CDA Examples
1.0.0 - active
CDA Examples
1.0.0 - active
CDA Examples, published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-Examples/ and changes regularly. See the Directory of published versions
Represents an American Community Survey (ACS) Disability Status using Assessment Scale Supporting Observations.
This file includes examples of the following templates:
<section xmlns="urn:hl7-org:v3">
<templateId root="2.16.840.1.113883.10.20.22.2.14" extension="2014-06-09"/>
<code displayName="Functional status assessment note"
codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="47420-5"/>
<title>Functional Status</title>
<text>
<table ID="disabilityStatus">
<caption>Disability Status Survey</caption>
<thead>
<tr>
<th>Question</th>
<th>Answer</th>
<th>Comments</th>
</tr>
</thead>
<tbody>
<tr ID="dis1">
<td>Are you deaf or do you have serious difficulty hearing?</td>
<td>No</td>
<td/>
</tr>
<tr ID="dis2">
<td>Do you have serious difficulty seeing, even when wearing glasses?</td>
<td>No</td>
<td/>
</tr>
<tr ID="dis3">
<td>Do you have serious difficulty concentrating, remembering, or making decisions?</td>
<td>Yes</td>
<td ID="dis3comment">ADHD</td>
</tr>
<tr ID="dis4">
<td>Do you have serious difficulty walking or climbing stairs?</td>
<td>No</td>
<td/>
</tr>
<tr ID="dis5">
<td>Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone
such as visiting a doctor’s office or shopping?</td>
<!-- Not-applicable because the patient is under 15 -->
<td>N/A</td>
<td/>
</tr>
</tbody>
</table>
</text>
<entry>
<!-- Disability Status Observation -->
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.505"
extension="2023-05-01"/>
<!-- Note in https://jira.hl7.org/browse/CDA-21379 this was expanded
from a single code (89571-4: Disability Status [CUBS])
to also allow 101720-1: Disability Status -->
<code xsi:type="CD" displayName="Disability Status"
codeSystem="2.16.840.1.113883.6.1" code="101720-1"/>
<text xsi:type="ED">
<reference value="#disabilityStatus"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20221111"/>
<value xsi:type="CD" nullFlavor="UNK"/>
<entryRelationship typeCode="COMP">
<!-- Assessment Scale Observation -->
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.69"
extension="2022-06-01"/>
<id root="c6b5a04b-2bf4-49d1-8336-636a3813df0b"/>
<!-- Optional category, added in 2025. If present, one category of "survey" is required. -->
<sdtc:sdtcCategory xmlns:sdtc="urn:hl7-org:sdtc"
codeSystem="2.16.840.1.113883.4.642.1.1125" code="survey"/>
<!-- Identifies this as a disability assessment -->
<sdtc:sdtcCategory xmlns:sdtc="urn:hl7-org:sdtc"
codeSystem="2.16.840.1.113883.4.642.1.1125" code="disability-status"/>
<!-- LOINC code for HHS panel -->
<code xsi:type="CD"
displayName="Race, ethnicity, sex, primary language, disability - Health and Human Services (HHS) panel" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1"
code="69919-9"/>
<statusCode code="completed"/>
<effectiveTime value="20250904"/>
<!-- TBD: what would the overall value be? -->
<value xsi:type="CD" nullFlavor="OTH"/>
<!-- One Assessment Scale Supporting Observation for each question -->
<entryRelationship typeCode="RSON">
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.86"
extension="2022-06-01"/>
<id root="f4dce790-8328-11db-9fe1-0800200c9a44"/>
<code xsi:type="CD"
displayName="Are you deaf, or do you have serious difficulty hearing?" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="69856-3"/>
<text xsi:type="ED">
<reference value="#dis1"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" displayName="No"
codeSystemName="SNOMED-CT" codeSystem="2.16.840.1.113883.6.1" code="LA32-8"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="RSON">
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.86"
extension="2022-06-01"/>
<id root="239d9c5f-29fd-4f3b-834c-eba3cff08eb4"/>
<code xsi:type="CD"
displayName="Are you blind, or do you have serious difficulty seeing, even when wearing glasses?" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="69857-1"/>
<text xsi:type="ED">
<reference value="#dis2"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" displayName="No"
codeSystemName="SNOMED-CT" codeSystem="2.16.840.1.113883.6.1" code="LA32-8"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="RSON">
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.86"
extension="2022-06-01"/>
<id root="90f8996a-b7cd-4448-93cb-df740aaf6cdd"/>
<code xsi:type="CD"
displayName="Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="69858-9"/>
<text xsi:type="ED">
<reference value="#dis3"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" displayName="Yes"
codeSystemName="SNOMED-CT" codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="RSON">
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.86"
extension="2022-06-01"/>
<id root="8d8074e2-998c-49e6-8934-5049a92e32a5"/>
<code xsi:type="CD"
displayName="Do you have serious difficulty walking or climbing stairs?" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="69859-7"/>
<text xsi:type="ED">
<reference value="#dis4"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" displayName="No"
codeSystemName="SNOMED-CT" codeSystem="2.16.840.1.113883.6.1" code="LA32-8"/>
</observation>
</entryRelationship>
<entryRelationship typeCode="RSON">
<observation moodCode="EVN" classCode="OBS">
<templateId root="2.16.840.1.113883.10.20.22.4.86"
extension="2022-06-01"/>
<id root="6e1ff22d-6d19-4757-b7d2-2fd1f9c00d88"/>
<code xsi:type="CD"
displayName="Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a physician's office or shopping?" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="69861-3"/>
<text xsi:type="ED">
<reference value="#dis5"/>
</text>
<statusCode code="completed"/>
<value xsi:type="CD" nullFlavor="NA"/>
</observation>
</entryRelationship>
</observation>
</entryRelationship>
</observation>
</entry>
</section>
IG © Health Level Seven. Package hl7.cda.examples#1.0.0 based on FHIR 5.0.0. Generated 2025-09-17
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