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: Purpose of Reference Observation

Official URL: http://hl7.org/fhir/cda/ccda/StructureDefinition/2.16.840.1.113883.10.20.6.2.9 | Version: 2.2
Active as of 2022-05-13 | Computable Name: PurposeofReferenceObservation
Other Identifiers: : urn:oid:2.16.840.1.113883.10.20.6.2.9

A Purpose of Reference Observation describes the purpose of the DICOM composite object reference. Appropriate codes, such as externally defined DICOM codes, may be used to specify the semantics of the purpose of reference. When this observation is absent, it implies that the reason for the reference is unknown.

Usage:

- Use this Resource Profile: SOP Instance Observation

### 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: 5 elements

Slices

This structure defines the following Slices:

- The element Observation.templateId is sliced based on the value of value:root

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
templateId:primary |  | 1..1 | II |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.6.2.9
code | I | 1..1 | CD | 81-19209: For backwards compatibility with the DICOM CMET, the code MAY be drawn from ValueSet 2.16.840.1.113883.11.20.9.28 DICOMPurposeOfReference DYNAMIC (CONF:81-19209).
code |  | 0..1 | string | Required Pattern: ASSERTION
value |  | 0..1 | CD | The value element is a SHOULD to allow backwards compatibility with the DICOM CMET. Note that the use of ASSERTION for the code differs from the DICOM CMET. This is intentional. The DICOM CMET was created before the Term Info guidelines describing the use of the assertion pattern were released. It was determined that this IG should follow the latest Term Info guidelines. Implementers using both this IG and the DICOM CMET should be aware of this difference and apply appropriate transformations. Binding: VSAC 2.16.840.1.113883.11.20.9.28 (preferred)
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
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: 2.16.840.1.113883.10.20.6.2.9
extension |  | 0..1 | string |
id |  | 0..* | II |
code | I | 1..1 | CD | Binding: ObservationType (extensible) 81-19209: For backwards compatibility with the DICOM CMET, the code MAY be drawn from ValueSet 2.16.840.1.113883.11.20.9.28 DICOMPurposeOfReference DYNAMIC (CONF:81-19209).
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
code |  | 0..1 | string | Required Pattern: ASSERTION
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 |
translation |  | 0..* | CD |
derivationExpr |  | 0..1 | ED |
text |  | 0..1 | ED |
statusCode |  | 0..1 | CS | Binding: ActStatus (required)
effectiveTime |  | 0..1 | IVL_TS |
priorityCode |  | 0..1 | CE | Binding: ActPriority (extensible)
repeatNumber |  | 0..1 | IVL_INT |
languageCode |  | 0..1 | CS | Binding: HumanLanguage (required)
value |  | 0..1 | CD | The value element is a SHOULD to allow backwards compatibility with the DICOM CMET. Note that the use of ASSERTION for the code differs from the DICOM CMET. This is intentional. The DICOM CMET was created before the Term Info guidelines describing the use of the assertion pattern were released. It was determined that this IG should follow the latest Term Info guidelines. Implementers using both this IG and the DICOM CMET should be aware of this difference and apply appropriate transformations. Binding: VSAC 2.16.840.1.113883.11.20.9.28 (preferred)
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..* | Author |
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 |
participant |  | 0..* | Participant2 |
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 |
reference |  | 0..* | Element |
typeCode |  | 1..1 | code |
seperatableInd |  | 0..1 | BL |
externalAct |  | 0..1 | ExternalAct |
externalObservation |  | 0..1 | ExternalObservation |
externalProcedure |  | 0..1 | ExternalProcedure |
externalDocument |  | 0..1 | ExternalDocument |
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: 5 elements

Slices

This structure defines the following Slices:

- The element Observation.templateId is sliced based on the value of value:root

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
templateId:primary |  | 1..1 | II |
root |  | 1..1 | string | Required Pattern: 2.16.840.1.113883.10.20.6.2.9
code | I | 1..1 | CD | 81-19209: For backwards compatibility with the DICOM CMET, the code MAY be drawn from ValueSet 2.16.840.1.113883.11.20.9.28 DICOMPurposeOfReference DYNAMIC (CONF:81-19209).
code |  | 0..1 | string | Required Pattern: ASSERTION
value |  | 0..1 | CD | The value element is a SHOULD to allow backwards compatibility with the DICOM CMET. Note that the use of ASSERTION for the code differs from the DICOM CMET. This is intentional. The DICOM CMET was created before the Term Info guidelines describing the use of the assertion pattern were released. It was determined that this IG should follow the latest Term Info guidelines. Implementers using both this IG and the DICOM CMET should be aware of this difference and apply appropriate transformations. Binding: VSAC 2.16.840.1.113883.11.20.9.28 (preferred)
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
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: 2.16.840.1.113883.10.20.6.2.9
extension |  | 0..1 | string |
id |  | 0..* | II |
code | I | 1..1 | CD | Binding: ObservationType (extensible) 81-19209: For backwards compatibility with the DICOM CMET, the code MAY be drawn from ValueSet 2.16.840.1.113883.11.20.9.28 DICOMPurposeOfReference DYNAMIC (CONF:81-19209).
nullFlavor |  | 0..1 | code | Binding: NullFlavor (required)
code |  | 0..1 | string | Required Pattern: ASSERTION
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 |
translation |  | 0..* | CD |
derivationExpr |  | 0..1 | ED |
text |  | 0..1 | ED |
statusCode |  | 0..1 | CS | Binding: ActStatus (required)
effectiveTime |  | 0..1 | IVL_TS |
priorityCode |  | 0..1 | CE | Binding: ActPriority (extensible)
repeatNumber |  | 0..1 | IVL_INT |
languageCode |  | 0..1 | CS | Binding: HumanLanguage (required)
value |  | 0..1 | CD | The value element is a SHOULD to allow backwards compatibility with the DICOM CMET. Note that the use of ASSERTION for the code differs from the DICOM CMET. This is intentional. The DICOM CMET was created before the Term Info guidelines describing the use of the assertion pattern were released. It was determined that this IG should follow the latest Term Info guidelines. Implementers using both this IG and the DICOM CMET should be aware of this difference and apply appropriate transformations. Binding: VSAC 2.16.840.1.113883.11.20.9.28 (preferred)
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..* | Author |
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 |
participant |  | 0..* | Participant2 |
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 |
reference |  | 0..* | Element |
typeCode |  | 1..1 | code |
seperatableInd |  | 0..1 | BL |
externalAct |  | 0..1 | ExternalAct |
externalObservation |  | 0..1 | ExternalObservation |
externalProcedure |  | 0..1 | ExternalProcedure |
externalDocument |  | 0..1 | ExternalDocument |
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 | extensible | ObservationType
Observation.code.nullFlavor | required | NullFlavor
Observation.statusCode | required | ActStatus
Observation.priorityCode | extensible | ActPriority
Observation.languageCode | required | HumanLanguage
Observation.value | preferred | http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.28
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.referenceRange.typeCode | required | Fixed Value: REFV

#### Constraints

Id | Grade | Path | Details | Requirements
81-19209 | warning | Observation.code | For backwards compatibility with the DICOM CMET, the code MAY be drawn from ValueSet 2.16.840.1.113883.11.20.9.28 DICOMPurposeOfReference DYNAMIC (CONF:81-19209). : |
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 |