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: Plan of Treatment Section

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/PlanofTreatmentSection | Version: 2.1
Draft as of 2023-09-29 | Computable Name: PlanofTreatmentSection
Other Identifiers: id: urn:hl7ii:2.16.840.1.113883.10.20.22.2.10:2014-06-09

This section, formerly known as “Plan of Care”, contains data that define pending orders, interventions, encounters, services, and procedures for the patient. It is limited to prospective, unfulfilled, or incomplete orders and requests only. These are indicated by the @moodCode of the entries within this section. All active, incomplete, or pending orders, appointments, referrals, procedures, services, or any other pending event of clinical significance to the current care of the patient should be listed.

This section may also contain information about ongoing care of the patient, clinical reminders, patient’s values, beliefs, preferences, care expectations, and overarching care goals.

Clinical reminders are placed here to provide prompts for disease prevention and management, patient safety, and healthcare quality improvements, including widely accepted performance measures.

Values may include the importance of quality of life over longevity. These values are taken into account when prioritizing all problems and their treatments.

Beliefs may include comfort with dying or the refusal of blood transfusions because of the patient’s religious convictions.

Preferences may include liquid medicines over tablets, or treatment via secure email instead of in person.

Care expectations may range from being treated only by female clinicians, to expecting all calls to be returned within 24 hours.

Overarching goals described in this section are not tied to a specific condition, problem, health concern, or intervention. Examples of overarching goals could be to minimize pain or dependence on others, or to walk a daughter down the aisle for her marriage.

The plan may also indicate that patient education will be provided.

Usage:

- Use this Logical Model: Consultation Note, Continuity of Care Document (CCD), Discharge Summary, History and Physical... Show 5 more, Operative Note, Procedure Note, Progress Note, 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
Slices for templateId |  | 1..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 1..1 | II |
root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.10
extension |  | 1..1 | st | Required Pattern: 2014-06-09
code |  | 1..1 | CE |
code |  | 1..1 | cs | Required Pattern: 18776-5
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 |  | 0..* | Entry | Slice: Unordered, Open by profile:observation, profile:encounter, profile:act, profile:procedure, profile:substanceAdministration, profile:supply
entry:plannedObs |  | 0..* | Entry |
observation |  | 1..1 | PlannedObservation | Base for all types and resources
entry:plannedEnc |  | 0..* | Entry |
encounter |  | 1..1 | PlannedEncounter | Base for all types and resources
entry:plannedAct |  | 0..* | Entry |
act |  | 1..1 | PlannedAct | Base for all types and resources
entry:plannedProc |  | 0..* | Entry |
procedure |  | 1..1 | PlannedProcedure | Base for all types and resources
entry:plannedMed |  | 0..* | Entry |
substanceAdministration |  | 1..1 | PlannedMedicationActivity | Base for all types and resources
entry:plannedSupply |  | 0..* | Entry |
supply |  | 1..1 | PlannedSupply | Base for all types and resources
entry:instruction |  | 0..* | Entry |
act |  | 1..1 | Instruction | Base for all types and resources
entry:handoffCommParticipants |  | 0..* | Entry |
act |  | 1..1 | HandoffCommunicationParticipants | Base for all types and resources
entry:nutrition |  | 0..* | Entry |
act |  | 1..1 | NutritionRecommendation | Base for all types and resources
entry:plannedImmunization |  | 0..* | Entry |
substanceAdministration |  | 1..1 | PlannedImmunizationActivity | Base for all types and resources
entry:goal |  | 0..* | Entry |
observation |  | 1..1 | GoalObservation | Base for all types and resources
Documentation for this format

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
Slices for templateId |  | 1..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 1..1 | II |
@root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.10
@extension |  | 1..1 | st | Required Pattern: 2014-06-09
code |  | 1..1 | CE | Binding: DocumentSectionType (extensible)
@code |  | 1..1 | cs | Required Pattern: 18776-5
@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 |  | 0..* | Entry | Slice: Unordered, Open by profile:observation, profile:encounter, profile:act, profile:procedure, profile:substanceAdministration, profile:supply
entry:plannedObs |  | 0..* | Entry |
observation |  | 1..1 | PlannedObservation | Base for all types and resources
entry:plannedEnc |  | 0..* | Entry |
encounter |  | 1..1 | PlannedEncounter | Base for all types and resources
entry:plannedAct |  | 0..* | Entry |
act |  | 1..1 | PlannedAct | Base for all types and resources
entry:plannedProc |  | 0..* | Entry |
procedure |  | 1..1 | PlannedProcedure | Base for all types and resources
entry:plannedMed |  | 0..* | Entry |
substanceAdministration |  | 1..1 | PlannedMedicationActivity | Base for all types and resources
entry:plannedSupply |  | 0..* | Entry |
supply |  | 1..1 | PlannedSupply | Base for all types and resources
entry:instruction |  | 0..* | Entry |
act |  | 1..1 | Instruction | Base for all types and resources
entry:handoffCommParticipants |  | 0..* | Entry |
act |  | 1..1 | HandoffCommunicationParticipants | Base for all types and resources
entry:nutrition |  | 0..* | Entry |
act |  | 1..1 | NutritionRecommendation | Base for all types and resources
entry:plannedImmunization |  | 0..* | Entry |
substanceAdministration |  | 1..1 | PlannedImmunizationActivity | Base for all types and resources
entry:goal |  | 0..* | Entry |
observation |  | 1..1 | GoalObservation | Base for all types and resources
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet
Section.code | extensible | DocumentSectionType

#### Constraints

Id | Grade | Path(s) | Details | Requirements
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)
@classCode |  | 0..1 | cs | Binding: ActClassRecordOrganizer (required) Fixed Value: DOCSECT
@moodCode |  | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN
Slices for templateId |  | 1..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 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: 2.16.840.1.113883.10.20.22.2.10
@extension |  | 1..1 | st | Required Pattern: 2014-06-09
id |  | 0..1 | II |
code |  | 1..1 | CE | Binding: DocumentSectionType (extensible)
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
@code |  | 1..1 | cs | Required Pattern: 18776-5
@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 |  | 0..* | Entry | Slice: Unordered, Open by profile:observation, profile:encounter, profile:act, profile:procedure, profile:substanceAdministration, profile:supply
entry:plannedObs |  | 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 | PlannedObservation | 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:plannedEnc |  | 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 |  | 1..1 | PlannedEncounter | Base for all types and resources
observation |  | 0..1 | Observation |
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:plannedAct |  | 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 |  | 1..1 | PlannedAct | Base for all types and resources
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
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:plannedProc |  | 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 |  | 0..1 | Organizer |
procedure |  | 1..1 | PlannedProcedure | Base for all types and resources
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 0..1 | Supply |
entry:plannedMed |  | 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 |  | 0..1 | Organizer |
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 1..1 | PlannedMedicationActivity | Base for all types and resources
supply |  | 0..1 | Supply |
entry:plannedSupply |  | 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 |  | 0..1 | Organizer |
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 1..1 | PlannedSupply | Base for all types and resources
entry:instruction |  | 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 |  | 1..1 | Instruction | Base for all types and resources
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
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:handoffCommParticipants |  | 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 |  | 1..1 | HandoffCommunicationParticipants | Base for all types and resources
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
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:nutrition |  | 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 |  | 1..1 | NutritionRecommendation | Base for all types and resources
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
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:plannedImmunization |  | 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 |  | 0..1 | Organizer |
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 1..1 | PlannedImmunizationActivity | Base for all types and resources
supply |  | 0..1 | Supply |
entry:goal |  | 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 | GoalObservation | 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 |
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 | NullFlavor
Section.classCode | required | Fixed Value: DOCSECT
Section.moodCode | required | Fixed Value: EVN
Section.templateId:primary.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:plannedObs.nullFlavor | required | NullFlavor
Section.entry:plannedObs.typeCode | required | XActRelationshipEntry
Section.entry:plannedEnc.nullFlavor | required | NullFlavor
Section.entry:plannedEnc.typeCode | required | XActRelationshipEntry
Section.entry:plannedAct.nullFlavor | required | NullFlavor
Section.entry:plannedAct.typeCode | required | XActRelationshipEntry
Section.entry:plannedProc.nullFlavor | required | NullFlavor
Section.entry:plannedProc.typeCode | required | XActRelationshipEntry
Section.entry:plannedMed.nullFlavor | required | NullFlavor
Section.entry:plannedMed.typeCode | required | XActRelationshipEntry
Section.entry:plannedSupply.nullFlavor | required | NullFlavor
Section.entry:plannedSupply.typeCode | required | XActRelationshipEntry
Section.entry:instruction.nullFlavor | required | NullFlavor
Section.entry:instruction.typeCode | required | XActRelationshipEntry
Section.entry:handoffCommParticipants.nullFlavor | required | NullFlavor
Section.entry:handoffCommParticipants.typeCode | required | XActRelationshipEntry
Section.entry:nutrition.nullFlavor | required | NullFlavor
Section.entry:nutrition.typeCode | required | XActRelationshipEntry
Section.entry:plannedImmunization.nullFlavor | required | NullFlavor
Section.entry:plannedImmunization.typeCode | required | XActRelationshipEntry
Section.entry:goal.nullFlavor | required | NullFlavor
Section.entry:goal.typeCode | required | XActRelationshipEntry
Section.component.nullFlavor | required | NullFlavor

#### Constraints

Id | Grade | Path(s) | Details | Requirements
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 (11 nested mandatory elements)

Structures

This structure refers to these other structures:

- Planned Observation (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedObservation)
- Planned Encounter (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedEncounter)
- Planned Act (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedAct)
- Planned Procedure (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedProcedure)
- Planned Medication Activity (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedMedicationActivity)
- Planned Supply (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedSupply)
- Instruction (http://hl7.org/cda/us/ccda/StructureDefinition/Instruction)
- Handoff Communication Participants (http://hl7.org/cda/us/ccda/StructureDefinition/HandoffCommunicationParticipants)
- Nutrition Recommendation (http://hl7.org/cda/us/ccda/StructureDefinition/NutritionRecommendation)
- Planned Immunization Activity (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedImmunizationActivity)
- Goal Observation (http://hl7.org/cda/us/ccda/StructureDefinition/GoalObservation)

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 values of profile:observation, profile:encounter, profile:act, profile:procedure, profile:substanceAdministration, profile:supply

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
Slices for templateId |  | 1..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 1..1 | II |
root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.10
extension |  | 1..1 | st | Required Pattern: 2014-06-09
code |  | 1..1 | CE |
code |  | 1..1 | cs | Required Pattern: 18776-5
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 |  | 0..* | Entry | Slice: Unordered, Open by profile:observation, profile:encounter, profile:act, profile:procedure, profile:substanceAdministration, profile:supply
entry:plannedObs |  | 0..* | Entry |
observation |  | 1..1 | PlannedObservation | Base for all types and resources
entry:plannedEnc |  | 0..* | Entry |
encounter |  | 1..1 | PlannedEncounter | Base for all types and resources
entry:plannedAct |  | 0..* | Entry |
act |  | 1..1 | PlannedAct | Base for all types and resources
entry:plannedProc |  | 0..* | Entry |
procedure |  | 1..1 | PlannedProcedure | Base for all types and resources
entry:plannedMed |  | 0..* | Entry |
substanceAdministration |  | 1..1 | PlannedMedicationActivity | Base for all types and resources
entry:plannedSupply |  | 0..* | Entry |
supply |  | 1..1 | PlannedSupply | Base for all types and resources
entry:instruction |  | 0..* | Entry |
act |  | 1..1 | Instruction | Base for all types and resources
entry:handoffCommParticipants |  | 0..* | Entry |
act |  | 1..1 | HandoffCommunicationParticipants | Base for all types and resources
entry:nutrition |  | 0..* | Entry |
act |  | 1..1 | NutritionRecommendation | Base for all types and resources
entry:plannedImmunization |  | 0..* | Entry |
substanceAdministration |  | 1..1 | PlannedImmunizationActivity | Base for all types and resources
entry:goal |  | 0..* | Entry |
observation |  | 1..1 | GoalObservation | Base for all types and resources
Documentation for this format

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
Slices for templateId |  | 1..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 1..1 | II |
@root |  | 1..1 | oid, uuid, ruid | Required Pattern: 2.16.840.1.113883.10.20.22.2.10
@extension |  | 1..1 | st | Required Pattern: 2014-06-09
code |  | 1..1 | CE | Binding: DocumentSectionType (extensible)
@code |  | 1..1 | cs | Required Pattern: 18776-5
@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 |  | 0..* | Entry | Slice: Unordered, Open by profile:observation, profile:encounter, profile:act, profile:procedure, profile:substanceAdministration, profile:supply
entry:plannedObs |  | 0..* | Entry |
observation |  | 1..1 | PlannedObservation | Base for all types and resources
entry:plannedEnc |  | 0..* | Entry |
encounter |  | 1..1 | PlannedEncounter | Base for all types and resources
entry:plannedAct |  | 0..* | Entry |
act |  | 1..1 | PlannedAct | Base for all types and resources
entry:plannedProc |  | 0..* | Entry |
procedure |  | 1..1 | PlannedProcedure | Base for all types and resources
entry:plannedMed |  | 0..* | Entry |
substanceAdministration |  | 1..1 | PlannedMedicationActivity | Base for all types and resources
entry:plannedSupply |  | 0..* | Entry |
supply |  | 1..1 | PlannedSupply | Base for all types and resources
entry:instruction |  | 0..* | Entry |
act |  | 1..1 | Instruction | Base for all types and resources
entry:handoffCommParticipants |  | 0..* | Entry |
act |  | 1..1 | HandoffCommunicationParticipants | Base for all types and resources
entry:nutrition |  | 0..* | Entry |
act |  | 1..1 | NutritionRecommendation | Base for all types and resources
entry:plannedImmunization |  | 0..* | Entry |
substanceAdministration |  | 1..1 | PlannedImmunizationActivity | Base for all types and resources
entry:goal |  | 0..* | Entry |
observation |  | 1..1 | GoalObservation | Base for all types and resources
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet
Section.code | extensible | DocumentSectionType

#### Constraints

Id | Grade | Path(s) | Details | Requirements
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)
@classCode |  | 0..1 | cs | Binding: ActClassRecordOrganizer (required) Fixed Value: DOCSECT
@moodCode |  | 0..1 | cs | Binding: ActMood (required) Fixed Value: EVN
Slices for templateId |  | 1..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 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: 2.16.840.1.113883.10.20.22.2.10
@extension |  | 1..1 | st | Required Pattern: 2014-06-09
id |  | 0..1 | II |
code |  | 1..1 | CE | Binding: DocumentSectionType (extensible)
@nullFlavor |  | 0..1 | cs | Binding: NullFlavor (required)
@code |  | 1..1 | cs | Required Pattern: 18776-5
@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 |  | 0..* | Entry | Slice: Unordered, Open by profile:observation, profile:encounter, profile:act, profile:procedure, profile:substanceAdministration, profile:supply
entry:plannedObs |  | 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 | PlannedObservation | 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:plannedEnc |  | 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 |  | 1..1 | PlannedEncounter | Base for all types and resources
observation |  | 0..1 | Observation |
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:plannedAct |  | 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 |  | 1..1 | PlannedAct | Base for all types and resources
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
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:plannedProc |  | 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 |  | 0..1 | Organizer |
procedure |  | 1..1 | PlannedProcedure | Base for all types and resources
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 0..1 | Supply |
entry:plannedMed |  | 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 |  | 0..1 | Organizer |
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 1..1 | PlannedMedicationActivity | Base for all types and resources
supply |  | 0..1 | Supply |
entry:plannedSupply |  | 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 |  | 0..1 | Organizer |
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 1..1 | PlannedSupply | Base for all types and resources
entry:instruction |  | 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 |  | 1..1 | Instruction | Base for all types and resources
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
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:handoffCommParticipants |  | 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 |  | 1..1 | HandoffCommunicationParticipants | Base for all types and resources
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
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:nutrition |  | 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 |  | 1..1 | NutritionRecommendation | Base for all types and resources
encounter |  | 0..1 | Encounter |
observation |  | 0..1 | Observation |
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:plannedImmunization |  | 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 |  | 0..1 | Organizer |
procedure |  | 0..1 | Procedure |
regionOfInterest |  | 0..1 | RegionOfInterest |
substanceAdministration |  | 1..1 | PlannedImmunizationActivity | Base for all types and resources
supply |  | 0..1 | Supply |
entry:goal |  | 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 | GoalObservation | 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 |
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 | NullFlavor
Section.classCode | required | Fixed Value: DOCSECT
Section.moodCode | required | Fixed Value: EVN
Section.templateId:primary.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:plannedObs.nullFlavor | required | NullFlavor
Section.entry:plannedObs.typeCode | required | XActRelationshipEntry
Section.entry:plannedEnc.nullFlavor | required | NullFlavor
Section.entry:plannedEnc.typeCode | required | XActRelationshipEntry
Section.entry:plannedAct.nullFlavor | required | NullFlavor
Section.entry:plannedAct.typeCode | required | XActRelationshipEntry
Section.entry:plannedProc.nullFlavor | required | NullFlavor
Section.entry:plannedProc.typeCode | required | XActRelationshipEntry
Section.entry:plannedMed.nullFlavor | required | NullFlavor
Section.entry:plannedMed.typeCode | required | XActRelationshipEntry
Section.entry:plannedSupply.nullFlavor | required | NullFlavor
Section.entry:plannedSupply.typeCode | required | XActRelationshipEntry
Section.entry:instruction.nullFlavor | required | NullFlavor
Section.entry:instruction.typeCode | required | XActRelationshipEntry
Section.entry:handoffCommParticipants.nullFlavor | required | NullFlavor
Section.entry:handoffCommParticipants.typeCode | required | XActRelationshipEntry
Section.entry:nutrition.nullFlavor | required | NullFlavor
Section.entry:nutrition.typeCode | required | XActRelationshipEntry
Section.entry:plannedImmunization.nullFlavor | required | NullFlavor
Section.entry:plannedImmunization.typeCode | required | XActRelationshipEntry
Section.entry:goal.nullFlavor | required | NullFlavor
Section.entry:goal.typeCode | required | XActRelationshipEntry
Section.component.nullFlavor | required | NullFlavor

#### Constraints

Id | Grade | Path(s) | Details | Requirements
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 (11 nested mandatory elements)

Structures

This structure refers to these other structures:

- Planned Observation (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedObservation)
- Planned Encounter (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedEncounter)
- Planned Act (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedAct)
- Planned Procedure (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedProcedure)
- Planned Medication Activity (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedMedicationActivity)
- Planned Supply (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedSupply)
- Instruction (http://hl7.org/cda/us/ccda/StructureDefinition/Instruction)
- Handoff Communication Participants (http://hl7.org/cda/us/ccda/StructureDefinition/HandoffCommunicationParticipants)
- Nutrition Recommendation (http://hl7.org/cda/us/ccda/StructureDefinition/NutritionRecommendation)
- Planned Immunization Activity (http://hl7.org/cda/us/ccda/StructureDefinition/PlannedImmunizationActivity)
- Goal Observation (http://hl7.org/cda/us/ccda/StructureDefinition/GoalObservation)

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 values of profile:observation, profile:encounter, profile:act, profile:procedure, profile:substanceAdministration, profile:supply

Other representations of profile: CSV, Excel