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: Policy Activity Example

  <!--  Coverange Plan
  <entryRelationship typeCode="REFR">
    <act classCode="ACT" moodCode="EVN">
      <templateId root="2.16.840.1.113883.10.20.1.19" />
             . . .
        
        
    </act>
  </entryRelationship>  -->
<act xmlns="urn:hl7-org:v3" moodCode="EVN" classCode="ACT">
  <templateId root="2.16.840.1.113883.10.20.22.4.61" extension="2024-05-01"/>
  <id root="3e676a50-7aac-11db-9fe1-0800200c9a66"/>
  <code
        displayName="Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan" codeSystemName="Insurance Type Code (x12N-1336)"
        codeSystem="2.16.840.1.113883.6.255.1336" code="12">
    <translation xsi:type="CD" displayName="Medicare"
                 codeSystemName="Source of Payment Typology (PHDSC)" codeSystem="2.16.840.1.113883.3.221.5" code="2"/>
  </code>
  <statusCode code="completed"/>
  <!--  Insurance company information  -->
  <performer typeCode="PRF">
    <templateId root="2.16.840.1.113883.10.20.22.4.87"/>
    <time>
      <low nullFlavor="UNK"/>
      <high nullFlavor="UNK"/>
    </time>
    <assignedEntity>
      <id root="2.16.840.1.113883.19"/>
      <code codeSystemName="HL7 RoleCode"
            codeSystem="2.16.840.1.113883.5.110" code="PAYOR"/>
      <!--  US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1  -->
      <addr use="WP">
        <streetAddressLine>123 Insurance Road</streetAddressLine>
        <city>Blue Bell</city>
        <state>MA</state>
        <postalCode>02368</postalCode>
        <country>US</country>
      </addr>
      <telecom value="tel:+(555)555-1515" use="WP"/>
      <representedOrganization>
        <name>Good Health Insurance</name>
        <telecom value="tel:+(555)555-1515" use="WP"/>
        <addr use="WP">
          <streetAddressLine>123 Insurance Road</streetAddressLine>
          <city>Blue Bell</city>
          <state>MA</state>
          <postalCode>02368</postalCode>
          <country>US</country>
        </addr>
      </representedOrganization>
    </assignedEntity>
  </performer>
  <!--  Guarantor information (the person responsible for the final bill)  -->
  <performer typeCode="PRF">
    <templateId root="2.16.840.1.113883.10.20.22.4.88"/>
    <time>
      <low nullFlavor="UNK"/>
      <high nullFlavor="UNK"/>
    </time>
    <assignedEntity>
      <id root="329fcdf0-7ab3-11db-9fe1-0800200c9a66"/>
      <code codeSystemName="HL7 RoleCode"
            codeSystem="2.16.840.1.113883.5.110" code="GUAR"/>
      <addr use="HP">
        <streetAddressLine>17 Daws Rd.</streetAddressLine>
        <city>Blue Bell</city>
        <state>MA</state>
        <postalCode>02368</postalCode>
        <country>US</country>
      </addr>
      <telecom value="tel:+(781)555-1212" use="HP"/>
      <assignedPerson>
        <name>
          <prefix>Mr.</prefix>
          <given>Adam</given>
          <given>Frankie</given>
          <family>Everyman</family>
        </name>
      </assignedPerson>
    </assignedEntity>
  </performer>
  <!--  Covered party  -->
  <participant typeCode="COV">
    <templateId root="2.16.840.1.113883.10.20.22.4.89"/>
    <time>
      <low nullFlavor="UNK"/>
      <high nullFlavor="UNK"/>
    </time>
    <participantRole classCode="PAT">
      <!--  Health plan ID for patient.  -->
      <id root="1.1.1.1.1.1.1.1.14" extension="1138345"/>
      <code codeSystem="2.16.840.1.113883.5.111" code="FAMDEP"/>
      <addr use="HP">
        <streetAddressLine>17 Daws Rd.</streetAddressLine>
        <city>Blue Bell</city>
        <state>MA</state>
        <postalCode>02368</postalCode>
        <country>US</country>
      </addr>
      <playingEntity>
        <name>
          <!--  Name is needed if different than name on health plan.  -->
          <prefix>Mr.</prefix>
          <given>Frank</given>
          <given>A.</given>
          <family>Everyman</family>
        </name>
        <sdtc:sdtcBirthTime xmlns:sdtc="urn:hl7-org:sdtc" value="19620206"/>
      </playingEntity>
    </participantRole>
  </participant>
  <!--  Policy holder / Subscriber - not allowed if the COV participant's code is SELF  -->
  <participant typeCode="HLD">
    <templateId root="2.16.840.1.113883.10.20.22.4.90"/>
    <participantRole>
      <id root="2.16.840.1.113883.19" extension="1138345"/>
      <addr use="HP">
        <streetAddressLine>17 Daws Rd.</streetAddressLine>
        <city>Blue Bell</city>
        <state>MA</state>
        <postalCode>02368</postalCode>
        <country>US</country>
      </addr>
    </participantRole>
  </participant>
</act>