Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-ccda/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON

Logical Model: Problem Observation

This template reflects a discrete observation about a patient's problem. Because it is a discrete observation, it will have a statusCode of "completed". The effectiveTime, also referred to as the "biologically relevant time" is the time at which the observation holds for the patient. For a provider seeing a patient in the clinic today, observing a history of heart attack that occurred five years ago, the effectiveTime is five years ago.

The effectiveTime of the Problem Observation is the definitive indication of whether or not the underlying condition is inactive. If the problem is known to be resolved, in remission, or otherwise inactive, then an effectiveTime/high would be present. If the date of resolution is not known, then effectiveTime/high will be present with a nullFlavor of "UNK".

Usage:

• Derived from this Logical Model: Longitudinal Care Wound Observation
• Use this Logical Model: Complications Section, Deceased Observation, Encounter Diagnosis, Health Concern Act... Show 8 more, Hospital Admission Diagnosis, Hospital Discharge Diagnosis, Past Medical History, Postprocedure Diagnosis, Preoperative Diagnosis, Problem Concern Act, Procedure Findings Section and Risk Concern Act

Formal Views of Template Content

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

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

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-author: SHOULD contain author
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:problem-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.4
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Fixed Value: OBS
@moodCode		1..1	cs	Fixed Value: EVN
@negationInd		0..1	bl	The negationInd is used to indicate the absence of the condition in observation/value. A negationInd of "true" coupled with an observation/value of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions.
id		1..*	II
code		1..1	CD	Binding: Problem Type (preferred)
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS	If the problem is known to be resolved, but the date of resolution is not known, then the high element **SHALL** be present, and the nullFlavor attribute **SHALL** be set to 'UNK'. Therefore, the existence of a high element within a problem does indicate that the problem has been resolved.
low		1..1	IVXB_TS	The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.
high		0..1	IVXB_TS	𝗨𝗦𝗖𝗗𝗜: Date of Resolution - The effectiveTime/high (a.k.a. resolution date) asserts when the condition became biologically resolved.
value		1..1	CD	𝗨𝗦𝗖𝗗𝗜: SDOH Problems/Health Concerns Binding: US Core Condition Codes (preferred)
@code		0..1	cs	A negationInd of "true" coupled with an observation/value/@code of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions. When the Problem is Social Determinant of Health Observation, the observation/value SHOULD be a SNOMED code selected from ValueSet Social Determinant of Health Conditions 2.16.840.1.113762.1.4.1196.788 DYNAMIC (CONF:4515-32951). Binding Description (No ValueSet): (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Social Determinant of Health Observations
qualifier		0..*	CR	The observation/value and all the qualifiers together (often referred to as a post-coordinated expression) make up one concept. Qualifiers constrain the meaning of the primary code, and cannot negate it or change its meaning. Qualifiers can only be used according to well-defined rules of post-coordination and only if the underlying code system defines the use of such qualifiers or if there is a third code system that specifies how other code systems may be combined. In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1 using the V3 CD Data type 1 style. This is shown in the sample XML.
author		0..*	AuthorParticipation	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:observation, profile:act
entryRelationship:age		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: SUBJ
@inversionInd		1..1	bl	Fixed Value: true
observation		1..1	AgeObservation	Base for all types and resources
entryRelationship:prognosis		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: REFR
observation		1..1	PrognosisObservation	Base for all types and resources
entryRelationship:priority		0..*	EntryRelationship
@typeCode		1..1	cs	Fixed Value: REFR
observation		1..1	PriorityPreference	Base for all types and resources
entryRelationship:status		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: REFR
observation		1..1	ProblemStatus	Base for all types and resources
entryRelationship:reference		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: SPRT
act		1..1	EntryReference	Base for all types and resources
entryRelationship:assessment		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: SPRT
observation		1..1	AssessmentScaleObservation	Base for all types and resources
entryRelationship:dateOfDiagnosis		0..1	EntryRelationship	𝗨𝗦𝗖𝗗𝗜: Date of Diagnosis
@typeCode		1..1	cs	Fixed Value: COMP
act		1..1	DateOfDiagnosisAct	Base for all types and resources
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code	preferred	ProblemType http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.1 from https://vsac.nlm.nih.gov
Observation.value	preferred	USCoreConditionCodes http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
Observation.value.code	example

Constraints

Id	Grade	Path(s)	Details	Requirements
should-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-author: SHOULD contain author
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:problem-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.4
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Binding: CDAActClassObservation (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl	The negationInd is used to indicate the absence of the condition in observation/value. A negationInd of "true" coupled with an observation/value of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions.
id		1..*	II
code		1..1	CD	Binding: Problem Type (preferred)
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS	Binding: ActStatus (required)
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS	If the problem is known to be resolved, but the date of resolution is not known, then the high element **SHALL** be present, and the nullFlavor attribute **SHALL** be set to 'UNK'. Therefore, the existence of a high element within a problem does indicate that the problem has been resolved.
low		1..1	IVXB_TS	The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.
high		0..1	IVXB_TS	𝗨𝗦𝗖𝗗𝗜: Date of Resolution - The effectiveTime/high (a.k.a. resolution date) asserts when the condition became biologically resolved.
value		1..1	CD	𝗨𝗦𝗖𝗗𝗜: SDOH Problems/Health Concerns Binding: US Core Condition Codes (preferred)
@code		0..1	cs	A negationInd of "true" coupled with an observation/value/@code of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions. When the Problem is Social Determinant of Health Observation, the observation/value SHOULD be a SNOMED code selected from ValueSet Social Determinant of Health Conditions 2.16.840.1.113762.1.4.1196.788 DYNAMIC (CONF:4515-32951). Binding Description (No ValueSet): (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Social Determinant of Health Observations
qualifier		0..*	CR	The observation/value and all the qualifiers together (often referred to as a post-coordinated expression) make up one concept. Qualifiers constrain the meaning of the primary code, and cannot negate it or change its meaning. Qualifiers can only be used according to well-defined rules of post-coordination and only if the underlying code system defines the use of such qualifiers or if there is a third code system that specifies how other code systems may be combined. In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1 using the V3 CD Data type 1 style. This is shown in the sample XML.
author		0..*	AuthorParticipation	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:observation, profile:act
entryRelationship:age		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SUBJ
@inversionInd		1..1	bl	Fixed Value: true
observation	C	1..1	AgeObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:prognosis		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
observation	C	1..1	PrognosisObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:priority		0..*	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
observation	C	1..1	PriorityPreference	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime should-author: SHOULD contain author
entryRelationship:status		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
observation	C	1..1	ProblemStatus	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:reference		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
act	C	1..1	EntryReference	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:assessment		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:dateOfDiagnosis		0..1	EntryRelationship	𝗨𝗦𝗖𝗗𝗜: Date of Diagnosis
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: COMP
act	C	1..1	DateOfDiagnosisAct	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.classCode	required	Fixed Value: OBS http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
Observation.moodCode	required	Fixed Value: EVN http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
Observation.code	preferred	ProblemType http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.1 from https://vsac.nlm.nih.gov
Observation.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.value	preferred	USCoreConditionCodes http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
Observation.value.code	example
Observation.entryRelationship:age.typeCode	required	Fixed Value: SUBJ http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:prognosis.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:priority.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:status.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:reference.typeCode	required	Fixed Value: SPRT http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:assessment.typeCode	required	Fixed Value: SPRT http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:dateOfDiagnosis.typeCode	required	Fixed Value: COMP http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship

Constraints

Id	Grade	Path(s)	Details	Requirements
should-author	warning	Observation	SHOULD contain author : author.exists()
should-author	warning	Observation.entryRelationship:priority.observation	SHOULD contain author : author.exists()
should-effectiveTime	warning	Observation.entryRelationship:priority.observation	SHOULD contain effectiveTime : effectiveTime.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Observation.entryRelationship:age.observation, Observation.entryRelationship:prognosis.observation, Observation.entryRelationship:priority.observation, Observation.entryRelationship:status.observation, Observation.entryRelationship:reference.act, Observation.entryRelationship:assessment.observation, Observation.entryRelationship:dateOfDiagnosis.act	SHOULD contain text/reference/@value : text.reference.value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-author: SHOULD contain author
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:problem-obs		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.4
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Binding: CDAActClassObservation (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl	The negationInd is used to indicate the absence of the condition in observation/value. A negationInd of "true" coupled with an observation/value of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions.
id		1..*	II
sdtcCategory		0..*	CD	XML Namespace: urn:hl7-org:sdtc XML: category (urn:hl7-org:sdtc)
code		1..1	CD	Binding: Problem Type (preferred)
derivationExpr		0..1	ST
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CDACompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	Binding: MediaType (example)
@representation		0..1	cs	Binding: CDABinaryDataEncoding (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
thumbnail		0..1	ED
statusCode		1..1	CS	Binding: ActStatus (required)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Fixed Value: completed
@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)
effectiveTime		1..1	IVL_TS	If the problem is known to be resolved, but the date of resolution is not known, then the high element **SHALL** be present, and the nullFlavor attribute **SHALL** be set to 'UNK'. Therefore, the existence of a high element within a problem does indicate that the problem has been resolved.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
@operator		0..1	cs	Binding: CDASetOperator (required)
low		1..1	IVXB_TS	The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.
center		0..1	TS
width		0..1	PQ
high		0..1	IVXB_TS	𝗨𝗦𝗖𝗗𝗜: Date of Resolution - The effectiveTime/high (a.k.a. resolution date) asserts when the condition became biologically resolved.
priorityCode		0..1	CE	Binding: ActPriority (example)
repeatNumber		0..1	IVL_INT
languageCode		0..1	CS	Binding: AllLanguages (required)
value		1..1	CD	𝗨𝗦𝗖𝗗𝗜: SDOH Problems/Health Concerns Binding: US Core Condition Codes (preferred)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		0..1	cs	A negationInd of "true" coupled with an observation/value/@code of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions. When the Problem is Social Determinant of Health Observation, the observation/value SHOULD be a SNOMED code selected from ValueSet Social Determinant of Health Conditions 2.16.840.1.113762.1.4.1196.788 DYNAMIC (CONF:4515-32951). Binding Description (No ValueSet): (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Social Determinant of Health Observations
@codeSystem		0..1	oid, uuid, ruid
@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
qualifier		0..*	CR	The observation/value and all the qualifiers together (often referred to as a post-coordinated expression) make up one concept. Qualifiers constrain the meaning of the primary code, and cannot negate it or change its meaning. Qualifiers can only be used according to well-defined rules of post-coordination and only if the underlying code system defines the use of such qualifiers or if there is a third code system that specifies how other code systems may be combined. In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1 using the V3 CD Data type 1 style. This is shown in the sample XML.
translation		0..*	CD
interpretationCode		0..*	CE	Binding: CDAObservationInterpretation (required)
methodCode		0..*	CE	Binding: ObservationMethod (example)
targetSiteCode		0..*	CD
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	AuthorParticipation	Base for all types and resources
informant		0..*	Informant
participant		0..*	Participant2
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:observation, profile:act
entryRelationship:age		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SUBJ
@inversionInd		1..1	bl	Fixed Value: true
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	AgeObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:prognosis		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	PrognosisObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:priority		0..*	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	PriorityPreference	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime should-author: SHOULD contain author
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:status		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	ProblemStatus	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:reference		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	EntryReference	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
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
entryRelationship:assessment		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:dateOfDiagnosis		0..1	EntryRelationship	𝗨𝗦𝗖𝗗𝗜: Date of Diagnosis
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: COMP
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	DateOfDiagnosisAct	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
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
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
referenceRange		0..*	InfrastructureRoot
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		0..1	cs	Binding: CDAActRelationshipType (required) Fixed Value: REFV
observationRange		1..1	ObservationRange
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.templateId:problem-obs.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.classCode	required	Fixed Value: OBS http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
Observation.moodCode	required	Fixed Value: EVN http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
Observation.code	preferred	ProblemType http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.1 from https://vsac.nlm.nih.gov
Observation.text.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.text.compression	required	CDACompressionAlgorithm http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.text.mediaType	example	MediaType http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.text.representation	required	BinaryDataEncoding http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.statusCode.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.operator	required	CDASetOperator http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.priorityCode	example	ActPriority http://terminology.hl7.org/ValueSet/v3-ActPriority
Observation.languageCode	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages from the FHIR Standard
Observation.value	preferred	USCoreConditionCodes http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
Observation.value.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.value.code	example
Observation.interpretationCode	required	CDAObservationInterpretation http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
Observation.methodCode	example	ObservationMethod http://terminology.hl7.org/ValueSet/v3-ObservationMethod
Observation.entryRelationship:age.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:age.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:age.typeCode	required	Fixed Value: SUBJ http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:prognosis.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:prognosis.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:prognosis.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:priority.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:priority.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:priority.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:status.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:status.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:status.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:reference.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:reference.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:reference.typeCode	required	Fixed Value: SPRT http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:assessment.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:assessment.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:assessment.typeCode	required	Fixed Value: SPRT http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:dateOfDiagnosis.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:dateOfDiagnosis.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:dateOfDiagnosis.typeCode	required	Fixed Value: COMP http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.referenceRange.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeCode	required	Fixed Value: REFV http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

Constraints

Id	Grade	Path(s)	Details	Requirements
should-author	warning	Observation	SHOULD contain author : author.exists()
should-author	warning	Observation.entryRelationship:priority.observation	SHOULD contain author : author.exists()
should-effectiveTime	warning	Observation.entryRelationship:priority.observation	SHOULD contain effectiveTime : effectiveTime.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Observation.entryRelationship:age.observation, Observation.entryRelationship:prognosis.observation, Observation.entryRelationship:priority.observation, Observation.entryRelationship:status.observation, Observation.entryRelationship:reference.act, Observation.entryRelationship:assessment.observation, Observation.entryRelationship:dateOfDiagnosis.act	SHOULD contain text/reference/@value : text.reference.value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

This structure is derived from Observation

Summary

Mandatory: 10 elements(8 nested mandatory elements)
Fixed: 11 elements

Structures

This structure refers to these other structures:

• Author Participation (http://hl7.org/cda/us/ccda/StructureDefinition/AuthorParticipation)
• Age Observation (http://hl7.org/cda/us/ccda/StructureDefinition/AgeObservation)
• Prognosis Observation (http://hl7.org/cda/us/ccda/StructureDefinition/PrognosisObservation)
• Priority Preference (http://hl7.org/cda/us/ccda/StructureDefinition/PriorityPreference)
• Problem Status (http://hl7.org/cda/us/ccda/StructureDefinition/ProblemStatus)
• Entry Reference (http://hl7.org/cda/us/ccda/StructureDefinition/EntryReference)
• Assessment Scale Observation (http://hl7.org/cda/us/ccda/StructureDefinition/AssessmentScaleObservation)
• Date of Diagnosis Act (http://hl7.org/cda/us/ccda/StructureDefinition/DateOfDiagnosisAct)

Slices

This structure defines the following Slices:

• The element 2 is sliced based on the values of Observation.templateId
• The element 2 is sliced based on the values of Observation.entryRelationship

Differential View

This structure is derived from Observation

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-author: SHOULD contain author
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:problem-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.4
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Fixed Value: OBS
@moodCode		1..1	cs	Fixed Value: EVN
@negationInd		0..1	bl	The negationInd is used to indicate the absence of the condition in observation/value. A negationInd of "true" coupled with an observation/value of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions.
id		1..*	II
code		1..1	CD	Binding: Problem Type (preferred)
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS	If the problem is known to be resolved, but the date of resolution is not known, then the high element **SHALL** be present, and the nullFlavor attribute **SHALL** be set to 'UNK'. Therefore, the existence of a high element within a problem does indicate that the problem has been resolved.
low		1..1	IVXB_TS	The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.
high		0..1	IVXB_TS	𝗨𝗦𝗖𝗗𝗜: Date of Resolution - The effectiveTime/high (a.k.a. resolution date) asserts when the condition became biologically resolved.
value		1..1	CD	𝗨𝗦𝗖𝗗𝗜: SDOH Problems/Health Concerns Binding: US Core Condition Codes (preferred)
@code		0..1	cs	A negationInd of "true" coupled with an observation/value/@code of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions. When the Problem is Social Determinant of Health Observation, the observation/value SHOULD be a SNOMED code selected from ValueSet Social Determinant of Health Conditions 2.16.840.1.113762.1.4.1196.788 DYNAMIC (CONF:4515-32951). Binding Description (No ValueSet): (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Social Determinant of Health Observations
qualifier		0..*	CR	The observation/value and all the qualifiers together (often referred to as a post-coordinated expression) make up one concept. Qualifiers constrain the meaning of the primary code, and cannot negate it or change its meaning. Qualifiers can only be used according to well-defined rules of post-coordination and only if the underlying code system defines the use of such qualifiers or if there is a third code system that specifies how other code systems may be combined. In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1 using the V3 CD Data type 1 style. This is shown in the sample XML.
author		0..*	AuthorParticipation	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:observation, profile:act
entryRelationship:age		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: SUBJ
@inversionInd		1..1	bl	Fixed Value: true
observation		1..1	AgeObservation	Base for all types and resources
entryRelationship:prognosis		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: REFR
observation		1..1	PrognosisObservation	Base for all types and resources
entryRelationship:priority		0..*	EntryRelationship
@typeCode		1..1	cs	Fixed Value: REFR
observation		1..1	PriorityPreference	Base for all types and resources
entryRelationship:status		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: REFR
observation		1..1	ProblemStatus	Base for all types and resources
entryRelationship:reference		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: SPRT
act		1..1	EntryReference	Base for all types and resources
entryRelationship:assessment		0..1	EntryRelationship
@typeCode		1..1	cs	Fixed Value: SPRT
observation		1..1	AssessmentScaleObservation	Base for all types and resources
entryRelationship:dateOfDiagnosis		0..1	EntryRelationship	𝗨𝗦𝗖𝗗𝗜: Date of Diagnosis
@typeCode		1..1	cs	Fixed Value: COMP
act		1..1	DateOfDiagnosisAct	Base for all types and resources
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Observation.code	preferred	ProblemType http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.1 from https://vsac.nlm.nih.gov
Observation.value	preferred	USCoreConditionCodes http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
Observation.value.code	example

Constraints

Id	Grade	Path(s)	Details	Requirements
should-author	warning	Observation	SHOULD contain author : author.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-author: SHOULD contain author
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:problem-obs		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.4
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Binding: CDAActClassObservation (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl	The negationInd is used to indicate the absence of the condition in observation/value. A negationInd of "true" coupled with an observation/value of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions.
id		1..*	II
code		1..1	CD	Binding: Problem Type (preferred)
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
statusCode		1..1	CS	Binding: ActStatus (required)
@code		1..1	cs	Fixed Value: completed
effectiveTime		1..1	IVL_TS	If the problem is known to be resolved, but the date of resolution is not known, then the high element **SHALL** be present, and the nullFlavor attribute **SHALL** be set to 'UNK'. Therefore, the existence of a high element within a problem does indicate that the problem has been resolved.
low		1..1	IVXB_TS	The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.
high		0..1	IVXB_TS	𝗨𝗦𝗖𝗗𝗜: Date of Resolution - The effectiveTime/high (a.k.a. resolution date) asserts when the condition became biologically resolved.
value		1..1	CD	𝗨𝗦𝗖𝗗𝗜: SDOH Problems/Health Concerns Binding: US Core Condition Codes (preferred)
@code		0..1	cs	A negationInd of "true" coupled with an observation/value/@code of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions. When the Problem is Social Determinant of Health Observation, the observation/value SHOULD be a SNOMED code selected from ValueSet Social Determinant of Health Conditions 2.16.840.1.113762.1.4.1196.788 DYNAMIC (CONF:4515-32951). Binding Description (No ValueSet): (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Social Determinant of Health Observations
qualifier		0..*	CR	The observation/value and all the qualifiers together (often referred to as a post-coordinated expression) make up one concept. Qualifiers constrain the meaning of the primary code, and cannot negate it or change its meaning. Qualifiers can only be used according to well-defined rules of post-coordination and only if the underlying code system defines the use of such qualifiers or if there is a third code system that specifies how other code systems may be combined. In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1 using the V3 CD Data type 1 style. This is shown in the sample XML.
author		0..*	AuthorParticipation	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:observation, profile:act
entryRelationship:age		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SUBJ
@inversionInd		1..1	bl	Fixed Value: true
observation	C	1..1	AgeObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:prognosis		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
observation	C	1..1	PrognosisObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:priority		0..*	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
observation	C	1..1	PriorityPreference	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime should-author: SHOULD contain author
entryRelationship:status		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
observation	C	1..1	ProblemStatus	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:reference		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
act	C	1..1	EntryReference	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:assessment		0..1	EntryRelationship
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
entryRelationship:dateOfDiagnosis		0..1	EntryRelationship	𝗨𝗦𝗖𝗗𝗜: Date of Diagnosis
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: COMP
act	C	1..1	DateOfDiagnosisAct	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.classCode	required	Fixed Value: OBS http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
Observation.moodCode	required	Fixed Value: EVN http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
Observation.code	preferred	ProblemType http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.1 from https://vsac.nlm.nih.gov
Observation.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.value	preferred	USCoreConditionCodes http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
Observation.value.code	example
Observation.entryRelationship:age.typeCode	required	Fixed Value: SUBJ http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:prognosis.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:priority.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:status.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:reference.typeCode	required	Fixed Value: SPRT http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:assessment.typeCode	required	Fixed Value: SPRT http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:dateOfDiagnosis.typeCode	required	Fixed Value: COMP http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship

Constraints

Id	Grade	Path(s)	Details	Requirements
should-author	warning	Observation	SHOULD contain author : author.exists()
should-author	warning	Observation.entryRelationship:priority.observation	SHOULD contain author : author.exists()
should-effectiveTime	warning	Observation.entryRelationship:priority.observation	SHOULD contain effectiveTime : effectiveTime.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Observation.entryRelationship:age.observation, Observation.entryRelationship:prognosis.observation, Observation.entryRelationship:priority.observation, Observation.entryRelationship:status.observation, Observation.entryRelationship:reference.act, Observation.entryRelationship:assessment.observation, Observation.entryRelationship:dateOfDiagnosis.act	SHOULD contain text/reference/@value : text.reference.value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	1..1	Observation	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value should-author: SHOULD contain author
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:problem-obs		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.4
@extension		1..1	st	Required Pattern: 2024-05-01
@classCode		1..1	cs	Binding: CDAActClassObservation (required) Fixed Value: OBS
@moodCode		1..1	cs	Binding: XActMoodDocumentObservation (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl	The negationInd is used to indicate the absence of the condition in observation/value. A negationInd of "true" coupled with an observation/value of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions.
id		1..*	II
sdtcCategory		0..*	CD	XML Namespace: urn:hl7-org:sdtc XML: category (urn:hl7-org:sdtc)
code		1..1	CD	Binding: Problem Type (preferred)
derivationExpr		0..1	ST
text		0..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CDACompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	Binding: MediaType (example)
@representation		0..1	cs	Binding: CDABinaryDataEncoding (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	0..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
thumbnail		0..1	ED
statusCode		1..1	CS	Binding: ActStatus (required)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Fixed Value: completed
@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)
effectiveTime		1..1	IVL_TS	If the problem is known to be resolved, but the date of resolution is not known, then the high element **SHALL** be present, and the nullFlavor attribute **SHALL** be set to 'UNK'. Therefore, the existence of a high element within a problem does indicate that the problem has been resolved.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
@operator		0..1	cs	Binding: CDASetOperator (required)
low		1..1	IVXB_TS	The effectiveTime/low (a.k.a. "onset date") asserts when the condition became biologically active.
center		0..1	TS
width		0..1	PQ
high		0..1	IVXB_TS	𝗨𝗦𝗖𝗗𝗜: Date of Resolution - The effectiveTime/high (a.k.a. resolution date) asserts when the condition became biologically resolved.
priorityCode		0..1	CE	Binding: ActPriority (example)
repeatNumber		0..1	IVL_INT
languageCode		0..1	CS	Binding: AllLanguages (required)
value		1..1	CD	𝗨𝗦𝗖𝗗𝗜: SDOH Problems/Health Concerns Binding: US Core Condition Codes (preferred)
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		0..1	cs	A negationInd of "true" coupled with an observation/value/@code of SNOMED code 64572001 "Disease (disorder)" indicates that the patient has no known conditions. When the Problem is Social Determinant of Health Observation, the observation/value SHOULD be a SNOMED code selected from ValueSet Social Determinant of Health Conditions 2.16.840.1.113762.1.4.1196.788 DYNAMIC (CONF:4515-32951). Binding Description (No ValueSet): (example): See additional binding Additional Bindings Purpose Documentation Social Determinants of Health Conditions Preferred Social Determinant of Health Observations
@codeSystem		0..1	oid, uuid, ruid
@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
qualifier		0..*	CR	The observation/value and all the qualifiers together (often referred to as a post-coordinated expression) make up one concept. Qualifiers constrain the meaning of the primary code, and cannot negate it or change its meaning. Qualifiers can only be used according to well-defined rules of post-coordination and only if the underlying code system defines the use of such qualifiers or if there is a third code system that specifies how other code systems may be combined. In cases where SNOMED CT does not have a precoordinated code that would be appropriate for the problem list, concept post coordination may be used in CDA following the principles outlined in HL7 Version 3 Implementation Guide: TermInfo - Using SNOMED CT in CDA R2 Models, Release 1 using the V3 CD Data type 1 style. This is shown in the sample XML.
translation		0..*	CD
interpretationCode		0..*	CE	Binding: CDAObservationInterpretation (required)
methodCode		0..*	CE	Binding: ObservationMethod (example)
targetSiteCode		0..*	CD
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	AuthorParticipation	Base for all types and resources
informant		0..*	Informant
participant		0..*	Participant2
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by profile:observation, profile:act
entryRelationship:age		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SUBJ
@inversionInd		1..1	bl	Fixed Value: true
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	AgeObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:prognosis		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	PrognosisObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:priority		0..*	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	PriorityPreference	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value should-effectiveTime: SHOULD contain effectiveTime should-author: SHOULD contain author
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:status		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: REFR
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	ProblemStatus	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:reference		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	EntryReference	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
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
entryRelationship:assessment		0..1	EntryRelationship
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: SPRT
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		0..1	Encounter
observation	C	1..1	AssessmentScaleObservation	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
entryRelationship:dateOfDiagnosis		0..1	EntryRelationship	𝗨𝗦𝗖𝗗𝗜: Date of Diagnosis
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: COMP
@inversionInd		0..1	bl
@contextConductionInd		0..1	bl
@negationInd		0..1	bl
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act	C	1..1	DateOfDiagnosisAct	Base for all types and resources should-text-ref-value: SHOULD contain text/reference/@value
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
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
referenceRange		0..*	InfrastructureRoot
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		0..1	cs	Binding: CDAActRelationshipType (required) Fixed Value: REFV
observationRange		1..1	ObservationRange
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Observation.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.templateId:problem-obs.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.classCode	required	Fixed Value: OBS http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
Observation.moodCode	required	Fixed Value: EVN http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
Observation.code	preferred	ProblemType http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1267.1 from https://vsac.nlm.nih.gov
Observation.text.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.text.compression	required	CDACompressionAlgorithm http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.text.mediaType	example	MediaType http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.text.representation	required	BinaryDataEncoding http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.statusCode.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.operator	required	CDASetOperator http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.priorityCode	example	ActPriority http://terminology.hl7.org/ValueSet/v3-ActPriority
Observation.languageCode	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages from the FHIR Standard
Observation.value	preferred	USCoreConditionCodes http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code
Observation.value.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.value.code	example
Observation.interpretationCode	required	CDAObservationInterpretation http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
Observation.methodCode	example	ObservationMethod http://terminology.hl7.org/ValueSet/v3-ObservationMethod
Observation.entryRelationship:age.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:age.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:age.typeCode	required	Fixed Value: SUBJ http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:prognosis.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:prognosis.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:prognosis.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:priority.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:priority.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:priority.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:status.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:status.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:status.typeCode	required	Fixed Value: REFR http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:reference.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:reference.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:reference.typeCode	required	Fixed Value: SPRT http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:assessment.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:assessment.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:assessment.typeCode	required	Fixed Value: SPRT http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.entryRelationship:dateOfDiagnosis.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:dateOfDiagnosis.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.entryRelationship:dateOfDiagnosis.typeCode	required	Fixed Value: COMP http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Observation.referenceRange.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeCode	required	Fixed Value: REFV http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

Constraints

Id	Grade	Path(s)	Details	Requirements
should-author	warning	Observation	SHOULD contain author : author.exists()
should-author	warning	Observation.entryRelationship:priority.observation	SHOULD contain author : author.exists()
should-effectiveTime	warning	Observation.entryRelationship:priority.observation	SHOULD contain effectiveTime : effectiveTime.exists()
should-text-ref-value	warning	Observation	SHOULD contain text/reference/@value : text.reference.value.exists()
should-text-ref-value	warning	Observation.entryRelationship:age.observation, Observation.entryRelationship:prognosis.observation, Observation.entryRelationship:priority.observation, Observation.entryRelationship:status.observation, Observation.entryRelationship:reference.act, Observation.entryRelationship:assessment.observation, Observation.entryRelationship:dateOfDiagnosis.act	SHOULD contain text/reference/@value : text.reference.value.exists()
value-starts-octothorpe	error	Observation.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

This structure is derived from Observation

Summary

Mandatory: 10 elements(8 nested mandatory elements)
Fixed: 11 elements

Structures

This structure refers to these other structures:

• Author Participation (http://hl7.org/cda/us/ccda/StructureDefinition/AuthorParticipation)
• Age Observation (http://hl7.org/cda/us/ccda/StructureDefinition/AgeObservation)
• Prognosis Observation (http://hl7.org/cda/us/ccda/StructureDefinition/PrognosisObservation)
• Priority Preference (http://hl7.org/cda/us/ccda/StructureDefinition/PriorityPreference)
• Problem Status (http://hl7.org/cda/us/ccda/StructureDefinition/ProblemStatus)
• Entry Reference (http://hl7.org/cda/us/ccda/StructureDefinition/EntryReference)
• Assessment Scale Observation (http://hl7.org/cda/us/ccda/StructureDefinition/AssessmentScaleObservation)
• Date of Diagnosis Act (http://hl7.org/cda/us/ccda/StructureDefinition/DateOfDiagnosisAct)

Slices

This structure defines the following Slices:

• The element 2 is sliced based on the values of Observation.templateId
• The element 2 is sliced based on the values of Observation.entryRelationship