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
Problem Section Examples from C-CDA
Name | Description | Approval |
---|---|---|
Active Problem |
This example illustrates how to structure an active problem. |
2014-11-06, 2016-12-01 |
Complete or Resolved Problem |
This example illustrates how to structure a resolved problem, both by having a biological resolution date and a completed status of the concern. |
2014-06-05, 2016-12-01 |
No Known Problems |
This is an example of no known problems. |
2015-03-06, 2016-12-01 |
Patient Does Not Have Diabetes |
This is an example of an author asserting a patient does not have diabetes. |
2015-11-12, 2017-02-02 |
Pregnancy with Week Gestation |
This is an example of a patient pregnancy in problem list with information about estimateed delivery date. This is an alternative place to document and share pregancy informatoin in addition to social history and detailed pregnancy sections (see HL7 IG for more on pregancy status here: http://www.hl7.org/implement/standards/product_brief.cfm?product_id=494) |
2023-03-09 |
Problem TargetSiteCode Qualifier |
This is an example of adding a SNOMED qualifier to an ambiguous ICD-9 which could be used in qualifying patients related to QRDA/eCQM measure |
2017-05-18 |
Problem Value, Translation, Qualifier examples |
This example illustrates how to structure an active problem with value codes that need translation & qualifiers. Note that no formally vetted post-coordination semantics exist for codesystems besides SNOMED today (eg ICD-10), which is a limitation to this example. Example was updated after the March 2022 C-CDA Implementation-a-thon. |
2023-03-09 |
SDOH Problem |
This example illustrates how to structure an Active SDOH problem with a translation to ICD10. Some systems may document active SDOH issues in the Social History Section or the Health Concerns Section. Gravity and other industry initiatives may provide additional guidance on best practices. |
2024-06-06 |