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 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

• Narrative Content

Example Binary: Advance Directive Observation Example

<observation xmlns="urn:hl7-org:v3" moodCode="EVN" classCode="OBS">
  <!--  ** Advance Directive Observation**  -->
  <templateId root="2.16.840.1.113883.10.20.22.4.48" extension="2025-05-01"/>
  <id root="9b54c3c9-1673-49c7-aef9-b037ed72ed27"/>
  <code xsi:type="CD" codeSystemName="LOINC"
        codeSystem="2.16.840.1.113883.6.1" code="75320-2">
    <translation xsi:type="CD" codeSystemName="LOINC"
                 codeSystem="2.16.840.1.113883.6.1" code="81334-5"/>
  </code>
  <text/>
  <statusCode code="completed"/>
  <effectiveTime>
    <!--  The time at which the person named this individual to be his or her healthcare agent  -->
    <low value="20110219"/>
    <high nullFlavor="NA"/>
  </effectiveTime>
  <value xsi:type="CD" displayName="Healthcare decision making"
         codeSystemName="SNOMED CT" codeSystem="2.16.840.1.113883.6.96" code="405083000"/>
  <author>
    <templateId root="2.16.840.1.113883.10.20.22.4.119"/>
    <time value="20130801123500-0800"/>
    <assignedAuthor>
      <!--  Refers to another author somewhere else in the document  -->
      <id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/>
      <addr use="H">
        <streetAddressLine>23 Anywhere Street</streetAddressLine>
        <city>El Paso</city>
        <state>TX</state>
        <postalCode>90210</postalCode>
        <country>US</country>
      </addr>
      <telecom value="tel:(999)555-1212" use="WP"/>
      <assignedPerson>
        <name>
          <prefix>Mrs.</prefix>
          <given>Martha</given>
          <family>Jones</family>
        </name>
      </assignedPerson>
    </assignedAuthor>
  </author>
  <informant typeCode="INF" contextControlCode="OP">
    <assignedEntity>
      <id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/>
    </assignedEntity>
  </informant>
  <participant typeCode="VRF">
    <templateId root="2.16.840.1.113883.10.20.1.58"/>
    <time value="20130213"/>
    <participantRole classCode="CON">
      <id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/>
      <code displayName="Registered nurse"
            codeSystemName="Health Care Provider Taxonomy (HIPAA)" codeSystem="2.16.840.1.113883.6.101" code="163W00000X"/>
      <addr use="H">
        <streetAddressLine>23 Anywhere Street</streetAddressLine>
        <city>El Paso</city>
        <state>TX</state>
        <postalCode>90210</postalCode>
        <country>US</country>
      </addr>
      <playingEntity classCode="PSN">
        <code displayName="Principal" codeSystemName="SNOMED-CT"
              codeSystem="2.16.840.1.113883.6.96" code="63161005"/>
        <name>
          <given>Nurse</given>
          <family>Florence</family>
          <suffix>RN</suffix>
        </name>
      </playingEntity>
    </participantRole>
  </participant>
  <participant typeCode="CST">
    <templateId root="2.16.840.1.113883.10.20.1.58"/>
    <participantRole classCode="AGNT">
      <code displayName="Mother" codeSystem="2.16.840.1.113883.5.111"
            code="MTH"/>
      <addr use="H">
        <streetAddressLine>23 Anywhere Street</streetAddressLine>
        <city>El Paso</city>
        <state>TX</state>
        <postalCode>90210</postalCode>
        <country>US</country>
      </addr>
      <telecom value="tel:(999)555-1212" use="WP"/>
      <playingEntity classCode="PSN">
        <code displayName="Principal" codeSystemName="SNOMED-CT"
              codeSystem="2.16.840.1.113883.6.96" code="63161005"/>
        <name>
          <prefix>Mrs.</prefix>
          <given>Martha</given>
          <family>Jones</family>
        </name>
      </playingEntity>
    </participantRole>
  </participant>
  <reference typeCode="REFR">
    <externalDocument>
      <id root="b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3"/>
      <code
            displayName="Advance directive - do not hospitalize [Minimum Data Set]" codeSystemName="LOINC" codeSystem="2.16.840.1.113883.6.1"
            code="45475-1"/>
      <text mediaType="application/pdf">
        <reference
                   value="AdvanceDirective.b50b7910-7ffb-4f4c-bbe4-177ed68cbbf3.pdf"/>
      </text>
      <versionNumber value="1"/>
    </externalDocument>
  </reference>
</observation>