<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:mif="urn:hl7-org:v3/mif"
                  xmlns:voc="urn:hl7-org:v3/voc" xmlns:sdtc="urn:hl7-org:sdtc">
  <!-- This example was updated on 12/11/2025 to include a recommended pattern for representing a Direct Address as a telecom element
       distinguishing it from other mailto telecom addresses which do not require the use of Direct for the telecommunication protocol.
       The recommended pattern is a workaround which is required because there is no way to extend the supported use attributes for CDA R2.
       This practice recommendation offers an option for distinguishing Direct addresses from other types of mailto addresses which
       semantically extends the definition of use="DIR" to include a telecommunication Direct address that reaches the individual or organization
       directly without intermediaries.
       This implies it is a Direct address where the certificate that backs the Direct address is associated with the individual or organization
       associated with the telecom element.
       This recommended telecom pattern is consistent with the earlier part of the example which shows how to assert a Direct address
       as an identifier of an entity.
       The same implication exists for that aspect of the example.  If a Direct address is asserted as an entity's identifier, it should be true
       that the certificate that backs the Direct address is associated with the individual or organization associated with the telecom element.
       
       The portion of the example showing how to include a Direct address as an additional identifier of an entity was approved on 11/30/2017.
       The portion of the example showing how to include a Direct address as a telecom for an entity was approved on 1/22/2026 -->
  <realmCode code="US"/>
  <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
  <templateId root="2.16.840.1.113883.10.20.22.1.1"/>
  <templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2024-05-01"/> <!-- C-CDA 3.0 -->
  <id root="2.16.840.1.113883.3.109" extension="bf6b3a62-4293-47b4-9f14-c8829a156f4b"/>
  <code code="34133-9" codeSystem="2.16.840.1.113883.6.1"
        displayName="Summary of episode note" codeSystemName="LOINC" />
  <title>Continuity of Care Document (C-CDA)</title>
  <effectiveTime value="20170528150200-0400"/>
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"
                       displayName="normal" codeSystemName="HL7 Confidentiality" />
  <languageCode code="en-US"/>
  <recordTarget>
    <patientRole>
      <!-- Here is a public id that has an external meaning based on a root OID that is publically identifiable. -->
      <!-- root="1.3.6.1.4.1.41179.2.4" is the assigningAutorityName for
           Direct Trust's Patient/Consumer addresses "DT.org PATIENT" -->
      <id root="1.3.6.1.4.1.41179.2.4" extension="lisarnelson@direct.myphd.us" assigningAuthorityName="DT.org PATIENT"/>
      <!-- More ids may be used. -->
      <!-- Here is the patient's MRN at RVHS  -->
      <id root="2.16.840.1.113883.1.111.12345" extension="12345-0828" assigningAuthorityName="River Valley Health Services"/>
      <!-- Use the identifiedBy extention to indicate an identifier type.
           If a coded concept is not available in the identifierType Code System, use originalText to describe the identifier type -->
      <sdtc:identifiedBy typeCode="REL">
        <sdtc:alternateIdentification classCode="IDENT">
          <sdtc:id root="1.3.6.1.4.1.41179.2.4" extension="lisarnelson@direct.myphd.us" />
          <sdtc:code><originalText>DirectTrust Consumer Identity</originalText></sdtc:code>
        </sdtc:alternateIdentification>
      </sdtc:identifiedBy>
      <!-- Available Direct Trust identitifier types include the following:
           <sdtc:identifiedBy typeCode="REL">
             <sdtc:alternateIdentification classCode="IDENT">
               <sdtc:id root="1.3.6.1.4.1.41179.2.3" extension="lisarnelson@direct.myphd.us" />
               <sdtc:code><originalText>DirectTrust Practitioner Identity</originalText></sdtc:code>
             </sdtc:alternateIdentification>
           </sdtc:identifiedBy>
           <sdtc:identifiedBy typeCode="REL">
             <sdtc:alternateIdentification classCode="IDENT">
               <sdtc:id root="1.3.6.1.4.1.41179.2.2" extension="lisarnelson@direct.myphd.us" />
               <sdtc:code><originalText>DirectTrust Business Associate Identity</originalText></sdtc:code>
             </sdtc:alternateIdentification>
           </sdtc:identifiedBy>
           <sdtc:identifiedBy typeCode="REL">
             <sdtc:alternateIdentification classCode="IDENT">
               <sdtc:id root="1.3.6.1.4.1.41179.2.1" extension="lisarnelson@direct.myphd.us" />
               <sdtc:code><originalText>DirectTrust Covered Entity Identity</originalText></sdtc:code>
             </sdtc:alternateIdentification>
           </sdtc:identifiedBy> -->
      <sdtc:identifiedBy typeCode="REL">
        <sdtc:alternateIdentification classCode="IDENT">
          <sdtc:id root="2.16.840.1.113883.1.111.12345" extension="12345-0828" />
          <sdtc:code code="MR" codeSystem="2.16.840.1.113883.18.108" codeSystemName="v2-0203" displayName="Medical record number"></sdtc:code>
        </sdtc:alternateIdentification>
      </sdtc:identifiedBy>
      <addr>
        <streetAddressLine>1 Happy Valley Road</streetAddressLine>
        <city>Westerly</city>
        <state>RI</state>
        <postalCode>02891</postalCode>
        <country nullFlavor="UNK"/>
      </addr>
      <telecom use="WP" value="tel:+1-4013482345"/>
      <telecom use="HP" value="tel:+1-4016412345"/>
      <telecom value="mailto:lisanelson@gmail.com"/>
      <!-- Recommended pattern for expressing a Direct address for this Patient. -->
      <!-- DIR is used for Direct addresses that support an "individual use" use case -->
      <!-- Usage Note:  the use attribute supports multiple attributes by separating them with a space.
           thus "HP DIR" or "DIR HP" also would be acceptable. -->
      <telecom use="DIR" value="mailto:lisarnelson@direct.myphd.us"/>
      <patient>
        <name use="L">
          <family>Nelson</family>
          <given qualifier="CL">Lisa</given>
        </name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1"
                                  displayName="Female" codeSystemName="HL7 AdministrativeGender" />
        <birthTime value="19620828"/>
        <maritalStatusCode code="M" codeSystem="2.16.840.1.113883.5.2"
                           displayName="Married" codeSystemName="HL7 MaritalStatus" />
        <raceCode code="2106-3" codeSystem="2.16.840.1.113883.6.238"
                  displayName="White" codeSystemName="CDC Race and Ethnicity" />
        <ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.6.238"
                         displayName="Not Hispanic or Latino" codeSystemName="CDC Race and Ethnicity" />
        <languageCommunication>
          <templateId root="2.16.840.1.113883.3.88.11.32.2"/>
          <languageCode code="en"/>
          <preferenceInd value="true"/>
        </languageCommunication>
      </patient>
      <providerOrganization>
        <!-- This is a public id where the root is registered to indicate the National Provider ID -->
        <id root="2.16.840.1.113883.4.6" extension="1417947383" assigningAuthorityName="National Provider ID" />
        <!-- This is a public id where the root indicates this is a Provider Direct Address. -->
        <!-- root="1.3.6.1.4.1.41179.2.1" is the assigningAutorityName for
             Direct Trust's Covered Entity addresses "DT.org CE" -->
        <id root="1.3.6.1.4.1.41179.2.1" extension="rvhs@rvhs.direct.md" assigningAuthorityName="DT.org CE (Covered Entity)"/>
        <!-- By including a root OID attribute for a healthcare organization, you can use this information to
             indicate a patient's MRN id at that organization.-->
        <id root="2.16.840.1.113883.1.111.12345" assigningAuthorityName="River Valley Health Services local patient Medical Record Number" />
        <name>River Valley Health Services</name>
        <telecom use="WP" value="tel:+1-4015394321"/>
        <!-- Recommended pattern for expressing a Direct address for this Provider Organization-->
        <!-- PUB is used for Direct addresses that support a workflow address that is not intended for a specific individual user. -->
        <!-- Usage Note:  the use attribute supports multiple attributes by separating them with a space, thus "WP PUB" or "PUB WP" also would be acceptable.
             In FHIR US Core, three concepts are represented separately:
             ContentPoint
             FHIR system = phone | fax | email | pager | url | sms | other (in FHIR email is the system when representing Direct Secure Messaging)
             CDA system =  not21 | note2 | note3| pager | note4|
             
             FHIR use = home | work | temp | old | mobile
             CDA  use = HP   | WP   |TMP   |     | MC
             
             FHIR extension.us-core-direct value [x] TRUE with a required boolean, then other value[x] elements are permitted.
             value [codeableConcept] can be used to express the two aligned concepts for
             codeSystemName=AddressUse codeSystem=http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.20
             FHIR CodeSystemName=TelecomUseUSRealmHeader
             DIR display="direct"
             PUB display="public"
             CDA us-core-direct use DIR or PUB
             
             note1 use tel:
             note2 use mailto:
             note3 use fax:
             note4 use http: or https:
             rare but ftp: also is supported.
             
             <telecom use="WP PUB" value="mailto:rvhs@rvhs.direct.md"/> and <telecom use="WP DIR" value="mailto:rvhs@rvhs.direct.md"/>
             also would be valid and offers full alignment with FHIR contact-point.
             When uncertian if the Direct address supports individual access or workflow "group access" use cases, best practice guidance is to use DIR.
             -->
        <telecom use="PUB" value="mailto:rvhs@rvhs.direct.md"/>
        <addr>
          <streetAddressLine>823 Main Street</streetAddressLine>
          <city>River Valley</city>
          <state>RI</state>
          <postalCode>02832</postalCode>
          <country>US</country>
        </addr>
      </providerOrganization>
    </patientRole>
  </recordTarget>
  <!-- Recommended pattern for expressing a Direct address for any entity in other roles in the CDA also can use this telecom use pattern of use="DIR" or use="PUB". -->
  <!-- DIR is used for Direct addresses that support an "individual use" use case -->
  <!-- PUB is used for Direct addresses that support a message workflow that is not intended for a specific individual user. -->
  <!-- Usage Note:  the use attribute supports multiple attributes by separating them with a space. For example, "WP DIR" or "DIR WP" or "DIR HP" also would be acceptable
       where telecom elements are included in header or body entries in the CDA document. -->
  <author>
    <time nullFlavor="NI"/>
    <assignedAuthor>
      <id nullFlavor="NI"/>
      <addr nullFlavor="NI"/>
      <telecom nullFlavor="NI"/>
      <assignedAuthoringDevice>
        <manufacturerModelName nullFlavor="NI"/>
        <softwareName nullFlavor="NI"/>
      </assignedAuthoringDevice>
    </assignedAuthor>
  </author>
  <custodian>
    <assignedCustodian>
      <representedCustodianOrganization>
        <id nullFlavor="NI" />
        <name nullFlavor="NI" />
        <telecom nullFlavor="NI" />
        <addr nullFlavor="NI" />
      </representedCustodianOrganization>
    </assignedCustodian>
  </custodian>
  <!-- ... -->
  <component>
    <structuredBody>
      <component>
        <section>
          <!-- ... -->
        </section>
      </component>
    </structuredBody>
  </component>
</ClinicalDocument>