothorpeerrorAct.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:problem-concern-act 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.3
    ..... @extension 1..1 st Required Pattern: 2024-05-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... code 1..1 CD Binding: v3 Code System ActCode (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: CONC
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.6
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs Binding: MediaType (example)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.
    Binding: ActStatus (required)
    .... @code 1..1 cs Binding: ProblemAct statusCode . (required)
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime 1..1 IVL_TS
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 1..1 IVXB_TS The effectiveTime/low of the Problem Concern Act asserts when the concern became active.
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 0..* AuthorParticipation
    ... informant 0..* Informant
    ... participant 0..* Participant2
    ... Slices for entryRelationship 1..* EntryRelationship The following entryRelationship represents the importance of the concern to a provider.
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:problem 1..1 EntryRelationship
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: SUBJ
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 ProblemObservation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    .... entryRelationship:priority 0..* EntryRelationship
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: REFR
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 PriorityPreference
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... reference 0..* Reference
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.templateId:problem-concern-act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.classCoderequiredFixed Value: ACT
    http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
    Act.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
    Act.codeexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    Act.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Act.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Act.text.mediaTypeexampleMediaType
    http://terminology.hl7.org/ValueSet/v3-MediaType
    Act.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Act.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.statusCode.coderequiredProblemActStatusCode .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.19
    Act.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Act.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Act.entryRelationship:problem.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:problem.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:problem.typeCoderequiredFixed Value: SUBJ
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Act.entryRelationship:priority.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:priority.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:priority.typeCoderequiredFixed Value: REFR
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship

    Constraints

    IdGradePath(s)DetailsRequirements
    II-1errorAct.typeId, Act.entryRelationship:problem.typeId, Act.entryRelationship:priority.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    should-authorwarningActSHOULD contain author
    : author.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-starts-octothorpeerrorAct.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:problem-concern-act 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.3
    ..... @extension 1..1 st Required Pattern: 2024-05-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... code 1..1 CD Binding: v3 Code System ActCode (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: CONC
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.6
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs Binding: MediaType (example)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS The statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.
    Binding: ActStatus (required)
    .... @code 1..1 cs Binding: ProblemAct statusCode . (required)
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    ... effectiveTime 1..1 IVL_TS
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 1..1 IVXB_TS The effectiveTime/low of the Problem Concern Act asserts when the concern became active.
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS The effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 0..* AuthorParticipation
    ... informant 0..* Informant
    ... participant 0..* Participant2
    ... Slices for entryRelationship 1..* EntryRelationship The following entryRelationship represents the importance of the concern to a provider.
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:problem 1..1 EntryRelationship
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: SUBJ
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 ProblemObservation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    .... entryRelationship:priority 0..* EntryRelationship
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: REFR
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 PriorityPreference
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... reference 0..* Reference
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.templateId:problem-concern-act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.classCoderequiredFixed Value: ACT
    http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
    Act.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
    Act.codeexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    Act.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Act.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Act.text.mediaTypeexampleMediaType
    http://terminology.hl7.org/ValueSet/v3-MediaType
    Act.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Act.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.statusCode.coderequiredProblemActStatusCode .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.19
    Act.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Act.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Act.entryRelationship:problem.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:problem.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:problem.typeCoderequiredFixed Value: SUBJ
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Act.entryRelationship:priority.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:priority.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:priority.typeCoderequiredFixed Value: REFR
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship

    Constraints

    IdGradePath(s)DetailsRequirements
    II-1errorAct.typeId, Act.entryRelationship:problem.typeId, Act.entryRelationship:priority.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    should-authorwarningActSHOULD contain author
    : author.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    value-starts-octothorpeerrorAct.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
    : value.exists() implies value.startsWith('#')

    This structure is derived from Act

    Summary

    Mandatory: 14 elements(1 nested mandatory element)
    Fixed: 4 elements
    Prohibited: 1 element

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 2 is sliced based on the values of Act.templateId
    • The element 1 is sliced based on the value of Act.entryRelationship

     

    Other representations of profile: CSV, Excel