CDA Examples
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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

Example: Parent Document Replace Relationship

Approval Status: Approved
Task Force Approval: 2017-05-04
SDWG Approval: 2017-05-18

This is an example of how a continuity of care document (or other document) may reference parent documents. This one replaces a previous document.

This file includes examples of the following templates:

This content is an example of the US Realm Header Logical Model and is not a FHIR Resource

    
<!--
     This sample shows a document which replaces a prior clinical document (e.g. CCD)
     The reason for this example is to demonstrate the use of relatedDocument@typeCode="RPLC"
     No clinical data is contained in any of the sections
     Look to lines 364 for the relevant illustrative example xml -->
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:sdtc="urn:hl7-org:sdtc">
  <realmCode code="US"/>
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
  <!-- US Realm Header ID-->
  <templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2024-05-01"/> <!-- C-CDA 3.0 -->
  <templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01"/>
  <templateId root="2.16.840.1.113883.10.20.22.1.1"/>
  <!-- CCD template ID-->
  <templateId root="2.16.840.1.113883.10.20.22.1.2" extension="2024-05-01"/> <!-- C-CDA 3.0 -->
  <templateId root="2.16.840.1.113883.10.20.22.1.2" extension="2015-08-01"/>
  <templateId root="2.16.840.1.113883.10.20.22.1.2"/>
  <!-- Globally unique identifier for the document  -->
  <id extension="TT662" root="2.16.840.1.113883.19.5.99999.1"/>
  <code code="34133-9" displayName="Summary of episode note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
  <!-- Title of this document -->
  <title>CCD Demonstrating Replacement of Prior CCD</title>
  <effectiveTime value="201507221800-0500" />
  <confidentialityCode code="N" displayName="normal" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality"/>
  <languageCode code="en-US"/>
  <setId root="004bb033-b948-4f4c-b5bf-a8dbd7d8dd40"/>
  <!-- Version of this document -->
  <versionNumber value="2"/>
  <recordTarget>
    <patientRole>
      <id extension="414122222" root="2.16.840.1.113883.4.1"/>
      <!-- Example Social Security Number using the actual SSN OID. -->
      <addr use="HP">
        <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
        <streetAddressLine>1357 Amber Dr</streetAddressLine>
        <city>Beaverton</city>
        <state>OR</state>
        <postalCode>97006</postalCode>
        <country>US</country>
        <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      </addr>
      <telecom value="tel:+1(555)-777-1234" use="MC"/>
      <telecom value="tel:+1(555)-723-1544" use="HP"/>
      <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
      <patient>
        <name use="L">
          <given>Richard</given>
          <family>Maur</family>
          <suffix>jr</suffix>
        </name>
        <administrativeGenderCode code="M" displayName="Male" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender"/>
        <!-- Date of birth need only be precise to the day -->
        <birthTime value="19800801"/>
        <maritalStatusCode nullFlavor="NI"/>
        <religiousAffiliationCode code="1013" codeSystem="2.16.840.1.113883.5.1076"
                                  displayName="Christian (non-Catholic, non-specific)" codeSystemName="HL7 Religious Affiliation" />
        <raceCode nullFlavor="UNK"/>
        <sdtc:raceCode nullFlavor="UNK"/>
        <ethnicGroupCode nullFlavor="UNK"/>
        <languageCommunication>
          <languageCode code="en"/>
          <modeCode code="ESP" codeSystem="2.16.840.1.113883.5.60"
                    displayName="Expressed spoken" codeSystemName="LanguageAbilityMode" />
          <preferenceInd value="true"/>
        </languageCommunication>
      </patient>
      <providerOrganization>
        <id extension="99999999" root="2.16.840.1.113883.4.6"/>
        <name>Community Health and Hospitals</name>
        <telecom use="WP" value="tel:+1(555)-555-5000"/>
        <addr>
          <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
          <city>Portland</city>
          <state>OR</state>
          <postalCode>97266</postalCode>
          <country>US</country>
        </addr>
      </providerOrganization>
    </patientRole>
  </recordTarget>
  <!-- The author represents the person who provides the content in the document -->
  <author>
    <time value="20150722"/>
    <assignedAuthor>
      <id extension="111111" root="2.16.840.1.113883.4.6"/>
      <code code="281P00000X" codeSystem="2.16.840.1.113883.6.101"
            displayName="Hospitals; Chronic Disease Hospital" />
      <addr>
        <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>97266</postalCode>
        <country>US</country>
      </addr>
      <telecom use="WP" value="tel:+1(555)-555-1002"/>
      <assignedPerson>
        <name>
          <prefix>Dr</prefix>
          <given>Henry</given>
          <family>Seven</family>
        </name>
      </assignedPerson>
    </assignedAuthor>
  </author>
  <!-- The dataEnterer transferred the content created by the author into the document -->
  <dataEnterer>
    <assignedEntity>
      <id root="2.16.840.1.113883.4.6" extension="999999943252"/>
      <addr>
        <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>97266</postalCode>
        <country>US</country>
      </addr>
      <telecom use="WP" value="tel:+1(555)-555-1002"/>
      <assignedPerson>
        <name>
          <given>Mary</given>
          <family>McDonald</family>
        </name>
      </assignedPerson>
    </assignedEntity>
  </dataEnterer>
  <!-- The informant represents any sources of information for document content -->
  <informant>
    <assignedEntity>
      <id extension="KP00017" root="2.16.840.1.113883.19.5"/>
      <addr>
        <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>97266</postalCode>
        <country>US</country>
      </addr>
      <telecom use="WP" value="tel:+1(555)-555-1002"/>
      <assignedPerson>
        <name>
          <given>Henry</given>
          <family>Seven</family>
        </name>
      </assignedPerson>
    </assignedEntity>
  </informant>
  <informant>
    <relatedEntity classCode="PRS">
      <!-- classCode PRS represents a person with personal relationship with the patient. -->
      <code code="SPS" codeSystem="2.16.840.1.113883.1.11.19563"
            displayName="SPOUSE" codeSystemName="Personal Relationship Role Type Value Set" />
      <relatedPerson>
        <name>
          <given>Caroline</given>
          <family>Maur</family>
        </name>
      </relatedPerson>
    </relatedEntity>
  </informant>
  <!-- The custodian represents the organization charged with maintaining the original source document -->
  <custodian>
    <assignedCustodian>
      <representedCustodianOrganization>
        <id extension="99998899" root="2.16.840.1.113883.4.6"/>
        <name>Community Health and Hospitals</name>
        <telecom use="WP" value="tel:+1(555)-555-5000"/>
        <addr>
          <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
          <city>Portland</city>
          <state>OR</state>
          <postalCode>97266</postalCode>
          <country>US</country>
        </addr>
      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <!-- The informationRecipient represents the intended recipient of the document -->
  <informationRecipient>
    <intendedRecipient>
      <informationRecipient>
        <name>
          <prefix>Dr</prefix>
          <given>Henry</given>
          <family>Seven</family>
        </name>
      </informationRecipient>
      <receivedOrganization>
        <name>Community Health and Hospitals</name>
      </receivedOrganization>
    </intendedRecipient>
  </informationRecipient>
  <!-- The legalAuthenticator represents the individual who is responsible for the document -->
  <legalAuthenticator>
    <time value="20150722"/>
    <signatureCode code="S"/>
    <assignedEntity>
      <id extension="999998899" root="2.16.840.1.113883.4.6"/>
      <addr>
        <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>97266</postalCode>
        <country>US</country>
      </addr>
      <telecom use="WP" value="tel:+1(555)-555-1002"/>
      <assignedPerson>
        <name>
          <prefix>Dr</prefix>
          <given>Henry</given>
          <family>Seven</family>
        </name>
      </assignedPerson>
    </assignedEntity>
  </legalAuthenticator>
  <!-- The authenticator represents the individual attesting to the accuracy of information in the document-->
  <authenticator>
    <time value="20150722"/>
    <signatureCode code="S"/>
    <assignedEntity>
      <id extension="999998899" root="2.16.840.1.113883.4.6"/>
      <addr>
        <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>97266</postalCode>
        <country>US</country>
      </addr>
      <telecom use="WP" value="tel:+1(555)-555-1002"/>
      <assignedPerson>
        <name>
          <prefix>Dr</prefix>
          <given>Henry</given>
          <family>Seven</family>
        </name>
      </assignedPerson>
    </assignedEntity>
  </authenticator>
  <!-- The participant represents supporting entities -->
  <participant typeCode="IND">
    <!-- patient's grandfather -->
    <associatedEntity classCode="PRS">
      <code code="GPARNT" codeSystem="2.16.840.1.113883.1.11.19563"
            displayName="grandparent" codeSystemName="Personal Relationship Role Type Value Set" />
      <addr use="HP">
        <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
        <streetAddressLine>1357 Amber Dr</streetAddressLine>
        <city>Beaverton</city>
        <state>OR</state>
        <postalCode>97006</postalCode>
        <country>US</country>
        <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      </addr>
      <telecom value="tel:+1(555)-723-1544" use="HP"/>
      <associatedPerson>
        <name>
          <prefix>Mr.</prefix>
          <given>Issac</given>
          <family>Maur</family>
        </name>
      </associatedPerson>
    </associatedEntity>
  </participant>
  <!-- Note: Entities playing multiple roles are recorded in multiple participants -->
  <participant typeCode="IND">
    <!-- patient's spouse -->
    <associatedEntity classCode="PRS">
      <code code="SPS" codeSystem="2.16.840.1.113883.1.11.19563"
            displayName="SPOUSE" codeSystemName="Personal Relationship Role Type Value Set" />
      <addr use="HP">
        <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
        <streetAddressLine>1357 Amber Dr</streetAddressLine>
        <city>Beaverton</city>
        <state>OR</state>
        <postalCode>97006</postalCode>
        <country>US</country>
        <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      </addr>
      <telecom value="tel:+1(555)-723-1544" use="HP"/>
      <associatedPerson>
        <name>
          <prefix>Ms</prefix>
          <given>Caroline</given>
          <family>Maur</family>
        </name>
      </associatedPerson>
    </associatedEntity>
  </participant>
  <documentationOf>
    <serviceEvent classCode="PCPR">
      <code code="423123007" codeSystem="2.16.840.1.113883.6.96"
            codeSystemName="SNOMED-CT" displayName="Burn caused by fire" />
      <effectiveTime>
        <low value="2015072218-0500"/>
        <high value="2015072223-0500"/>
      </effectiveTime>
      <!-- since there are two Care Team members we need two performer elements. -db -->
      <!-- Note: example of Care Team here:
           https://github.com/gecole/HL7-Task-Force-Examples/blob/master/CareTeamToC170.314b2Ambulatory.xml
           db -->
      <performer typeCode="PRF">
        <functionCode code="PCP" codeSystem="2.16.840.1.113883.5.88" codeSystemName="ParticipationFunction" displayName="primary care physician">
          <originalText>Primary Care Provider</originalText>
        </functionCode>
        <assignedEntity>
          <id extension="5555555555" root="2.16.840.1.113883.4.6"/>
          <code code="207QA0505X" codeSystem="2.16.840.1.113883.6.101"
                displayName="Adult Medicine Physician" codeSystemName="Healthcare Provider Taxonomy (HIPAA)" />
          <addr>
            <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
            <city>Portland</city>
            <state>OR</state>
            <postalCode>97266</postalCode>
            <country>US</country>
          </addr>
          <telecom use="WP" value="tel:+1(555)-555-1002"/>
          <assignedPerson>
            <name>
              <prefix qualifier="TITLE">Dr</prefix>
              <given>Henry</given>
              <family>Seven</family>
            </name>
          </assignedPerson>
          <representedOrganization>
            <id extension="99998899" root="2.16.840.1.113883.4.6"/>
            <name>Community Health and Hospitals</name>
            <telecom use="WP" value="tel:+1(555)-555-5000"/>
            <addr>
              <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
              <city>Portland</city>
              <state>OR</state>
              <postalCode>97266</postalCode>
              <country>US</country>
            </addr>
          </representedOrganization>
        </assignedEntity>
      </performer>
      <performer typeCode="PRF">
        <!-- we do not have a function code for this person since recording as RN for now -->
        <time>
          <low nullFlavor="UNK"/>
        </time>
        <assignedEntity>
          <!-- this provider has an id, but it is not an NPI  -->
          <id extension="91138" root="1.3.6.1.4.1.22812.4.99930.4"/>
          <!-- the provider is a Registered Nurse - may not be so -->
          <!-- note: we don't know what Mary is from the test data
               but since not specified, RN should not be an issue -db -->
          <code code="163W00000X" codeSystem="2.16.840.1.113883.6.101"
                codeSystemName="NUCC Health Care Provider Taxonomy" displayName="Registered Nurse" />
          <addr>
            <streetAddressLine>1002 Healthcare Dr</streetAddressLine>
            <city>Portland</city>
            <state>OR</state>
            <postalCode>97266</postalCode>
            <country>US</country>
          </addr>
          <telecom use="WP" value="tel:+1(555)-555-1002"/>
          <assignedPerson>
            <name>
              <given>Mary</given>
              <family>McDonald</family>
            </name>
          </assignedPerson>
        </assignedEntity>
      </performer>
    </serviceEvent>
  </documentationOf>
  <!-- ******************************************************** START OF RELATED DOCUMENT EXAMPLE ******************************************************** -->
  <!-- This is the illustrative part of this example
       This replaces a previous continuity of care (CCD) document -->
  <relatedDocument typeCode="RPLC">
    <parentDocument>
      <id extension="TT661" root="2.16.840.1.113883.19.5.99999.1"/>
      <code code="34133-9" displayName="Summary of episode note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
      <!-- While not required, there is a benefit of using <setId> and <versionNumber> as a secondary key on documents.
           If the flow from a document source system or repository to a destination system is infrequent or  not able to guarantee
           sequential transmission of  document revisions.  The setId and versionNumber pair are actually better for detecting which
           new document revises a previous older version of that document.  -->
      <!-- If setId and versionNumber are not available or applicable, they may be omitted -->
      <setId root="004bb033-b948-4f4c-b5bf-a8dbd7d8dd40"/>
      <versionNumber value="1"/>
    </parentDocument>
  </relatedDocument>
  <!-- ******************************************************** END OF RELATED DOCUMENT EXAMPLE ******************************************************** -->
  <!-- added componentOf to represent encounter and to represent length of stay better as per SME suggestion -db -->
  <componentOf>
    <encompassingEncounter>
      <id extension="9937012" root="2.16.840.1.113883.19"/>
      <effectiveTime>
        <!-- represents length of time spent in hospital -db -->
        <low value="2015072218-0500"/>
        <high value="2015072223-0500"/>
      </effectiveTime>
    </encompassingEncounter>
  </componentOf>
  <!-- ******************************************************** CDA Body ******************************************************** -->
  <component>
    <structuredBody>
      
      <!-- ***************** ALLERGIES *************** -->
      <!-- No known allergies -->
      <component>
        <section>
          <!-- *** Allergies and Intolerances Section (entries required) (V3) *** -->
          <templateId root="2.16.840.1.113883.10.20.22.2.6.1" extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.2.6.1"/>
          <!-- Alerts section template -->
          <code code="48765-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
          <title>ALLERGIES AND ADVERSE REACTIONS</title>
          <text>No Known Drug Allergies</text>
          <!-- replaced Allergy Problem Act (R1.1) with
               Allergy Concern Act (V3) to meet R2.1 validation requirements -DB-->
          <entry typeCode="DRIV">
            <act classCode="ACT" moodCode="EVN">
              <!-- ** Allergy Concern Act (V3) ** -->
              <templateId root="2.16.840.1.113883.10.20.22.4.30" extension="2015-08-01"/>
              <!--Critical Change-->
              <templateId root="2.16.840.1.113883.10.20.22.4.30"/>
              <id root="36e3e930-7b15-11db-9fe1-0831200c9a66"/>
              <code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>
              <!-- The statusCode represents the need to continue tracking the allergy -->
              <!-- This is of ongoing concern to the provider -->
              <statusCode code="active"/>
              <effectiveTime>
                <!-- The low value represents when the allergy was first recorded in the patient's chart -->
                <low value="20150722"/>
              </effectiveTime>
              <entryRelationship typeCode="SUBJ">
                <!-- using negationInd="true" to signify that there are is NO food allergy (disorder) allergy -db -->
                <observation classCode="OBS" moodCode="EVN" negationInd="true">
                  <!-- ** Allergy observation (V2) ** -->
                  <templateId root="2.16.840.1.113883.10.20.22.4.7" extension="2014-06-09"/>
                  <templateId root="2.16.840.1.113883.10.20.22.4.7"/>
                  <!-- Substance or Device Allergy Intolerance Observation Template -->
                  <templateId root="2.16.840.1.113883.10.20.24.3.90" extension="2014-06-09"/>
                  <id root="4adc1020-7b16-11db-9fe1-0832200c9a66"/>
                  <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4"/>
                  <statusCode code="completed"/>
                  <effectiveTime nullFlavor="NA">
                    <low nullFlavor="NA"/>
                    <high nullFlavor="NA"/>
                  </effectiveTime>
                  <!-- using Drug allergy (disorder) along with negationInd instead -db -->
                  <value xsi:type="CD" code="416098002" codeSystem="2.16.840.1.113883.6.96"
                         displayName="Allergy to drug (finding)" codeSystemName="SNOMED CT">
                  </value>
                  <!-- In C-CDA R2 the participant is required. The SNOMED code ="105590001" displayName="Substance" could be used in the participant-->
                  <participant typeCode="CSM">
                    <participantRole classCode="MANU">
                      <playingEntity classCode="MMAT">
                        <code nullFlavor="NA"/>
                      </playingEntity>
                    </participantRole>
                  </participant>
                </observation>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
      
      <!-- ******************************* MEDICATIONS ***************************** -->
      <!-- No known medications -->
      <component>
        <section>
          <!-- *** Medications Section (entries required) (V2) *** -->
          <templateId root="2.16.840.1.113883.10.20.22.2.1.1" extension="2014-06-09"/>
          <templateId root="2.16.840.1.113883.10.20.22.2.1.1"/>
          <code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="HISTORY OF MEDICATION USE"/>
          <title>MEDICATIONS</title>
          <text>No known Medications</text>
          <entry>
            <!-- Act.actionNegationInd -->
            <substanceAdministration moodCode="EVN" classCode="SBADM" negationInd="true">
              <!-- ** Medication Activity (V2) ** -->
              <templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.16"/>
              <id root="cdbd33f0-6cde-11db-9fe1-0833200c9a66"/>
              <statusCode code="active"/>
              <effectiveTime xsi:type="IVL_TS" nullFlavor="NA">
                <low nullFlavor="NA"/>
              </effectiveTime>
              <doseQuantity nullFlavor="NA"/>
              <consumable>
                <manufacturedProduct classCode="MANU">
                  <!-- ** Medication information ** -->
                  <templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
                  <templateId root="2.16.840.1.113883.10.20.22.4.23"/>
                  <manufacturedMaterial>
                    <code nullFlavor="OTH" codeSystem="2.16.840.1.113883.6.88">
                      <translation code="410942007" codeSystem="2.16.840.1.113883.6.96"
                                   displayName="Drug or medicament (substance)" codeSystemName="SNOMED CT" />
                    </code>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </consumable>
            </substanceAdministration>
          </entry>
        </section>
      </component>
      
      <!-- ******************************* MEDICATIONS ADMINISTERED    *****************************
           NO known medications -->
      <component>
        <section>
          <!-- The section contains the medications taken by the patient prior to
               and
               at the time of admission to the facility. -->
          <!-- Admission Medications Section (entries optional) (V3) -->
          <templateId root="2.16.840.1.113883.10.20.22.2.44" extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.2.44"/>
          <code code="42346-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="MEDICATIONS ON ADMISSION"/>
          <title>Admission Medications</title>
          <text>No Medications Administered</text>
          <entry>
            <!-- Act.actionNegationInd -->
            <substanceAdministration moodCode="EVN" classCode="SBADM" negationInd="true">
              <!-- ** Medication Activity (V2) ** -->
              <templateId root="2.16.840.1.113883.10.20.22.4.16" extension="2014-06-09"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.16"/>
              <id root="cdbd33f0-6cde-11db-9fe1-0834200c9a66"/>
              <statusCode code="active"/>
              <effectiveTime nullFlavor="NA" xsi:type="IVL_TS">
                <low nullFlavor="NA"/>
              </effectiveTime>
              <doseQuantity nullFlavor="NA"/>
              <consumable>
                <manufacturedProduct classCode="MANU">
                  <!-- ** Medication information ** -->
                  <templateId root="2.16.840.1.113883.10.20.22.4.23" extension="2014-06-09"/>
                  <templateId root="2.16.840.1.113883.10.20.22.4.23"/>
                  <manufacturedMaterial>
                    <code nullFlavor="OTH" codeSystem="2.16.840.1.113883.6.88">
                      <translation code="410942007" codeSystem="2.16.840.1.113883.6.96"
                                   displayName="Drug or medicament (substance)" codeSystemName="SNOMED CT" />
                    </code>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </consumable>
            </substanceAdministration>
          </entry>
        </section>
      </component>
      <!-- Added Discharge Medications Section (entries required) (V3) No known medications -->
      <component>
        <section nullFlavor="NI">
          <!-- Discharge Medications Section (entries required) (V3) -->
          <templateId root="2.16.840.1.113883.10.20.22.2.11.1" extension="2015-08-01" />
          <templateId root="2.16.840.1.113883.10.20.22.2.11.1" />
          <code code="10183-2" codeSystem="2.16.840.1.113883.6.1"
                displayName="Hospital Discharge Medications" codeSystemName="LOINC">
            <translation code="75311-1" codeSystem="2.16.840.1.113883.6.1"
                         displayName="Discharge Medications" codeSystemName="LOINC" />
          </code>
          <title>Discharge Medications</title>
          <text>No Information</text>
        </section>
      </component>
      
      <!-- ***************** PROBLEM LIST *********************** -->
      <!-- No known problems -->
      <component>
        <section>
          <!--  *** Problem Section (entries required) (V3) *** -->
          <templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.2.5.1"/>
          <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROBLEM LIST"/>
          <title>PROBLEMS</title>
          <text ID="Concern_1">
            <content ID="problems1">No known <content ID="problemType1">health problems</content></content>
          </text>
          <entry typeCode="DRIV">
            <!-- Problem Concern Act -->
            <act classCode="ACT" moodCode="EVN">
              <templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2024-05-01" />
              <templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01" />
              <templateId root="2.16.840.1.113883.10.20.22.4.3" />
              <id root="36e3e930-7b14-11db-9fe1-0835200c9a66"/>
              <!-- SDWG supports 48765-2 or CONC in the code element -->
              <code code="CONC" codeSystem="2.16.840.1.113883.5.6"/>
              <text>
                <reference value="#Concern_1"/>
              </text>
              <statusCode code="active"/>
              <!-- The concern is not active, in terms of there being an active condition to be managed.-->
              <effectiveTime>
                <low value="20150722"/>
                <!-- Time at which THIS "concern" began being tracked.-->
              </effectiveTime>
              <!-- status is active so high is not applicable. If high is present it should have nullFlavor of NA-->
              <entryRelationship typeCode="SUBJ">
                <!-- Model of Meaning for No Problems -->
                <!-- The use of negationInd corresponds with the newer Observation.ValueNegationInd -->
                <!-- The negationInd = true negates the value element. -->
                <!-- problem observation template -->
                <observation classCode="OBS" moodCode="EVN" negationInd="true">
                  <templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2024-05-01"/>
                  <templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01"/>
                  <templateId root="2.16.840.1.113883.10.20.22.4.4"/>
                  <id root="4adc1021-7b14-11db-9fe1-0836200c9a67"/>
                  <!-- updated for R2.1 -db -->
                  <code code="55607006" displayName="Problem" codeSystemName="SNOMED-CT" codeSystem="2.16.840.1.113883.6.96">
                    <!-- This code SHALL contain at least one [1..*] translation, which SHOULD be selected from ValueSet Problem Type (LOINC) -->
                    <translation code="75326-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem"/>
                  </code>
                  <text>
                    <reference value="#problems1"/>
                  </text>
                  <statusCode code="completed"/>
                  <!-- The time when this was biologically relevant ie True for the patient. -->
                  <!-- As a minimum time interval over which this is true, populate the effectiveTime/low with the current time. -->
                  <!-- It would be equally valid to have a longer range of time over which this statement was represented as being true. -->
                  <!-- As a maximum, you would never indicate an effectiveTime/high that was greater than the current point in time. -->
                  <effectiveTime>
                    <low value="20150722"/>
                  </effectiveTime>
                  <!-- This idea assumes that the value element could come from the Problem value set, or-->
                  <!-- when negationInd was true, is could also come from the ProblemType value set (and code would be ASSERTION). -->
                  <value xsi:type="CD" code="55607006" codeSystem="2.16.840.1.113883.6.96"
                         displayName="Problem" codeSystemName="SNOMED CT">
                    <originalText>
                      <reference value="#problems1"/>
                    </originalText>
                  </value>
                </observation>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
      
      <!-- ************************ ENCOUNTERS *********************** -->
      <!-- No known encounters -->
      <component>
        <section nullFlavor="NI">
          <!-- *** Encounters section (entries required) (V3) *** -->
          <templateId root="2.16.840.1.113883.10.20.22.2.22.1" extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.2.22.1"/>
          <code code="46240-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of encounters"/>
          <title>ENCOUNTERS</title>
          <text>No Encounters</text>
        </section>
      </component>
      
      <!-- ************** PROCEDURES ***************** -->
      <!-- edited as per test doc - all of this data is directly relevant -db -->
      <!-- (NO) UDI section based off of   https://github.com/brettmarquard/HL7-C-CDA-Task-Force-Examples/blob/master/No_Implanted_Devices.xml
           -db -->
      <!-- ************** PROCEDURES and UDI ***************** -->
      <component>
        <!-- nullFlavor of NI indicates No Information.-->
        <section nullFlavor="NI">
          <templateId root="2.16.840.1.113883.10.20.22.2.7" extension="2014-06-09" />
          <!-- Procedures section template -->
          <code code="47519-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="PROCEDURES" />
          <title>Procedures</title>
          <text>No Information</text>
        </section>
      </component>
      
      <!-- ************** No UDI ***************** -->
      <component>
        <section>
          <!-- Medical equipment section -->
          <templateId root="2.16.840.1.113883.10.20.22.2.23" extension="2014-06-09"/>
          <code code="46264-8" codeSystem="2.16.840.1.113883.6.1" />
          <title>MEDICAL EQUIPMENT</title>
          <!-- Alternative text: Patient has no history of procedures with implantable devices'-->
          <!-- Alternative text: Patient has no implanted devices'-->
          <text>
            <paragraph ID="Proc2">Patient has no history of implantable devices</paragraph>
          </text>
          <entry>
            <procedure classCode="PROC" moodCode="EVN" negationInd="true">
              <!-- Procedure Activity Procedure V2-->
              <templateId root="2.16.840.1.113883.10.20.22.4.14"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2014-06-09"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.14" extension="2024-05-01"/> <!-- C-CDA 3.0-->
              <id root="d5b614bd-01ce-410d-8728-e1fd01dcc72a" />
              <code code="71388002" codeSystem="2.16.840.1.113883.6.96"
                    displayName="Procedure" />
              <text>
                <reference value="#Proc2"/>
              </text>
              <statusCode code="completed" />
              <effectiveTime nullFlavor="NA" />
              <participant typeCode="DEV">
                <participantRole classCode="MANU">
                  <templateId root="2.16.840.1.113883.10.20.22.4.37"/>
                  <!-- UDI is 'not applicable' since no procedure -->
                  <id nullFlavor="NA" root="2.16.840.1.113883.3.3719"/>
                  <playingDevice>
                    <code code="40388003" codeSystem="2.16.840.1.113883.6.96"
                          displayName="Implant" />
                  </playingDevice>
                  <scopingEntity>
                    <id root="2.16.840.1.113883.3.3719"/>
                  </scopingEntity>
                </participantRole>
              </participant>
            </procedure>
          </entry>
        </section>
      </component>
      
      <!-- ******************** IMMUNIZATIONS ********************* -->
      <!-- No immunizations -->
      <component>
        <section>
          <!-- *** Immunizations Section (entries required) (V2) *** -->
          <templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2014-06-09"/>
          <templateId root="2.16.840.1.113883.10.20.22.2.2.1" extension="2015-08-01"/> <!-- Companion Guide -->
          <templateId root="2.16.840.1.113883.10.20.22.2.2.1"/>
          <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="History of immunizations"/>
          <title>IMMUNIZATIONS</title>
          <text>No immunization history</text>
          <entry typeCode="DRIV">
            <!-- using negationInd="true" to signify that there are no known immunizations -->
            <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="true">
              <!-- ** Immunization Activity (V3) ** -->
              <templateId root="2.16.840.1.113883.10.20.22.4.52" extension="2015-08-01"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.52"/>
              <id root="de10790f-1496-4729-8fe6-f1b87b6219f7"/>
              <statusCode code="active"/>
              <effectiveTime nullFlavor="NA"/>
              <routeCode nullFlavor="NA"/>
              <consumable>
                <manufacturedProduct classCode="MANU">
                  <!-- ** Immunization Medication Information (V2) ** -->
                  <templateId root="2.16.840.1.113883.10.20.22.4.54" extension="2014-06-09"/>
                  <templateId root="2.16.840.1.113883.10.20.22.4.54"/>
                  <manufacturedMaterial>
                    <!-- there is no generic vaccine code and no known recommended way to do this -
                         leaving generic flu for now just as an example. Not sure if it makes more sense to apply a nullFlavor? -db -->
                    <code nullFlavor="OTH">
                      <!-- Optional original text -->
                      <originalText>Vaccination</originalText>
                      <translation code="71181003" codeSystem="2.16.840.1.113883.6.96"
                                   displayName="vaccine" codeSystemName="SNOMED CT" />
                    </code>
                    <!-- NA since there is no immunization data -db -->
                    <lotNumberText nullFlavor="NA"/>
                  </manufacturedMaterial>
                </manufacturedProduct>
              </consumable>
            </substanceAdministration>
          </entry>
        </section>
      </component>
      
      <!-- ************* VITAL SIGNS *************** -->
      <!-- No vital signs  -db -->
      <component>
        <section nullFlavor="NI">
          <templateId root="2.16.840.1.113883.10.20.22.2.4.1" extension="2015-08-01" />
          <code code="8716-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Vital signs" />
          <title>VITAL SIGNS</title>
          <text>No Recorded Vital Signs</text>
        </section>
      </component>
      
      <!-- ******************* SOCIAL HISTORY ********************* -->
      <!-- edited as per test doc - most of this data is directly relevant -db -->
      <component>
        <section>
          <!--  ** Social History Section (V3) ** -->
          <templateId root="2.16.840.1.113883.10.20.22.2.17" extension="2015-08-01"/>
          <code code="29762-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Social History"/>
          <title>SOCIAL HISTORY</title>
          <text>
            <table border="1" width="100%">
              <thead>
                <tr>
                  <th>Social History Observation</th>
                  <th>Description</th>
                  <th>Dates Observed</th>
                </tr>
              </thead>
              <tbody>
                <tr>
                  <td>Current Smoking Status</td>
                  <td>Current every day</td>
                  <td>July 22, 2015</td>
                </tr>
                <tr>
                  <td ID="BirthSexInfo">Birth Sex</td>
                  <td>Male</td>
                  <td>July 22, 2015</td>
                </tr>
              </tbody>
            </table>
          </text>
          <!-- Current Smoking Status - July 22, 2015 -db -->
          <entry typeCode="DRIV">
            <observation classCode="OBS" moodCode="EVN">
              <!-- ** Smoking Status - Meaningful Use (V2) ** -->
              <templateId root="2.16.840.1.113883.10.20.22.4.78" extension="2014-06-09"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.78" extension="2024-05-01"/> <!-- C-CDA 3.0 -->
              <templateId root="2.16.840.1.113883.10.20.22.4.78"/>
              <id extension="123456789" root="2.16.840.1.113883.19"/>
              <!-- code SHALL be 72166-2 for Smoking Status - Meaningful Use (V2) -db -->
              <code code="72166-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Tobacco smoking status NHIS"/>
              <statusCode code="completed"/>
              <!-- The effectiveTime reflects when the current smoking status was observed. -->
              <effectiveTime value="20150722"/>
              <!-- The value represents the patient's smoking status currently observed. -->
              <!-- Consol Smoking Status Meaningful Use2 SHALL contain exactly one [1..1] value (CONF:1098-14810), which SHALL be selected from ValueSet Current Smoking Status 2.16.840.1.113883.11.20.9.38 STATIC 2014-09-01 (CONF:1098-14817) -db -->
              <value xsi:type="CD" code="449868002" displayName="Smokes tobacco daily" codeSystem="2.16.840.1.113883.6.96"/>
            </observation>
          </entry>
          <!-- removed Social history observation (V3) entry for "Alcoholic drinks per day" -db -->
          <!-- Add Birth Sex entry -->
          <entry>
            <observation classCode="OBS" moodCode="EVN">
              <templateId root="2.16.840.1.113883.10.20.22.4.200" extension="2016-06-01"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.200" extension="2024-05-01"/> <!-- C-CDA 3.0 -->
              <code code="76689-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Sex Assigned At Birth"/>
              <text>
                <reference value="#BirthSexInfo"/>
              </text>
              <statusCode code="completed"/>
              <effectiveTime value="20150722"/>
              <value code="M" codeSystem="2.16.840.1.113883.5.1" xsi:type="CD" displayName="Male"/>
            </observation>
          </entry>
          
        </section>
      </component>
      
      <!-- ******************** RESULTS ************************ -->
      <!-- edited as per test doc - all of this data is directly relevant -db -->
      <component>
        <section nullFlavor="NI">
          <!-- Results Section (entries required) (V3) -->
          <templateId root="2.16.840.1.113883.10.20.22.2.3.1" extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.2.3.1"/>
          <code code="30954-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="RESULTS"/>
          <title>RESULTS</title>
          <text>Laboratory Test: None needed. Laboratory Values/Results: No Lab Result data</text>
        </section>
      </component>
      
      <!-- removed component Advance Directives as not required by test data -db -->
      
      <!-- removed component Family History as not required by test data -db -->
      
      <!-- removed component Functional Status as not required by test data (specific to 170.315(b)(1), (b)(2)) -db -->
      
      <!-- removed component Medical Equipment as not required by test data -db -->
      
      <!-- removed component Payers as not required by test data -db -->
      
      <!-- added Assessment -db -->
      <!--
           ********************************************************
           Assessment
           ******************************************************** -->
      <!-- edited as per test doc - all of this data is directly relevant -db -->
      <component>
        <section nullFlavor="NI">
          <!-- Assessment Section -db -->
          <!-- There is no R2.1 (or 2.0) version of Assessment Section, using R1.1 templateId only -db -->
          <templateId root="2.16.840.1.113883.10.20.22.2.8"/>
          <code code="51848-0" codeSystem="2.16.840.1.113883.6.1"
                codeSystemName="LOINC" displayName="Evaluation note" />
          <title>ASSESSMENTS</title>
          <text>No assessment information</text>
        </section>
      </component>
      
      <!-- ******************* PLAN OF TREATMENT ********************** -->
      <!-- edited as per test doc - all of this data is directly relevant -db -->
      <component>
        <section>
          <!--  **** Plan of Treatment Section (V2) **** -->
          <templateId root="2.16.840.1.113883.10.20.22.2.10" extension="2014-06-09"/>
          <templateId root="2.16.840.1.113883.10.20.22.2.10"/>
          <code code="18776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Plan of care note"/>
          <title>TREATMENT PLAN</title>
          <text>No Plan of treatment</text>
        </section>
      </component>
      
      <!-- Added Goals - original version from C-CDA_R2_Care_Plan.xml from R2.0 IG package.
           There are no duplicated template Ids with extensions -
           as there is only one version in existence for each section and entry listed -db -->
      <!--
           ********************************************************
           Goals
           ******************************************************** -->
      <!-- edited as per test doc -db -->
      <component>
        <section nullFlavor="NI">
          <!-- Goals Section -->
          <templateId root="2.16.840.1.113883.10.20.22.2.60"/>
          <code code="61146-7" displayName="Goals" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
          <title>Goals Section</title>
          <text>No goal information</text>
        </section>
      </component>
      
      <!-- added Health Concerns -db -->
      <!-- Note: There is no R1.1 version of Health Concerns Section or Health Concern Act -
           so there is only one templateId per section (they're NEW) -db -->
      <!-- updated as per ETF  https://github.com/brettmarquard/HL7-C-CDA-Task-Force-Examples/blob/master/No_Known_Health_Concerns.xml
           -db -->
      <!--
           ********************************************************
           Health Concerns
           ******************************************************** -->
      <!-- edited as per test doc -db -->
      <component>
        <!-- This example records assertion of no concerns -->
        <section>
          <!-- Health Concerns Section (V2) (V1 was added as a NEW template in R2.0, V2 was updated in R2.1) -db -->
          <templateId root="2.16.840.1.113883.10.20.22.2.58" extension="2015-08-01"/>
          <code code="75310-3" codeSystem="2.16.840.1.113883.6.1"
                displayName="Health Concerns Document" codeSystemName="LOINC" />
          <title>Health Concerns</title>
          <!--Including ID at text element is allowed -->
          <text ID="HealthConcern_1">No Known Health Concerns on 07/22/2015</text>
          <entry typeCode="COMP">
            <!-- negationInd=true indicates no known health concerns at the stated time-->
            <act classCode="ACT" moodCode="EVN" negationInd="true">
              <!-- There is no V1 version of this template -db -->
              <templateId root="2.16.840.1.113883.10.20.22.4.132" extension="2015-08-01"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.132" extension="2022-06-01"/>
              <id root="4eab0e52-dd7d-4285-99eb-72d32ddb195d"/>
              <code code="75310-3" codeSystem="2.16.840.1.113883.6.1"
                    codeSystemName="LOINC" displayName="Health Concern" />
              <text>
                <reference value="#HealthConcern_1"/>
              </text>
              <!-- This Health Concern has a statusCode of concern because assertion is ongoing -->
              <statusCode code="active"/>
              <!-- The effective time is the date that the Health Concern started being followed -
                   this does not necessarily correlate to the onset date of the contained health issues-->
              <effectiveTime value="20150722"/>
              <!-- Time at which THIS "concern" began being tracked.-->
            </act>
          </entry>
        </section>
      </component>
      
      <!--
           ************************************
           HOSPITAL DISCHARGE INSTRUCTIONS
           ************************************ -->
      <component>
        <section>
          <!-- Hospital Discharge Instructions Section - no R2.1 version for this template -db -->
          <templateId
            root="2.16.840.1.113883.10.20.22.2.41"/>
          <code code="8653-8" codeSystem="2.16.840.1.113883.6.1"
                codeSystemName="LOINC" displayName="Hospital Discharge instructions" />
          <title>HOSPITAL DISCHARGE INSTRUCTIONS</title>
          <!-- Unstructured text field -->
          <text>
            <list listType="ordered">
              <item>Appointments: Schedule an appointment with Dr Seven after 1 week. Follow up with Outpatient facility.</item>
              <item>In case of fever, take Tylenol as advised in plan of treatment.</item>
            </list>
          </text>
        </section>
      </component>
      
      <!-- removed Reason for Referral -db -->
      
      <!-- added Mental Status Section (V2) (used to be NEW in R2.0) 2.16.840.1.113883.10.20.22.2.56 as required by VDT inp test data -db -->
      <!--
           ********************************************************
           Mental Status Section
           ******************************************************** -->
      <component>
        <section nullFlavor="NI">
          <!-- note: the IG lists the wrong templateId in its example of this section, lists ...2,14 instead of 2.56 -db -->
          <!-- There is no R1.1 version of this template -db -->
          <templateId root="2.16.840.1.113883.10.20.22.2.56" extension="2015-08-01" />
          <!-- Mental Status Section -->
          <code code="10190-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Mental status Narrative" />
          <title>MENTAL STATUS</title>
          <text>No information</text>
        </section>
      </component>
      
      <!-- added component Functional Status as required by test data -db -->
      <!--
           ********************************************************
           FUNCTIONAL STATUS
           ******************************************************** -->
      <component>
        <section nullFlavor="NI">
          <!-- Functional Status Section (V2)-->
          <templateId root="2.16.840.1.113883.10.20.22.2.14" extension="2014-06-09"/>
          <!-- Functional Status Section -->
          <templateId root="2.16.840.1.113883.10.20.22.2.14"/>
          <code code="47420-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Functional status assessment note"/>
          <title>FUNCTIONAL STATUS</title>
          <text>No information</text>
        </section>
      </component>
      
      <!-- added Interventions -->
      <!--
           ********************************************************
           INTERVENTIONS
           ******************************************************** -->
      
      <component>
        <section nullFlavor="NI">
          <templateId root="2.16.840.1.113883.10.20.21.2.3" extension="2015-08-01" />
          <code code="62387-6" displayName="Interventions Provided" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
          <title>Interventions Section</title>
          <text>No intervention information</text>
        </section>
      </component>
      
    </structuredBody>
  </component>
</ClinicalDocument>