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: WE Care Assessment

Approval Status: Approved
Task Force Approval: 2023-04-06
SDWG Approval: 2023-04-06

WE CARE (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education) is a clinic-based screening and referral system developed for pediatric settings USCF. This example includes the assessment in the Social History section

This file includes examples of the following templates: 


<section xmlns="urn:hl7-org:v3">
  <!--  An assessment should be included in the section where it is appropriate in clinical context  -->
  <!--  Other asssessments may go into other sections. Depression screening is clinically appropriate for Mental Status  -->
  <templateId root="2.16.840.1.113883.10.20.22.2.17"/>
  <templateId root="2.16.840.1.113883.10.20.22.2.17" extension="2015-08-01"/>
  <code displayName="Social History" codeSystemName="LOINC"
        codeSystem="2.16.840.1.113883.6.1" code="29762-2"/>
  <title>Social History</title>
  <text>
    <table>
      <thead>
        <tr>
          <th>Date</th>
          <th>Assessment</th>
          <th>Value</th>
        </tr>
      </thead>
      <tbody>
        <!--  Note that WE Care doesn't include total score, detailed responses shown below  -->
        <tr>
          <td ID="assessment" colspan="5">WE Care Survey</td>
        </tr>
        <!--  WE CARE Questions  -->
        <tr ID="assessment1">
          <td>06/22/2015</td>
          <td>WE CARE Question: Do you have a high school degree?</td>
          <td>No</td>
        </tr>
        <tr ID="assessment2">
          <td>06/22/2015</td>
          <td>WE CARE Question: If no, would you like help to get a GED?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment3">
          <td>06/22/2015</td>
          <td>WE CARE Question: Do you have a job?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment4">
          <td>06/22/2015</td>
          <td>WE CARE Question: If no, would you like help with finding employment and or job training?</td>
          <td>Maybe Later</td>
        </tr>
        <!--  How do we code no answer. FHIR NLM LHC Omits  -->
        <tr ID="assessment5">
          <td>06/22/2015</td>
          <td>WE CARE Question: Do you need daycare for your child?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment6">
          <td>06/22/2015</td>
          <td>WE CARE Question: If yes, would you like help finding it?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment7">
          <td>06/22/2015</td>
          <td>WE CARE Question: Do you think you are at risk of becoming homeless?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment8">
          <td>06/22/2015</td>
          <td>WE CARE Question: If yes, would you like help with this?</td>
          <td>No</td>
        </tr>
        <tr ID="assessment9">
          <td>06/22/2015</td>
          <td>WE CARE Question: If yes, is this an emergency?</td>
          <td>No</td>
        </tr>
        <tr ID="assessment10">
          <td>06/22/2015</td>
          <td>WE CARE Question: Do you always have enough food for your family?</td>
          <td>No</td>
        </tr>
        <tr ID="assessment11">
          <td>06/22/2015</td>
          <td>WE CARE Question: If no, would you like help with this?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment12">
          <td>06/22/2015</td>
          <td>WE CARE Question: If yes, do you need food for tonight?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment13">
          <td>06/22/2015</td>
          <td>WE CARE Question: Do you have trouble paying your heating bill and or electricity bill?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment14">
          <td>06/22/2015</td>
          <td>WE CARE Question: If yes, would you like help with this?</td>
          <td>Yes</td>
        </tr>
        <tr ID="assessment15">
          <td>06/22/2015</td>
          <td>WE CARE Question: If yes, are you at risk of having your utilities shut off in the next week?</td>
          <td>No</td>
        </tr>
      </tbody>
    </table>
  </text>
  <entry typeCode="DRIV">
    <observation moodCode="EVN" classCode="OBS">
      <!--  Assessment Scale Observation  -->
      <templateId root="2.16.840.1.113883.10.20.22.4.69"
                  extension="2022-06-01"/>
      <id root="48a7c8f7-30d6-4173-b3c4-4ad4abcfdb1a"/>
      <code xsi:type="CD" displayName="WE CARE Survey"
            codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1" code="96447-8"/>
      <text xsi:type="ED">
        <reference value="#assessment"/>
      </text>
      <statusCode code="completed"/>
      <effectiveTime value="20150622"/>
      <!--  Note that the value attribute is required in an assessment scale observation. Since LOINC organizes this information  -->
      <!--  Where the total score is part of the panel, that total score code is shown through entryRelationship to supporting observation  -->
      <!--  The WE CARE scale does NOT have a total score so a numeric INT is inappropriate  -->
      <value xsi:type="CD" nullFlavor="NA"/>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <!--  Assessment Scale Supporting Observation  -->
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="a6a704ab-271a-4bfa-9f0d-1581da2b1235"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96446-0"/>
          <text xsi:type="ED">
            <reference value="#assessment1"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="No"
                 codeSystem="2.16.840.1.113883.6.1" code="LA32-8"/>
        </observation>
      </entryRelationship>
      <!--  The total score may be adequate for some use cases, although detail components can be sent as shown below as warranted by use case  -->
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="a6a704ab-271a-4bfa-9f0d-1581da2b1186"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96445-2"/>
          <text xsi:type="ED">
            <reference value="#assessment2"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="466f43c8-fc2b-4161-b9a1-2d88688e5f74"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96444-5"/>
          <text xsi:type="ED">
            <reference value="#assessment3"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="e3e5b3d7-76f5-48f1-8ba0-b2b4e6314f95"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96443-7"/>
          <text xsi:type="ED">
            <reference value="#assessment4"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Maybe Later"
                 codeSystem="2.16.840.1.113883.6.1" code="LA31439-5"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="4d77eb67-6588-4f77-b506-1d987eee1711"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96442-9"/>
          <text xsi:type="ED">
            <reference value="#assessment5"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="b24d5a2c-48d6-46a0-bd92-1c901e577cc3"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96433-8"/>
          <text xsi:type="ED">
            <reference value="#assessment6"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="c67c51ea-4928-449d-b6c0-0f85b1975e07"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96441-1"/>
          <text xsi:type="ED">
            <reference value="#assessment7"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="68301d32-9158-429b-92b6-1f1e553a2f8c"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96440-3"/>
          <text xsi:type="ED">
            <reference value="#assessment8"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="No"
                 codeSystem="2.16.840.1.113883.6.1" code="LA32-8"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="400a66ad-3d5f-4b6e-913e-81e46241d83b"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96439-5"/>
          <text xsi:type="ED">
            <reference value="#assessment9"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="No"
                 codeSystem="2.16.840.1.113883.6.1" code="LA32-8"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="36792a59-7905-406e-a920-701a2ae746be"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96434-6"/>
          <text xsi:type="ED">
            <reference value="#assessment10"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="No"
                 codeSystem="2.16.840.1.113883.6.1" code="LA32-8"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="36792a59-7905-406e-a920-701a2ae746be"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96438-7"/>
          <text xsi:type="ED">
            <reference value="#assessment11"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="36792a59-7905-406e-a920-701a2ae746be"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96437-9"/>
          <text xsi:type="ED">
            <reference value="#assessment12"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="36792a59-7905-406e-a920-701a2ae746be"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96436-1"/>
          <text xsi:type="ED">
            <reference value="#assessment13"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="36792a59-7905-406e-a920-701a2ae746be"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96753-9"/>
          <text xsi:type="ED">
            <reference value="#assessment14"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="Yes"
                 codeSystem="2.16.840.1.113883.6.1" code="LA33-6"/>
        </observation>
      </entryRelationship>
      <entryRelationship typeCode="COMP">
        <observation moodCode="EVN" classCode="OBS">
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2015-08-01"/>
          <templateId root="2.16.840.1.113883.10.20.22.4.86"
                      extension="2022-06-01"/>
          <!--  Companion Guide  -->
          <id root="36792a59-7905-406e-a920-701a2ae746be"/>
          <code xsi:type="CD" codeSystemName="LOINC"
                codeSystem="2.16.840.1.113883.6.1" code="96435-3"/>
          <text xsi:type="ED">
            <reference value="#assessment15"/>
          </text>
          <statusCode code="completed"/>
          <effectiveTime value="20150622"/>
          <!--  xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list  -->
          <value xsi:type="CO" displayName="No"
                 codeSystem="2.16.840.1.113883.6.1" code="LA32-8"/>
        </observation>
      </entryRelationship>
    </observation>
  </entry>
</section>