Consolidated CDA Release 2.1 StructureDefinition Publication
2.1 - CI Build

Consolidated CDA Release 2.1 StructureDefinition Publication, published by Health Level Seven. This is not an authorized publication; it is the continuous build for version 2.1). This version is based on the current content of https://github.com/HL7/CDA-ccda-2.1-sd/ and changes regularly. See the Directory of published versions

## Logical Model: Advance Directives Section

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectivesSection | Version: 2.1
Draft as of 2023-09-29 | Computable Name: AdvanceDirectivesSection
Other Identifiers: id: urn:hl7ii:2.16.840.1.113883.10.20.22.2.21.1:2015-08-01

This section contains data defining the patient’s advance directives and any reference to supporting documentation, including living wills, healthcare proxies, and CPR and resuscitation status. If the referenced documents are available, they can be included in the exchange package.

The most recent directives are required, if known, and should be listed in as much detail as possible.

This section differentiates between “advance directives” and “advance directive documents”. The former is the directions to be followed whereas the latter refers to a legal document containing those directions.

Usage:

- Use this Logical Model: Consultation Note, Continuity of Care Document (CCD), Referral Note and Transfer Summary

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Differential Table
- Key Elements Table
- Snapshot Table
- Statistics/References
- All

This structure is derived from CDAR2.Section

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Section |  |  | CDAR2.Section | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @ID, @nullFlavor, @classCode, @moodCode, templateId, id, code, title, text, confidentialityCode, languageCode, subject, author, informant, entry, component
nullFlavor |  | 0..1 | cs | Fixed Value: NI
Slices for templateId |  | 2..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:secondary |  | 1..1 | II |
root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.21.1
extension |  | 1..1 | st | Required Pattern: 2015-08-01
code |  | 1..1 | CE |
code |  | 1..1 | cs | Required Pattern: 42348-3
codeSystem |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.6.1
title |  | 1..1 | ST |
text |  | 1..1 | xhtml |
Slices for entry | C | 1..* | Entry | If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer (NEW): Slice: Unordered, Open by exists:* 1198-32881: This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881).
entry:observation |  | 0..* | Entry |
observation |  | 1..1 | AdvanceDirectiveObservation | Base for all types and resources
entry:organizer |  | 0..* | Entry |
organizer |  | 1..1 | AdvanceDirectiveOrganizer | Base for all types and resources
Documentation for this format

#### Constraints

Id | Grade | Path(s) | Details | Requirements
1198-32881 | error | Section.entry | This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881). : |

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Section |  | 1..1 | CDAR2.Section | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @ID, @nullFlavor, @classCode, @moodCode, templateId, id, code, title, text, confidentialityCode, languageCode, subject, author, informant, entry, component Base for all types and resources
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required) Fixed Value: NI
Slices for templateId |  | 2..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:secondary |  | 1..1 | II |
@root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.21.1
@extension |  | 1..1 | st | Required Pattern: 2015-08-01
code |  | 1..1 | CE | Binding: DocumentSectionType (extensible)
@code |  | 1..1 | cs | Required Pattern: 42348-3
@codeSystem |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.6.1
title |  | 1..1 | ST |
text | S | 1..1 | xhtml |
Slices for entry | C | 1..* | Entry | If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer (NEW): Slice: Unordered, Open by exists:* 1198-32881: This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881).
entry:observation |  | 0..* | Entry |
observation |  | 1..1 | AdvanceDirectiveObservation | Base for all types and resources
entry:organizer |  | 0..* | Entry |
organizer |  | 1..1 | AdvanceDirectiveOrganizer | Base for all types and resources
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code
Section.nullFlavor | required | Fixed Value: NI
Section.code | extensible | DocumentSectionType

#### Constraints

Id | Grade | Path(s) | Details | Requirements
1198-32881 | error | Section.entry | This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881). : |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Section |  | 1..1 | CDAR2.Section | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @ID, @nullFlavor, @classCode, @moodCode, templateId, id, code, title, text, confidentialityCode, languageCode, subject, author, informant, entry, component Base for all types and resources
@ID |  | 0..1 | xs:ID |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required) Fixed Value: NI
@classCode |  | 0..1 | cs | Binding: ActClassRecordOrganizer (required) Fixed Value: DOCSECT
@moodCode |  | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN
Slices for templateId |  | 2..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:secondary |  | 1..1 | II |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
@assigningAuthorityName |  | 0..1 | st |
@displayable |  | 0..1 | bl |
@root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.21.1
@extension |  | 1..1 | st | Required Pattern: 2015-08-01
id |  | 0..1 | II |
code |  | 1..1 | CE | Binding: DocumentSectionType (extensible)
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
@code |  | 1..1 | cs | Required Pattern: 42348-3
@codeSystem |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.6.1
@codeSystemName |  | 0..1 | st |
@codeSystemVersion |  | 0..1 | st |
@displayName |  | 0..1 | st |
@sdtcValueSet |  | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion |  | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
originalText |  | 0..1 | ED |
translation |  | 0..* | CD |
title |  | 1..1 | ST |
text | S | 1..1 | xhtml |
confidentialityCode |  | 0..1 | CE |
languageCode |  | 0..1 | CS | Binding: HumanLanguage (required)
subject |  | 0..1 | Subject |
author |  | 0..* | Author |
informant |  | 0..* | Informant |
Slices for entry | C | 1..* | Entry | If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer (NEW): Slice: Unordered, Open by exists:* 1198-32881: This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881).
entry:observation |  | 0..* | Entry |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
templateId |  | 0..* | II |
@typeCode |  | 0..1 | cs | Binding: x_ActRelationshipEntry (required)
@contextConductionInd |  | 0..1 | bl | Fixed Value: true
act |  | 0..1 | Act |
encounter |  | 0..1 | Encounter |
observation |  | 1..1 | AdvanceDirectiveObservation | Base for all types and resources
observationMedia |  | 0..1 | ObservationMedia |
organizer |  | 0..1 | Organizer |
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 0..1 | Supply |
entry:organizer |  | 0..* | Entry |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
templateId |  | 0..* | II |
@typeCode |  | 0..1 | cs | Binding: x_ActRelationshipEntry (required)
@contextConductionInd |  | 0..1 | bl | Fixed Value: true
act |  | 0..1 | Act |
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
observationMedia |  | 0..1 | ObservationMedia |
organizer |  | 1..1 | AdvanceDirectiveOrganizer | Base for all types and resources
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 0..1 | Supply |
component |  | 0..* | InfrastructureRoot |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
templateId |  | 0..* | II |
@typeCode |  | 0..1 | cs | Fixed Value: COMP
@contextConductionInd |  | 0..1 | bl | Fixed Value: true
section |  | 1..1 | Section |
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code
Section.nullFlavor | required | Fixed Value: NI
Section.classCode | required | Fixed Value: DOCSECT
Section.moodCode | required | Fixed Value: EVN
Section.templateId:secondary.nullFlavor | required | NullFlavor
Section.code | extensible | DocumentSectionType
Section.code.nullFlavor | required | NullFlavor
Section.languageCode | required | HumanLanguage (a valid code from `http://terminology.hl7.org/CodeSystem/ietf3066`)
Section.entry:observation.nullFlavor | required | NullFlavor
Section.entry:observation.typeCode | required | XActRelationshipEntry
Section.entry:organizer.nullFlavor | required | NullFlavor
Section.entry:organizer.typeCode | required | XActRelationshipEntry
Section.component.nullFlavor | required | NullFlavor

#### Constraints

Id | Grade | Path(s) | Details | Requirements
1198-32881 | error | Section.entry | This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881). : |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |

This structure is derived from CDAR2.Section

Summary

Mandatory: 9 elements (2 nested mandatory elements)
Fixed Value: 1 element

Structures

This structure refers to these other structures:

- Advance Directive Observation (http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation)
- Advance Directive Organizer (http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveOrganizer)

Slices

This structure defines the following Slices:

- The element Section.templateId is sliced based on the values of value:root, value:extension
- The element Section.entry is sliced based on the value of exists:*

Differential View

This structure is derived from CDAR2.Section

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Section |  |  | CDAR2.Section | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @ID, @nullFlavor, @classCode, @moodCode, templateId, id, code, title, text, confidentialityCode, languageCode, subject, author, informant, entry, component
nullFlavor |  | 0..1 | cs | Fixed Value: NI
Slices for templateId |  | 2..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:secondary |  | 1..1 | II |
root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.21.1
extension |  | 1..1 | st | Required Pattern: 2015-08-01
code |  | 1..1 | CE |
code |  | 1..1 | cs | Required Pattern: 42348-3
codeSystem |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.6.1
title |  | 1..1 | ST |
text |  | 1..1 | xhtml |
Slices for entry | C | 1..* | Entry | If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer (NEW): Slice: Unordered, Open by exists:* 1198-32881: This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881).
entry:observation |  | 0..* | Entry |
observation |  | 1..1 | AdvanceDirectiveObservation | Base for all types and resources
entry:organizer |  | 0..* | Entry |
organizer |  | 1..1 | AdvanceDirectiveOrganizer | Base for all types and resources
Documentation for this format

#### Constraints

Id | Grade | Path(s) | Details | Requirements
1198-32881 | error | Section.entry | This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881). : |

Key Elements View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Section |  | 1..1 | CDAR2.Section | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @ID, @nullFlavor, @classCode, @moodCode, templateId, id, code, title, text, confidentialityCode, languageCode, subject, author, informant, entry, component Base for all types and resources
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required) Fixed Value: NI
Slices for templateId |  | 2..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:secondary |  | 1..1 | II |
@root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.21.1
@extension |  | 1..1 | st | Required Pattern: 2015-08-01
code |  | 1..1 | CE | Binding: DocumentSectionType (extensible)
@code |  | 1..1 | cs | Required Pattern: 42348-3
@codeSystem |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.6.1
title |  | 1..1 | ST |
text | S | 1..1 | xhtml |
Slices for entry | C | 1..* | Entry | If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer (NEW): Slice: Unordered, Open by exists:* 1198-32881: This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881).
entry:observation |  | 0..* | Entry |
observation |  | 1..1 | AdvanceDirectiveObservation | Base for all types and resources
entry:organizer |  | 0..* | Entry |
organizer |  | 1..1 | AdvanceDirectiveOrganizer | Base for all types and resources
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code
Section.nullFlavor | required | Fixed Value: NI
Section.code | extensible | DocumentSectionType

#### Constraints

Id | Grade | Path(s) | Details | Requirements
1198-32881 | error | Section.entry | This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881). : |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Section |  | 1..1 | CDAR2.Section | XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors: @ID, @nullFlavor, @classCode, @moodCode, templateId, id, code, title, text, confidentialityCode, languageCode, subject, author, informant, entry, component Base for all types and resources
@ID |  | 0..1 | xs:ID |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required) Fixed Value: NI
@classCode |  | 0..1 | cs | Binding: ActClassRecordOrganizer (required) Fixed Value: DOCSECT
@moodCode |  | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN
Slices for templateId |  | 2..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:secondary |  | 1..1 | II |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
@assigningAuthorityName |  | 0..1 | st |
@displayable |  | 0..1 | bl |
@root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.21.1
@extension |  | 1..1 | st | Required Pattern: 2015-08-01
id |  | 0..1 | II |
code |  | 1..1 | CE | Binding: DocumentSectionType (extensible)
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
@code |  | 1..1 | cs | Required Pattern: 42348-3
@codeSystem |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.6.1
@codeSystemName |  | 0..1 | st |
@codeSystemVersion |  | 0..1 | st |
@displayName |  | 0..1 | st |
@sdtcValueSet |  | 0..1 | oid | XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion |  | 0..1 | st | XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
originalText |  | 0..1 | ED |
translation |  | 0..* | CD |
title |  | 1..1 | ST |
text | S | 1..1 | xhtml |
confidentialityCode |  | 0..1 | CE |
languageCode |  | 0..1 | CS | Binding: HumanLanguage (required)
subject |  | 0..1 | Subject |
author |  | 0..* | Author |
informant |  | 0..* | Informant |
Slices for entry | C | 1..* | Entry | If section/@nullFlavor is not present SHALL contain an Advance Directive Observation OR an Advance Directive Organizer (NEW): Slice: Unordered, Open by exists:* 1198-32881: This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881).
entry:observation |  | 0..* | Entry |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
templateId |  | 0..* | II |
@typeCode |  | 0..1 | cs | Binding: x_ActRelationshipEntry (required)
@contextConductionInd |  | 0..1 | bl | Fixed Value: true
act |  | 0..1 | Act |
encounter |  | 0..1 | Encounter |
observation |  | 1..1 | AdvanceDirectiveObservation | Base for all types and resources
observationMedia |  | 0..1 | ObservationMedia |
organizer |  | 0..1 | Organizer |
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 0..1 | Supply |
entry:organizer |  | 0..* | Entry |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
templateId |  | 0..* | II |
@typeCode |  | 0..1 | cs | Binding: x_ActRelationshipEntry (required)
@contextConductionInd |  | 0..1 | bl | Fixed Value: true
act |  | 0..1 | Act |
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
observationMedia |  | 0..1 | ObservationMedia |
organizer |  | 1..1 | AdvanceDirectiveOrganizer | Base for all types and resources
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 0..1 | Supply |
component |  | 0..* | InfrastructureRoot |
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
templateId |  | 0..* | II |
@typeCode |  | 0..1 | cs | Fixed Value: COMP
@contextConductionInd |  | 0..1 | bl | Fixed Value: true
section |  | 1..1 | Section |
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code
Section.nullFlavor | required | Fixed Value: NI
Section.classCode | required | Fixed Value: DOCSECT
Section.moodCode | required | Fixed Value: EVN
Section.templateId:secondary.nullFlavor | required | NullFlavor
Section.code | extensible | DocumentSectionType
Section.code.nullFlavor | required | NullFlavor
Section.languageCode | required | HumanLanguage (a valid code from `http://terminology.hl7.org/CodeSystem/ietf3066`)
Section.entry:observation.nullFlavor | required | NullFlavor
Section.entry:observation.typeCode | required | XActRelationshipEntry
Section.entry:organizer.nullFlavor | required | NullFlavor
Section.entry:organizer.typeCode | required | XActRelationshipEntry
Section.component.nullFlavor | required | NullFlavor

#### Constraints

Id | Grade | Path(s) | Details | Requirements
1198-32881 | error | Section.entry | This entry **SHALL** contain *EITHER* an Advance Directive Observation *OR* an Advance Directive Organizer (CONF:1198-32881). : |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |

This structure is derived from CDAR2.Section

Summary

Mandatory: 9 elements (2 nested mandatory elements)
Fixed Value: 1 element

Structures

This structure refers to these other structures:

- Advance Directive Observation (http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation)
- Advance Directive Organizer (http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveOrganizer)

Slices

This structure defines the following Slices:

- The element Section.templateId is sliced based on the values of value:root, value:extension
- The element Section.entry is sliced based on the value of exists:*

Other representations of profile: CSV, Excel