Consolidated CDA Release 2.2
2.2 - CI Build

Consolidated CDA Release 2.2, published by Health Level Seven. This is not an authorized publication; it is the continuous build for version 2.2). This version is based on the current content of https://github.com/HL7/CDA-ccda-2.2/ and changes regularly. See the Directory of published versions

## Resource Profile: Advance Directive Observation

Official URL: http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.4.48 | Version: 2.2
Active as of 2022-05-13 | Computable Name: AdvanceDirectiveObservation
Other Identifiers: : urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01

This clinical statement represents Advance Directive Observation findings (e.g., resuscitation status is Full Code) rather than orders. It should not be considered a legal document or a substitute for the actual Advance Directive document. The related legal documents are referenced using the reference/externalReference element. The Advance Directive Observation describes the patients directives, including but not limited to: Medications Transfer of Care to Hospital Treatment Procedures Intubation and Ventilation Diagnostic Tests Tests

The observation/value element contains the detailed patient directive which may be coded or text. For example, a category directive may be antibiotics, and the details would be intravenous antibiotics only.

Usage:

- Use this Resource Profile: Advance Directives Section (entries required), Advance Directives Section (entries optional), Advance Directive Organizer, Intervention Act, Planned Intervention Act

### Formal Views of Profile Content

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

- Text Summary
- Differential Table
- Snapshot Table
- Snapshot Table (Must Support)
- All

This structure is derived from CDAR2.Observation

Summary

Mandatory: 20 elements (9 nested mandatory elements)

Structures

This structure refers to these other structures:

- Author Participation (http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.4.119)
- US Realm Address (AD.US.FIELDED) (http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.5.2)
- US Realm Person Name (PN.US.FIELDED) (http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.5.1.1)

Slices

This structure defines the following Slices:

- The element Observation.templateId is sliced based on the values of value:root, value:extension
- The element Observation.code.translation is sliced based on the values of value:code, value:codeSystem
- There is a slice with no discriminator at Observation.value
- The element Observation.participant is sliced based on the values of value:participantRole, value:typeCode
- The element Observation.participant.templateId is sliced based on the value of value:root
- The element Observation.reference is sliced based on the values of value:externalDocument, value:typeCode

This structure is derived from CDAR2.Observation

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Observation |  | 1..1 | CDAR2.Observation |
classCode |  | 1..1 | code | Required Pattern: OBS
moodCode |  | 1..1 | code | Required Pattern: EVN
Slices for templateId |  | 0..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 1..1 | II |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.22.4.48
extension |  | 1..1 | string | Required Pattern: 2015-08-01
id |  | 1..* | II |
code |  | 1..1 | CD | Binding: Advance Directive Type Code (preferred)
Slices for translation |  | 0..* | CD | Slice: Unordered, Open by value:code, value:codeSystem
translation:advanceDirective |  | 1..1 | CD |
code |  | 1..1 | string | Required Pattern: 75320-2
codeSystem |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.6.1
statusCode |  | 1..1 | CS | Required Pattern: Completed
code |  | 1..1 | string | Required Pattern: completed
effectiveTime |  | 1..1 | IVL_TS |
low |  | 1..1 | TS |
high | I | 1..1 | TS | 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
Slices for value |  | 0..* | BL, ED, ED, CD, CV, CE, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ | Slice: Unordered, Open by
value:value1 | I | 1..1 | BL, ED, ED, CD, CV, CE, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ | 1198-32493: If type CD, then value will be SNOMED-CT 2.16.840.1.113883.6.96 (CONF:1198-32493).
author |  | 0..* | AuthorParticipation |
Slices for participant |  | 0..* | Participant2 | This custodian (CST) participant identifies a legal representative for the patient's advance directive. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. If there is more than one legal representative, a qualifier may be used to designate the legal representative as primary or secondary. Slice: Unordered, Open by value:participantRole, value:typeCode
participant:participant1 |  | 0..* | Participant2 | The participant "VRF" represents the clinician(s) who verified the patient advance directive observation.
typeCode |  | 1..1 | code | Required Pattern: VRF
Slices for templateId |  | 0..* | II | Slice: Unordered, Open by value:root
templateId:primary |  | 1..1 | II |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.1.58
time | I | 0..1 | IVL_TS | 1198-8666: The data type of Observation/participant/time in a verification **SHALL** be *TS* (time stamp) (CONF:1198-8666).
participantRole |  | 1..1 | ParticipantRole |
code |  | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred)
addr |  | 0..* | USRealmAddressADUSFIELDED |
playingEntity |  | 0..1 | PlayingEntity |
name |  | 0..* | USRealmPersonNamePNUSFIELDED |
participant:participant2 |  | 0..* | Participant2 |
typeCode |  | 1..1 | code | Required Pattern: CST
participantRole |  | 1..1 | ParticipantRole |
classCode |  | 1..1 | code | Required Pattern: AGNT
code |  | 0..1 | CE | Binding: Personal And Legal Relationship Role Type (preferred)
addr |  | 0..1 | USRealmAddressADUSFIELDED |
telecom |  | 0..* | TEL |
playingEntity |  | 1..1 | PlayingEntity |
code |  | 0..1 | CE | Binding: Healthcare Agent Qualifier (preferred)
name |  | 1..1 | EN | Record the name of the agent who can provide a copy of the Advance Directive in the name element.
Slices for reference |  | 0..* | Element | Slice: Unordered, Open by value:externalDocument, value:typeCode
reference:reference1 |  | 1..* | Element |
typeCode |  | 1..1 | code | Required Pattern: REFR
externalDocument |  | 1..1 | ExternalDocument |
id |  | 1..* | II |
text |  | 0..1 | ED |
reference | I | 0..1 | TEL | 1198-8698: The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698). 1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Observation |  | 1..1 | CDAR2.Observation |
classCode |  | 1..1 | code | Binding: ActClassObservation (required) Required Pattern: OBS
moodCode |  | 1..1 | code | Required Pattern: EVN
negationInd |  | 0..1 | boolean |
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
Slices for templateId |  | 0..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 1..1 | II |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
assigningAuthorityName |  | 0..1 | string |
displayable |  | 0..1 | boolean |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.22.4.48
extension |  | 1..1 | string | Required Pattern: 2015-08-01
id |  | 1..* | II |
code |  | 1..1 | CD | Binding: Advance Directive Type Code (preferred)
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
code |  | 0..1 | string |
codeSystem |  | 0..1 | string |
codeSystemName |  | 0..1 | string |
codeSystemVersion |  | 0..1 | string |
displayName |  | 0..1 | string |
sdtcValueSet |  | 0..1 | string | XML: valueSet (urn:hl7-org:sdtc)
sdtcValueSetVersion |  | 0..1 | string | XML: valueSetVersion (urn:hl7-org:sdtc)
originalText |  | 0..1 | ED |
qualifier |  | 0..* | CR |
Slices for translation |  | 0..* | CD | Slice: Unordered, Open by value:code, value:codeSystem
translation:advanceDirective |  | 1..1 | CD |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
code |  | 1..1 | string | Required Pattern: 75320-2
codeSystem |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.6.1
codeSystemName |  | 0..1 | string |
codeSystemVersion |  | 0..1 | string |
displayName |  | 0..1 | string |
sdtcValueSet |  | 0..1 | string | XML: valueSet (urn:hl7-org:sdtc)
sdtcValueSetVersion |  | 0..1 | string | XML: valueSetVersion (urn:hl7-org:sdtc)
originalText |  | 0..1 | ED |
qualifier |  | 0..* | CR |
translation |  | 0..* | CD |
derivationExpr |  | 0..1 | ED |
text |  | 0..1 | ED |
statusCode |  | 1..1 | CS | Binding: ActStatus (required) Required Pattern: Completed
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
code |  | 1..1 | string | Required Pattern: completed
sdtcValueSet |  | 0..1 | string | XML: valueSet (urn:hl7-org:sdtc)
sdtcValueSetVersion |  | 0..1 | string | XML: valueSetVersion (urn:hl7-org:sdtc)
effectiveTime |  | 1..1 | IVL_TS |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
value |  | 0..1 | dateTime |
inclusive |  | 0..1 | boolean |
operator |  | 0..1 | code |
low |  | 1..1 | TS |
high | I | 1..1 | TS | 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
width |  | 0..1 | PQ |
center |  | 0..1 | TS |
priorityCode |  | 0..1 | CE | Binding: ActPriority (extensible)
repeatNumber |  | 0..1 | IVL_INT |
languageCode |  | 0..1 | CS | Binding: HumanLanguage (required)
Slices for value |  | 0..* |  | Slice: Unordered, Open by
value |  |  | BL |
value |  |  | ED |
value |  |  | ED |
value |  |  | CD |
value |  |  | CV |
value |  |  | CE |
value |  |  | SC |
value |  |  | II |
value |  |  | TEL |
value |  |  | AD |
value |  |  | EN |
value |  |  | INT |
value |  |  | REAL |
value |  |  | PQ |
value |  |  | MO |
value |  |  | TS |
value |  |  | IVL_PQ |
value |  |  | IVL_TS |
value |  |  | PIVL_TS |
value |  |  | EIVL_TS |
value |  |  | SXPR_TS |
value |  |  | RTO_PQ_PQ |
value:value1 | I | 1..1 |  | 1198-32493: If type CD, then value will be SNOMED-CT 2.16.840.1.113883.6.96 (CONF:1198-32493).
value |  |  | BL |
value |  |  | ED |
value |  |  | ED |
value |  |  | CD |
value |  |  | CV |
value |  |  | CE |
value |  |  | SC |
value |  |  | II |
value |  |  | TEL |
value |  |  | AD |
value |  |  | EN |
value |  |  | INT |
value |  |  | REAL |
value |  |  | PQ |
value |  |  | MO |
value |  |  | TS |
value |  |  | IVL_PQ |
value |  |  | IVL_TS |
value |  |  | PIVL_TS |
value |  |  | EIVL_TS |
value |  |  | SXPR_TS |
value |  |  | RTO_PQ_PQ |
interpretationCode |  | 0..* | CE | Binding: ObservationInterpretation (required)
methodCode |  | 0..* | CE | Binding: ObservationMethod (extensible)
targetSiteCode |  | 0..* | CD |
subject |  | 0..1 | Element |
typeCode |  | 1..1 | code | Binding: ParticipationTargetSubject (required) Fixed Value: SBJ
contextControlCode |  | 1..1 | code | Binding: ContextControl (required) Fixed Value: OP
awarenessCode |  | 0..1 | CE | Binding: TargetAwareness (extensible)
relatedSubject |  | 1..1 | RelatedSubject |
specimen |  | 0..* | Specimen |
performer |  | 0..* | Performer2 |
author |  | 0..* | AuthorParticipation |
informant |  | 0..* | Element |
typeCode |  | 1..1 | code | Binding: ParticipationInformationGenerator (required) Fixed Value: INF
contextControlCode |  | 1..1 | code | Binding: ContextControl (required) Fixed Value: OP
assignedEntity |  | 0..1 | AssignedEntity |
relatedEntity |  | 0..1 | RelatedEntity |
Slices for participant |  | 0..* | Participant2 | This custodian (CST) participant identifies a legal representative for the patient's advance directive. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. If there is more than one legal representative, a qualifier may be used to designate the legal representative as primary or secondary. Slice: Unordered, Open by value:participantRole, value:typeCode
participant:participant1 |  | 0..* | Participant2 | The participant "VRF" represents the clinician(s) who verified the patient advance directive observation.
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
typeCode |  | 1..1 | code | Binding: ParticipationType (required) Required Pattern: VRF
contextControlCode |  | 0..1 | code | Binding: ContextControl (required) Fixed Value: OP
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
Slices for templateId |  | 0..* | II | Slice: Unordered, Open by value:root
templateId:primary |  | 1..1 | II |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
assigningAuthorityName |  | 0..1 | string |
displayable |  | 0..1 | boolean |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.1.58
extension |  | 0..1 | string |
sdtcFunctionCode |  | 0..1 | CE | XML: functionCode (urn:hl7-org:sdtc)
time | I | 0..1 | IVL_TS | 1198-8666: The data type of Observation/participant/time in a verification **SHALL** be *TS* (time stamp) (CONF:1198-8666).
awarenessCode |  | 0..1 | CE |
participantRole |  | 1..1 | ParticipantRole |
classCode |  | 1..1 | code | Binding: RoleClassRoot (required)
templateId |  | 0..* | II |
id |  | 0..* | II |
sdtcIdentifiedBy |  | 0..* | IdentifiedBy | XML: identifiedBy (urn:hl7-org:sdtc)
code |  | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred)
addr | I | 0..* | USRealmAddressADUSFIELDED |
telecom |  | 0..* | TEL |
playingDevice |  | 0..1 | Device |
playingEntity |  | 0..1 | PlayingEntity |
classCode |  | 1..1 | code | Binding: EntityClassRoot (required)
determinerCode |  | 1..1 | code | Binding: EntityDeterminer (required) Fixed Value: INSTANCE
templateId |  | 0..* | II |
code |  | 0..1 | CE | Binding: EntityCode (extensible)
quantity |  | 0..* | PQ |
name | I | 0..* | USRealmPersonNamePNUSFIELDED |
desc |  | 0..1 | ED |
scopingEntity |  | 0..1 | Entity |
participant:participant2 |  | 0..* | Participant2 |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
typeCode |  | 1..1 | code | Binding: ParticipationType (required) Required Pattern: CST
contextControlCode |  | 0..1 | code | Binding: ContextControl (required) Fixed Value: OP
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
templateId |  | 0..* | II |
sdtcFunctionCode |  | 0..1 | CE | XML: functionCode (urn:hl7-org:sdtc)
time |  | 0..1 | IVL_TS |
awarenessCode |  | 0..1 | CE |
participantRole |  | 1..1 | ParticipantRole |
classCode |  | 1..1 | code | Binding: RoleClassRoot (required) Required Pattern: AGNT
templateId |  | 0..* | II |
id |  | 0..* | II |
sdtcIdentifiedBy |  | 0..* | IdentifiedBy | XML: identifiedBy (urn:hl7-org:sdtc)
code |  | 0..1 | CE | Binding: Personal And Legal Relationship Role Type (preferred)
addr | I | 0..1 | USRealmAddressADUSFIELDED |
telecom |  | 0..* | TEL |
playingDevice |  | 0..1 | Device |
playingEntity |  | 1..1 | PlayingEntity |
classCode |  | 1..1 | code | Binding: EntityClassRoot (required)
determinerCode |  | 1..1 | code | Binding: EntityDeterminer (required) Fixed Value: INSTANCE
templateId |  | 0..* | II |
code |  | 0..1 | CE | Binding: Healthcare Agent Qualifier (preferred)
quantity |  | 0..* | PQ |
name |  | 1..1 | EN | Record the name of the agent who can provide a copy of the Advance Directive in the name element.
desc |  | 0..1 | ED |
scopingEntity |  | 0..1 | Entity |
entryRelationship | I | 0..* | Element |
typeCode |  | 1..1 | code |
inversionInd |  | 0..1 | boolean |
contextConductionInd |  | 1..1 | boolean |
sequenceNumber |  | 0..1 | INT |
negationInd |  | 0..1 | boolean |
seperatableInd |  | 0..1 | BL |
(Choice of one) |  | 1..1 |  |
observation |  | 0..1 | Observation |
regionOfInterest |  | 0..1 | RegionOfInterest |
observationMedia |  | 0..1 | ObservationMedia |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 0..1 | Supply |
procedure |  | 0..1 | Procedure |
encounter |  | 0..1 | Encounter |
organizer |  | 0..1 | Organizer |
act |  | 0..1 | Act |
Slices for reference |  | 0..* | Element | Slice: Unordered, Open by value:externalDocument, value:typeCode
reference:All Slices |  |  |  | Content/Rules for all slices
typeCode |  | 1..1 | code |
seperatableInd |  | 0..1 | BL |
externalAct |  | 0..1 | ExternalAct |
externalObservation |  | 0..1 | ExternalObservation |
externalProcedure |  | 0..1 | ExternalProcedure |
externalDocument |  | 0..1 | ExternalDocument |
reference:reference1 |  | 1..* | Element |
typeCode |  | 1..1 | code | Required Pattern: REFR
seperatableInd |  | 0..1 | BL |
externalAct |  | 0..1 | ExternalAct |
externalObservation |  | 0..1 | ExternalObservation |
externalProcedure |  | 0..1 | ExternalProcedure |
externalDocument |  | 1..1 | ExternalDocument |
classCode |  | 1..1 | code | Binding: ActClassDocument (required)
moodCode |  | 1..1 | code | Binding: ActMood (required) Fixed Value: EVN
templateId |  | 0..* | II |
id |  | 1..* | II |
code |  | 0..1 | CD | ​Binding: http://terminology.hl7.org/ValueSet/v3-DocumentType (extensible)
text |  | 0..1 | ED |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
charset |  | 0..1 | code |
compression |  | 0..1 | code | Binding: CompressionAlgorithm (required)
integrityCheck |  | 0..1 | base64Binary |
integrityCheckAlgorithm |  | 0..1 | code | Binding: IntegrityCheckAlgorithm (required)
language |  | 0..1 | code |
mediaType |  | 0..1 | code |
representation |  | 0..1 | code |
data[x] |  | 0..1 |  |
dataString |  |  | string |
dataBase64Binary |  |  | base64Binary |
reference | I | 0..1 | TEL | 1198-8698: The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698). 1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
thumbnail |  | 0..1 | ED |
setId |  | 0..1 | II |
versionNumber |  | 0..1 | INT |
precondition |  | 0..* | Precondition |
referenceRange |  | 0..* | Element |
typeCode |  | 1..1 | code | Binding: ActRelationshipPertains (required) Fixed Value: REFV
observationRange |  | 1..1 | ObservationRange |
Documentation for this format

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Observation |  | 1..1 | CDAR2.Observation |
Documentation for this format

This structure is derived from CDAR2.Observation

Summary

Mandatory: 20 elements (9 nested mandatory elements)

Structures

This structure refers to these other structures:

- Author Participation (http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.4.119)
- US Realm Address (AD.US.FIELDED) (http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.5.2)
- US Realm Person Name (PN.US.FIELDED) (http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.22.5.1.1)

Slices

This structure defines the following Slices:

- The element Observation.templateId is sliced based on the values of value:root, value:extension
- The element Observation.code.translation is sliced based on the values of value:code, value:codeSystem
- There is a slice with no discriminator at Observation.value
- The element Observation.participant is sliced based on the values of value:participantRole, value:typeCode
- The element Observation.participant.templateId is sliced based on the value of value:root
- The element Observation.reference is sliced based on the values of value:externalDocument, value:typeCode

Differential View

This structure is derived from CDAR2.Observation

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Observation |  | 1..1 | CDAR2.Observation |
classCode |  | 1..1 | code | Required Pattern: OBS
moodCode |  | 1..1 | code | Required Pattern: EVN
Slices for templateId |  | 0..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 1..1 | II |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.22.4.48
extension |  | 1..1 | string | Required Pattern: 2015-08-01
id |  | 1..* | II |
code |  | 1..1 | CD | Binding: Advance Directive Type Code (preferred)
Slices for translation |  | 0..* | CD | Slice: Unordered, Open by value:code, value:codeSystem
translation:advanceDirective |  | 1..1 | CD |
code |  | 1..1 | string | Required Pattern: 75320-2
codeSystem |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.6.1
statusCode |  | 1..1 | CS | Required Pattern: Completed
code |  | 1..1 | string | Required Pattern: completed
effectiveTime |  | 1..1 | IVL_TS |
low |  | 1..1 | TS |
high | I | 1..1 | TS | 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
Slices for value |  | 0..* | BL, ED, ED, CD, CV, CE, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ | Slice: Unordered, Open by
value:value1 | I | 1..1 | BL, ED, ED, CD, CV, CE, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ | 1198-32493: If type CD, then value will be SNOMED-CT 2.16.840.1.113883.6.96 (CONF:1198-32493).
author |  | 0..* | AuthorParticipation |
Slices for participant |  | 0..* | Participant2 | This custodian (CST) participant identifies a legal representative for the patient's advance directive. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. If there is more than one legal representative, a qualifier may be used to designate the legal representative as primary or secondary. Slice: Unordered, Open by value:participantRole, value:typeCode
participant:participant1 |  | 0..* | Participant2 | The participant "VRF" represents the clinician(s) who verified the patient advance directive observation.
typeCode |  | 1..1 | code | Required Pattern: VRF
Slices for templateId |  | 0..* | II | Slice: Unordered, Open by value:root
templateId:primary |  | 1..1 | II |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.1.58
time | I | 0..1 | IVL_TS | 1198-8666: The data type of Observation/participant/time in a verification **SHALL** be *TS* (time stamp) (CONF:1198-8666).
participantRole |  | 1..1 | ParticipantRole |
code |  | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred)
addr |  | 0..* | USRealmAddressADUSFIELDED |
playingEntity |  | 0..1 | PlayingEntity |
name |  | 0..* | USRealmPersonNamePNUSFIELDED |
participant:participant2 |  | 0..* | Participant2 |
typeCode |  | 1..1 | code | Required Pattern: CST
participantRole |  | 1..1 | ParticipantRole |
classCode |  | 1..1 | code | Required Pattern: AGNT
code |  | 0..1 | CE | Binding: Personal And Legal Relationship Role Type (preferred)
addr |  | 0..1 | USRealmAddressADUSFIELDED |
telecom |  | 0..* | TEL |
playingEntity |  | 1..1 | PlayingEntity |
code |  | 0..1 | CE | Binding: Healthcare Agent Qualifier (preferred)
name |  | 1..1 | EN | Record the name of the agent who can provide a copy of the Advance Directive in the name element.
Slices for reference |  | 0..* | Element | Slice: Unordered, Open by value:externalDocument, value:typeCode
reference:reference1 |  | 1..* | Element |
typeCode |  | 1..1 | code | Required Pattern: REFR
externalDocument |  | 1..1 | ExternalDocument |
id |  | 1..* | II |
text |  | 0..1 | ED |
reference | I | 0..1 | TEL | 1198-8698: The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698). 1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
Documentation for this format

Snapshot View

Name | Flags | Card. | Type | Description & Constraints
--- | --- | --- | --- | ---
Observation |  | 1..1 | CDAR2.Observation |
classCode |  | 1..1 | code | Binding: ActClassObservation (required) Required Pattern: OBS
moodCode |  | 1..1 | code | Required Pattern: EVN
negationInd |  | 0..1 | boolean |
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
Slices for templateId |  | 0..* | II | Slice: Unordered, Open by value:root, value:extension
templateId:primary |  | 1..1 | II |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
assigningAuthorityName |  | 0..1 | string |
displayable |  | 0..1 | boolean |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.22.4.48
extension |  | 1..1 | string | Required Pattern: 2015-08-01
id |  | 1..* | II |
code |  | 1..1 | CD | Binding: Advance Directive Type Code (preferred)
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
code |  | 0..1 | string |
codeSystem |  | 0..1 | string |
codeSystemName |  | 0..1 | string |
codeSystemVersion |  | 0..1 | string |
displayName |  | 0..1 | string |
sdtcValueSet |  | 0..1 | string | XML: valueSet (urn:hl7-org:sdtc)
sdtcValueSetVersion |  | 0..1 | string | XML: valueSetVersion (urn:hl7-org:sdtc)
originalText |  | 0..1 | ED |
qualifier |  | 0..* | CR |
Slices for translation |  | 0..* | CD | Slice: Unordered, Open by value:code, value:codeSystem
translation:advanceDirective |  | 1..1 | CD |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
code |  | 1..1 | string | Required Pattern: 75320-2
codeSystem |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.6.1
codeSystemName |  | 0..1 | string |
codeSystemVersion |  | 0..1 | string |
displayName |  | 0..1 | string |
sdtcValueSet |  | 0..1 | string | XML: valueSet (urn:hl7-org:sdtc)
sdtcValueSetVersion |  | 0..1 | string | XML: valueSetVersion (urn:hl7-org:sdtc)
originalText |  | 0..1 | ED |
qualifier |  | 0..* | CR |
translation |  | 0..* | CD |
derivationExpr |  | 0..1 | ED |
text |  | 0..1 | ED |
statusCode |  | 1..1 | CS | Binding: ActStatus (required) Required Pattern: Completed
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
code |  | 1..1 | string | Required Pattern: completed
sdtcValueSet |  | 0..1 | string | XML: valueSet (urn:hl7-org:sdtc)
sdtcValueSetVersion |  | 0..1 | string | XML: valueSetVersion (urn:hl7-org:sdtc)
effectiveTime |  | 1..1 | IVL_TS |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
value |  | 0..1 | dateTime |
inclusive |  | 0..1 | boolean |
operator |  | 0..1 | code |
low |  | 1..1 | TS |
high | I | 1..1 | TS | 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
width |  | 0..1 | PQ |
center |  | 0..1 | TS |
priorityCode |  | 0..1 | CE | Binding: ActPriority (extensible)
repeatNumber |  | 0..1 | IVL_INT |
languageCode |  | 0..1 | CS | Binding: HumanLanguage (required)
Slices for value |  | 0..* |  | Slice: Unordered, Open by
value |  |  | BL |
value |  |  | ED |
value |  |  | ED |
value |  |  | CD |
value |  |  | CV |
value |  |  | CE |
value |  |  | SC |
value |  |  | II |
value |  |  | TEL |
value |  |  | AD |
value |  |  | EN |
value |  |  | INT |
value |  |  | REAL |
value |  |  | PQ |
value |  |  | MO |
value |  |  | TS |
value |  |  | IVL_PQ |
value |  |  | IVL_TS |
value |  |  | PIVL_TS |
value |  |  | EIVL_TS |
value |  |  | SXPR_TS |
value |  |  | RTO_PQ_PQ |
value:value1 | I | 1..1 |  | 1198-32493: If type CD, then value will be SNOMED-CT 2.16.840.1.113883.6.96 (CONF:1198-32493).
value |  |  | BL |
value |  |  | ED |
value |  |  | ED |
value |  |  | CD |
value |  |  | CV |
value |  |  | CE |
value |  |  | SC |
value |  |  | II |
value |  |  | TEL |
value |  |  | AD |
value |  |  | EN |
value |  |  | INT |
value |  |  | REAL |
value |  |  | PQ |
value |  |  | MO |
value |  |  | TS |
value |  |  | IVL_PQ |
value |  |  | IVL_TS |
value |  |  | PIVL_TS |
value |  |  | EIVL_TS |
value |  |  | SXPR_TS |
value |  |  | RTO_PQ_PQ |
interpretationCode |  | 0..* | CE | Binding: ObservationInterpretation (required)
methodCode |  | 0..* | CE | Binding: ObservationMethod (extensible)
targetSiteCode |  | 0..* | CD |
subject |  | 0..1 | Element |
typeCode |  | 1..1 | code | Binding: ParticipationTargetSubject (required) Fixed Value: SBJ
contextControlCode |  | 1..1 | code | Binding: ContextControl (required) Fixed Value: OP
awarenessCode |  | 0..1 | CE | Binding: TargetAwareness (extensible)
relatedSubject |  | 1..1 | RelatedSubject |
specimen |  | 0..* | Specimen |
performer |  | 0..* | Performer2 |
author |  | 0..* | AuthorParticipation |
informant |  | 0..* | Element |
typeCode |  | 1..1 | code | Binding: ParticipationInformationGenerator (required) Fixed Value: INF
contextControlCode |  | 1..1 | code | Binding: ContextControl (required) Fixed Value: OP
assignedEntity |  | 0..1 | AssignedEntity |
relatedEntity |  | 0..1 | RelatedEntity |
Slices for participant |  | 0..* | Participant2 | This custodian (CST) participant identifies a legal representative for the patient's advance directive. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. If there is more than one legal representative, a qualifier may be used to designate the legal representative as primary or secondary. Slice: Unordered, Open by value:participantRole, value:typeCode
participant:participant1 |  | 0..* | Participant2 | The participant "VRF" represents the clinician(s) who verified the patient advance directive observation.
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
typeCode |  | 1..1 | code | Binding: ParticipationType (required) Required Pattern: VRF
contextControlCode |  | 0..1 | code | Binding: ContextControl (required) Fixed Value: OP
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
Slices for templateId |  | 0..* | II | Slice: Unordered, Open by value:root
templateId:primary |  | 1..1 | II |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
assigningAuthorityName |  | 0..1 | string |
displayable |  | 0..1 | boolean |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.1.58
extension |  | 0..1 | string |
sdtcFunctionCode |  | 0..1 | CE | XML: functionCode (urn:hl7-org:sdtc)
time | I | 0..1 | IVL_TS | 1198-8666: The data type of Observation/participant/time in a verification **SHALL** be *TS* (time stamp) (CONF:1198-8666).
awarenessCode |  | 0..1 | CE |
participantRole |  | 1..1 | ParticipantRole |
classCode |  | 1..1 | code | Binding: RoleClassRoot (required)
templateId |  | 0..* | II |
id |  | 0..* | II |
sdtcIdentifiedBy |  | 0..* | IdentifiedBy | XML: identifiedBy (urn:hl7-org:sdtc)
code |  | 0..1 | CE | Binding: Healthcare Provider Taxonomy (preferred)
addr | I | 0..* | USRealmAddressADUSFIELDED |
telecom |  | 0..* | TEL |
playingDevice |  | 0..1 | Device |
playingEntity |  | 0..1 | PlayingEntity |
classCode |  | 1..1 | code | Binding: EntityClassRoot (required)
determinerCode |  | 1..1 | code | Binding: EntityDeterminer (required) Fixed Value: INSTANCE
templateId |  | 0..* | II |
code |  | 0..1 | CE | Binding: EntityCode (extensible)
quantity |  | 0..* | PQ |
name | I | 0..* | USRealmPersonNamePNUSFIELDED |
desc |  | 0..1 | ED |
scopingEntity |  | 0..1 | Entity |
participant:participant2 |  | 0..* | Participant2 |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
typeCode |  | 1..1 | code | Binding: ParticipationType (required) Required Pattern: CST
contextControlCode |  | 0..1 | code | Binding: ContextControl (required) Fixed Value: OP
realmCode |  | 0..* | CS |
typeId |  | 0..1 | II |
templateId |  | 0..* | II |
sdtcFunctionCode |  | 0..1 | CE | XML: functionCode (urn:hl7-org:sdtc)
time |  | 0..1 | IVL_TS |
awarenessCode |  | 0..1 | CE |
participantRole |  | 1..1 | ParticipantRole |
classCode |  | 1..1 | code | Binding: RoleClassRoot (required) Required Pattern: AGNT
templateId |  | 0..* | II |
id |  | 0..* | II |
sdtcIdentifiedBy |  | 0..* | IdentifiedBy | XML: identifiedBy (urn:hl7-org:sdtc)
code |  | 0..1 | CE | Binding: Personal And Legal Relationship Role Type (preferred)
addr | I | 0..1 | USRealmAddressADUSFIELDED |
telecom |  | 0..* | TEL |
playingDevice |  | 0..1 | Device |
playingEntity |  | 1..1 | PlayingEntity |
classCode |  | 1..1 | code | Binding: EntityClassRoot (required)
determinerCode |  | 1..1 | code | Binding: EntityDeterminer (required) Fixed Value: INSTANCE
templateId |  | 0..* | II |
code |  | 0..1 | CE | Binding: Healthcare Agent Qualifier (preferred)
quantity |  | 0..* | PQ |
name |  | 1..1 | EN | Record the name of the agent who can provide a copy of the Advance Directive in the name element.
desc |  | 0..1 | ED |
scopingEntity |  | 0..1 | Entity |
entryRelationship | I | 0..* | Element |
typeCode |  | 1..1 | code |
inversionInd |  | 0..1 | boolean |
contextConductionInd |  | 1..1 | boolean |
sequenceNumber |  | 0..1 | INT |
negationInd |  | 0..1 | boolean |
seperatableInd |  | 0..1 | BL |
(Choice of one) |  | 1..1 |  |
observation |  | 0..1 | Observation |
regionOfInterest |  | 0..1 | RegionOfInterest |
observationMedia |  | 0..1 | ObservationMedia |
substanceAdministration |  | 0..1 | SubstanceAdministration |
supply |  | 0..1 | Supply |
procedure |  | 0..1 | Procedure |
encounter |  | 0..1 | Encounter |
organizer |  | 0..1 | Organizer |
act |  | 0..1 | Act |
Slices for reference |  | 0..* | Element | Slice: Unordered, Open by value:externalDocument, value:typeCode
reference:All Slices |  |  |  | Content/Rules for all slices
typeCode |  | 1..1 | code |
seperatableInd |  | 0..1 | BL |
externalAct |  | 0..1 | ExternalAct |
externalObservation |  | 0..1 | ExternalObservation |
externalProcedure |  | 0..1 | ExternalProcedure |
externalDocument |  | 0..1 | ExternalDocument |
reference:reference1 |  | 1..* | Element |
typeCode |  | 1..1 | code | Required Pattern: REFR
seperatableInd |  | 0..1 | BL |
externalAct |  | 0..1 | ExternalAct |
externalObservation |  | 0..1 | ExternalObservation |
externalProcedure |  | 0..1 | ExternalProcedure |
externalDocument |  | 1..1 | ExternalDocument |
classCode |  | 1..1 | code | Binding: ActClassDocument (required)
moodCode |  | 1..1 | code | Binding: ActMood (required) Fixed Value: EVN
templateId |  | 0..* | II |
id |  | 1..* | II |
code |  | 0..1 | CD | ​Binding: http://terminology.hl7.org/ValueSet/v3-DocumentType (extensible)
text |  | 0..1 | ED |
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
charset |  | 0..1 | code |
compression |  | 0..1 | code | Binding: CompressionAlgorithm (required)
integrityCheck |  | 0..1 | base64Binary |
integrityCheckAlgorithm |  | 0..1 | code | Binding: IntegrityCheckAlgorithm (required)
language |  | 0..1 | code |
mediaType |  | 0..1 | code |
representation |  | 0..1 | code |
data[x] |  | 0..1 |  |
dataString |  |  | string |
dataBase64Binary |  |  | base64Binary |
reference | I | 0..1 | TEL | 1198-8698: The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698). 1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
thumbnail |  | 0..1 | ED |
setId |  | 0..1 | II |
versionNumber |  | 0..1 | INT |
precondition |  | 0..* | Precondition |
referenceRange |  | 0..* | Element |
typeCode |  | 1..1 | code | Binding: ActRelationshipPertains (required) Fixed Value: REFV
observationRange |  | 1..1 | ObservationRange |
Documentation for this format

Other representations of profile: CSV, Excel, Schematron

#### Terminology Bindings

Path | Conformance | ValueSet / Code
Observation.classCode | required | Pattern: OBS
Observation.templateId:primary.nullFlavor | required | NullFlavor
Observation.code | preferred | Advance Directive Type Code
Observation.code.nullFlavor | required | NullFlavor
Observation.code.translation:advanceDirective.nullFlavor | required | NullFlavor
Observation.statusCode | required | Pattern: Completed
Observation.statusCode.nullFlavor | required | NullFlavor
Observation.effectiveTime.nullFlavor | required | NullFlavor
Observation.priorityCode | extensible | ActPriority
Observation.languageCode | required | HumanLanguage
Observation.interpretationCode | required | ObservationInterpretation
Observation.methodCode | extensible | ObservationMethod
Observation.subject.typeCode | required | Fixed Value: SBJ
Observation.subject.contextControlCode | required | Fixed Value: OP
Observation.subject.awarenessCode | extensible | TargetAwareness
Observation.informant.typeCode | required | Fixed Value: INF
Observation.informant.contextControlCode | required | Fixed Value: OP
Observation.participant:participant1.nullFlavor | required | NullFlavor
Observation.participant:participant1.typeCode | required | Pattern: VRF
Observation.participant:participant1.contextControlCode | required | Fixed Value: OP
Observation.participant:participant1.templateId:primary.nullFlavor | required | NullFlavor
Observation.participant:participant1.participantRole.classCode | required | RoleClassRoot
Observation.participant:participant1.participantRole.code | preferred | HealthcareProviderTaxonomy
Observation.participant:participant1.participantRole.playingEntity.classCode | required | EntityClassRoot
Observation.participant:participant1.participantRole.playingEntity.determinerCode | required | Fixed Value: INSTANCE
Observation.participant:participant1.participantRole.playingEntity.code | extensible | EntityCode
Observation.participant:participant2.nullFlavor | required | NullFlavor
Observation.participant:participant2.typeCode | required | Pattern: CST
Observation.participant:participant2.contextControlCode | required | Fixed Value: OP
Observation.participant:participant2.participantRole.classCode | required | Pattern: AGNT
Observation.participant:participant2.participantRole.code | preferred | Personal And Legal Relationship Role Type
Observation.participant:participant2.participantRole.playingEntity.classCode | required | EntityClassRoot
Observation.participant:participant2.participantRole.playingEntity.determinerCode | required | Fixed Value: INSTANCE
Observation.participant:participant2.participantRole.playingEntity.code | preferred | Healthcare Agent Qualifier
Observation.reference:reference1.externalDocument.classCode | required | ActClassDocument
Observation.reference:reference1.externalDocument.moodCode | required | Fixed Value: EVN
Observation.reference:reference1.externalDocument.code | extensible | ​http://terminology.hl7.org/ValueSet/v3-DocumentType
Observation.reference:reference1.externalDocument.text.nullFlavor | required | NullFlavor
Observation.reference:reference1.externalDocument.text.compression | required | CompressionAlgorithm
Observation.reference:reference1.externalDocument.text.integrityCheckAlgorithm | required | IntegrityCheckAlgorithm
Observation.referenceRange.typeCode | required | Fixed Value: REFV

#### Constraints

Id | Grade | Path | Details | Requirements
1198-32449 | error | Observation.effectiveTime.high | If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449). : |
1198-32493 | error | Observation.value:value1 | If type CD, then value will be SNOMED-CT 2.16.840.1.113883.6.96 (CONF:1198-32493). : |
1198-8666 | warning | Observation.participant:participant1.time | The data type of Observation/participant/time in a verification **SHALL** be *TS* (time stamp) (CONF:1198-8666). : |
81-7296 | error | Observation.participant:participant1.participantRole.addr | **SHALL NOT** have mixed content except for white space (CONF:81-7296). : |
81-9371 | error | Observation.participant:participant1.participantRole.playingEntity.name | The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : |
81-9372 | error | Observation.participant:participant1.participantRole.playingEntity.name | The string **SHALL NOT** contain name parts (CONF:81-9372). : |
81-7296 | error | Observation.participant:participant2.participantRole.addr | **SHALL NOT** have mixed content except for white space (CONF:81-7296). : |
obs-er-1 | error | Observation.entryRelationship | Only one of observation, regionOfInterest, observationMedia, substanceAdministration, supply, procedure, encounter, organizer, and act : (observation | regionOfInterest | observationMedia | substanceAdministration | supply | procedure | encounter | organizer | act).count() = 1 |
1198-8698 | warning | Observation.reference:reference1.externalDocument.text.reference | The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698). : |
1198-8699 | warning | Observation.reference:reference1.externalDocument.text.reference | If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699). : |