Consolidated CDA Release 2.2
2.2 - CI Build United States of America flag

Consolidated CDA Release 2.2, published by Health Level Seven. This is not an authorized publication; it is the continuous build for version 2.2). This version is based on the current content of https://github.com/HL7/CDA-ccda-2.2/ and changes regularly. See the Directory of published versions

Example Binary: Example of Allergy Intolerance to Food Egg

    
<section>
	<templateId root="2.16.840.1.113883.10.20.22.2.6.1"/>
	<templateId root="2.16.840.1.113883.10.20.22.2.6.1" extension="2015-08-01"/>
	<!-- Allergies (entries required) section template -->
	<code code="48765-2" codeSystem="2.16.840.1.113883.6.1"/>
	<title>Allergies, Adverse Reactions and Alerts</title>
	<text>
		<table>
			<thead>
				<tr>
					<th>Allergen</th>
					<th>Reaction</th>
					<th>Reaction Severity</th>
					<th>Documentation Date</th>
					<th>Start Date</th>
				</tr>
			</thead>
			<tbody>
				<tr ID="allergy5">
					<td ID="allergy5allergen">Egg</td>
					<td ID="allergy5reaction">Hives</td>
					<td ID="allergy5reactionseverity">Moderate</td>
					<td>Jan 4 2014</td>
					<td>1998</td>
				</tr>
			</tbody>
		</table>
	</text>
	<entry typeCode="DRIV">
		<act classCode="ACT" moodCode="EVN">
			<!-- ** Allergy problem act ** -->
			<templateId root="2.16.840.1.113883.10.20.22.4.30"/>
			<templateId root="2.16.840.1.113883.10.20.22.4.30" extension="2015-08-01"/>
			<id root="0fffb34f-c1e0-47c2-92af-c414a3ff21ec"/>
			<code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>
			<text>
				<reference value="#allergy5" />
			</text>
			<statusCode code="active"/>
			<!-- This is the time stamp for when the allergy was first documented as a concern-->
			<effectiveTime>
				<low value="20140104123506-0500"/>
			</effectiveTime>
			<author>
				<templateId root="2.16.840.1.113883.10.20.22.4.119"/>
				<time value="20140104"/>
				<assignedAuthor>
					<id extension="99999999" root="2.16.840.1.113883.4.6"/>
					<code code="207Q00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Health Care Provider Taxonomy" displayName="Family Medicine" />
					<telecom use="WP" value="tel:555-555-1002"/>
					<assignedPerson>
						<name>
							<given>Henry</given>
							<family>Seven</family>
						</name>
					</assignedPerson>
				</assignedAuthor>
			</author>
			<entryRelationship typeCode="SUBJ">
				<observation classCode="OBS" moodCode="EVN">
					<!-- allergy observation template -->
					<templateId root="2.16.840.1.113883.10.20.22.4.7"/>
					<templateId root="2.16.840.1.113883.10.20.22.4.7" extension="2014-06-09"/>
					<id root="0fffb34f-c1e0-47c2-92af-c414a3ff21ec"/>
					<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
					<text>
						<reference value="#allergy5" />
					</text>
					<statusCode code="completed"/>
					<!-- This is the time stamp for the biological onset of the allergy. -->
					<!-- Just the year is shown since a specific month and date was not reported -->
					<effectiveTime>
						<low value="1998"/>
					</effectiveTime>
					<!-- This specifies that the allergy is to a food in contrast to other allergies (drug) -->
					<value xsi:type="CD" code="414285001" displayName="Food allergy (disorder)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"></value>
					<author>
						<templateId root="2.16.840.1.113883.10.20.22.4.119"/>
						<time value="20140104"/>
						<assignedAuthor>
							<id extension="99999999" root="2.16.840.1.113883.4.6"/>
							<code code="207Q00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Health Care Provider Taxonomy" displayName="Family Medicine" />
							<telecom use="WP" value="tel:555-555-1002"/>
							<assignedPerson>
								<name>
									<given>Henry</given>
									<family>Seven</family>
								</name>
							</assignedPerson>
						</assignedAuthor>
					</author>
					<!-- In C-CDA R2.1 the participant is required. -->
					<participant typeCode="CSM">
						<participantRole classCode="MANU">
							<playingEntity classCode="MMAT">
								<!-- The agent responsible for an allergy or adverse reaction is not always a manufactured material (for example, food allergies), 
													nor is it necessarily consumed. The following constraints reflect limitations in the base CDA R2 specification, 
													and should be used to represent any type of responsible agent, i.e., use playingEntity classCode = "MMAT" for all agents, 
													manufactured or not. -->
								<!-- 
													... the expectation for use is that the chosen concept identifier for a substance should be appropriately specific and 
													drawn from the available code systems in the following priority order: RXNORM, then SNOMED CT. 
													This overarching grouping value set is intended to support identification of drug classes, individual medication 
													ingredients, foods, general substances and environmental entities. Value set intensionally defined as a GROUPING made 
													up of:
													Value Set: Clinical Drug Ingredient (2.16.840.1.113762.1.4.1010.7) (RxNORM ingredient codes); 
													Value Set: Medication drug class for allergen intolerance SCT (2.16.840.1.113762.1.4.1114.14) (SNOMED CT substance codes);	
													Value Set: Substance Other Than Clinical Drug (2.16.840.1.113762.1.4.1010.9) (SNOMED CT substance codes).
												
												-->
								<code code="102263004" displayName="Eggs (edible)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
									<originalText>
										<reference value="#allergy5allergen"/>
									</originalText>
								</code>
							</playingEntity>
						</participantRole>
					</participant>
					<entryRelationship typeCode="MFST" inversionInd="true">
						<observation classCode="OBS" moodCode="EVN">
							<!-- Reaction Observation template -->
							<templateId root="2.16.840.1.113883.10.20.22.4.9"/>
							<templateId root="2.16.840.1.113883.10.20.22.4.9" extension="2014-06-09"/>
							<id root="d89ce431-e0f1-4f8d-a81f-489b6ed91f09"/>
							<code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
							<text>
								<reference value="#allergy5reaction"/>
							</text>
							<statusCode code="completed"/>
							<effectiveTime>
								<low value="1998"/>
								<high nullFlavor="UNK"/>
							</effectiveTime>
							<value xsi:type="CD" code="247472004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Hives"/>
							<entryRelationship typeCode="SUBJ" inversionInd="true">
								<observation classCode="OBS" moodCode="EVN">
									<!-- Severity Observation template -->
									<templateId root="2.16.840.1.113883.10.20.22.4.8"/>
									<templateId root="2.16.840.1.113883.10.20.22.4.8"
 extension="2014-06-09"/>
									<code code="SEV" codeSystem="2.16.840.1.113883.5.4" codeSystemName="ActCode"/>
									<text>
										<reference value="#allergy5reactionseverity"/>
									</text>
									<statusCode code="completed"/>
									<value xsi:type="CD" code="6736007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="moderate"/>
								</observation>
							</entryRelationship>
						</observation>
					</entryRelationship>
				</observation>
			</entryRelationship>
		</act>
	</entry>
</section>