Consolidated CDA Release 2.1 StructureDefinition Publication
2.1 - CI Build United States of America flag

Consolidated CDA Release 2.1 StructureDefinition Publication, published by Health Level Seven. This is not an authorized publication; it is the continuous build for version 2.1). This version is based on the current content of and changes regularly. See the Directory of published versions

IG Home Page

Official URL: Version: 2.1
Draft as of 2023-09-29 Computable Name: CCDA


This two-volume implementation guide (IG) contains an overview of Clinical Document Architecture (CDA) markup standards, design, and use (Volume 1) and a consolidated library of CDA templates for clinical notes applicable to the US Realm (Volume 2). These two volumes comprise a Draft Standard for Trial Use (DSTU). It has been adapted from the Release 2.0 version of the Consolidated CDA Templates for Clinical Notes to support backward compatibility “on the wire” with the 1.1 Release of the templates described in this guide. This will enable implementers of systems conforming to this guide to produce documents that can be understood by systems which only support the C-CDA Release 1.1 specification. The consolidated library incorporates previous efforts from Health Level Seven (HL7), Integrating the Healthcare Enterprise (IHE), the Health Information Technology Standards Panel (HITSP), the HL7 Health Story guides, HITSP C32, and related components of IHE Patient Care Coordination (IHE PCC). It has additional or enhanced document types for greater expressivity and decrease ambiguity (see Volume 2 Summary of Changes). Volume 1 adds new general guidance (see Summary of Changes). This guide, in conjunction with the HL7 CDA Release 2 (CDA R2) standard, is to be used for implementing the following CDA documents and header constraints for clinical notes.


The audience for this implementation guide includes architects and developers of healthcare information technology (HIT) systems in the US Realm that exchange patient clinical data. Business analysts and policy managers can also benefit from a basic understanding of the use of CDA templates across multiple implementation use cases.

Organization of the Guide

This implementation guide is organized into two volumes. Volume 1 contains primarily narrative text describing the Consolidated CDA Release 2 (C-CDA R2) guide, whereas Volume 2 contains normative CDA template definitions.


This R2.1 guide was developed and produced through the efforts of Health Level Seven (HL7).

The editors appreciate the support and sponsorship of the HL7 Structured Documents Working Group (SDWG), the HL7 Patient Care Work Group, the HL7 Child Health Work Group, and all volunteers and staff associated with the creation of this document. This guide would not have been possible without the support of the Department of Defense/Department of Veterans Affairs Interagency Program Office (DoD/VA IPO).

This material contains content from SNOMED CT® ( SNOMED CT is a registered trademark of the International Health Terminology Standard Development Organisation (IHTSDO).

This material contains content from the Logical Observation Identifiers Names and Codes (LOINC) organization ( The LOINC table, LOINC codes, and LOINC panels and forms file are copyright © 1995-2014, Regenstrief Institute, Inc. and LOINC Committee, and available at no cost under the license at


Primary Editor / Co-Chair: Rick Geimer
Lantana Consulting Group
Co-Editor: Benjamin Flessner
Primary Editor / Co-Chair: Brett Marquard
River Rock Associates
Co-Editor: Larry Garber, MD
Reliant Medical Group
Co-Chair: Calvin Beebe
Mayo Clinic
Co-Editor: Jennie Harvell, M.Ed US Health and Human Services
Co-Chair: Diana Behling
Iatric Systems
Co-Editor: Laura Heermann Langford, RN, PhD
Intermountain Healthcare
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SAIC Consultant to CDC/NHSN
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Co-Chair: Patrick Lloyd
Icode Solutions
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Harvard Medical School / Boston Children’s Hospital
Primary Editor / Co-Chair: Gaye Dolin, MSN, RN
Intelligent Medical Objects, Inc.
Co-Editor: Susan Matney, MSN, RN 3M
Health Information Systems
Primary Editor: Sarah Gaunt
Lantana Consulting Group
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Lantana Consulting Group
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Lantana Consulting Group
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Lantana Consulting Group
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Lantana Consulting Group
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Life Over Time Solutions
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Intuit Health
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Partners Healthcare
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GE Healthcare
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Lantana Consulting Group
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National E-Health Transition, Australia
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Lantana Consulting Group
Technical Editor: Adrienne Giannone
Lantana Consulting Group
Co-Editor: Robert H. Dolin, MD
Technical Editor: Diana Wright
Lantana Consulting Group
Co-Editor: Susan Campbell, PhD, RN
Technical Editor: Veronica Kwok