Consolidated CDA (C-CDA)
4.0.0 - STU4 United States of America flag

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

Logical Model: Advance Directive Observation

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation Version: 4.0.0
Draft as of 2025-10-02 Computable Name: AdvanceDirectiveObservation
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2025-05-01

The Advance Directive Observation template is nested within the Advance Directive Existence Observation, which indicates whether the individual has any advance directive documents. Each Advance Directive Observation template provides details about one type of advance directive document and may also include information about the document’s author, as well as any individuals who discussed and verified its contents with the patient or their designated healthcare agent.

The Advance Directive Observation template also can be nested within an Intervention Act to serve as documentation explaining why an intervention was planned/performed or not.

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 3.0.0:

  • New Content

    • Formal Views of Template Content

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

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-obs 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.48
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Fixed Value: OBS
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... code C 1..1 CD Advance Directive
    Constraints: should-translation
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS
    .... @code 1..1 cs Fixed Value: completed
    ... effectiveTime 1..1 IVL_TS
    .... low 1..1 IVXB_TS
    .... high 1..1 IVXB_TS If the Advance Directive does not have a specified ending time, use a nullFlavor of *NA*. If the ending time is unknown, use a nullFlavor of *UNK*.
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... author 0..* AuthorParticipation
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
    ...... templateId:primary 1..1 II
    ....... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.1.58
    ....... @extension 0..0
    ..... @typeCode 1..1 cs Fixed Value: VRF
    ..... time C 0..1 IVL_TS Constraints: value-only
    ...... @value 0..1 ts value should be used instead of low/high
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ...... addr 0..* USRealmAddress
    ...... playingEntity 1..1 PlayingEntity
    ....... name 1..1 USRealmPersonNamePNUSFIELDED
    .... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
    ..... @typeCode 1..1 cs Fixed Value: CST
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code, should-addr, should-telecom
    ...... @classCode 1..1 cs Fixed Value: AGNT
    ...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
    ...... addr 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
    ....... name 1..1 PN The name of the healthcare agent.
    ... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
    .... reference:reference1 1..* Reference
    ..... @typeCode 1..1 cs Fixed Value: REFR
    ..... externalDocument 1..1 ExternalDocument 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... id 1..* II
    ...... code 1..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ...... text 0..1 ED
    ....... reference C 0..1 TEL The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
    Constraints: 1198-8699
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Observation.code.translation Base preferred Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
    Observation.value Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.participant:verifier.​participantRole.code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Observation.participant:custodian.​participantRole.code Base preferred Healthcare Agent or Proxy Choices . 📦20221029 VSAC v0.23
    Observation.participant:custodian.​participantRole.playingEntity.​code Base preferred Personal And Legal Relationship Role Type . 📦20240606 VSAC v0.23
    Observation.reference:reference1.​externalDocument.code Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23

    Constraints

    Id Grade Path(s) Description Expression
    1198-8699 warning Observation.reference:reference1.externalDocument.text.reference If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
    should-addr warning Observation.participant:custodian.participantRole SHOULD contain addr addr.exists()
    should-author warning Observation SHOULD contain author author.exists()
    should-code warning Observation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntity SHOULD contain code code.exists()
    should-informant warning Observation SHOULD contain informant informant.exists()
    should-telecom warning Observation.participant:custodian.participantRole SHOULD contain telecom telecom.exists()
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    should-time warning Observation.participant:verifier SHOULD contain time time.exists()
    should-translation warning Observation.code SHOULD contain translation translation.exists()
    value-only error Observation.participant:verifier.time Interval fields SHALL NOT be present (low | high | width | center).empty()
    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('#')
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @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:advance-directive-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: 2.16.840.1.113883.10.20.22.4.48
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @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
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ... code C 1..1 CD Advance Directive
    Binding: ObservationType (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @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
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... derivationExpr 0..1 ST
    ... text 1..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 Constraints: value-starts-octothorpe
    .... 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
    .... @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
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 1..1 IVXB_TS If the Advance Directive does not have a specified ending time, use a nullFlavor of *NA*. If the ending time is unknown, use a nullFlavor of *UNK*.
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... 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
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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
    ...... templateId:primary 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: 2.16.840.1.113883.10.20.1.58
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: VRF
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time C 0..1 IVL_TS Constraints: value-only
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    ...... @operator 0..1 cs Binding: CDASetOperator (required)
    ...... low 0..1 IVXB_TS
    ...... center 0..1 TS
    ...... width 0..1 PQ
    ...... high 0..1 IVXB_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 0..* II
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ...... addr 0..* USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 1..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @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
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..1 USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    .... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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: CDAParticipationType (required)
    Fixed Value: CST
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time 0..1 IVL_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code, should-addr, should-telecom
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 1..1 cs Binding: CDARoleClassRoot (required)
    Fixed Value: AGNT
    ...... id 0..* II
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
    ...... addr 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @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
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
    ....... quantity 0..* PQ
    ....... name 1..1 PN The name of the healthcare agent.
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... entryRelationship 0..* EntryRelationship
    ... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
    .... reference:reference1 1..* Reference
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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_ActRelationshipExternalReference (required)
    Fixed Value: REFR
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument 1..1 ExternalDocument 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..* II
    ...... code 1..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ...... text 0..1 ED
    ....... @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 The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
    Constraints: 1198-8699
    ....... thumbnail 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)
    ... 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 C 0..1 II Constraints: II-1
    ..... @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)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Observation.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.templateId:advance-directive-obs.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.classCode Base required CDAActClassObservation 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Observation.code Base example ObservationType 📦3.0.0 THO v6.5
    Observation.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.code.translation Base preferred Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
    Observation.text.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.text.compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.text.mediaType Base example MediaType 📦3.0.0 THO v6.5
    Observation.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.effectiveTime.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.effectiveTime.​operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Observation.value Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.methodCode Base example ObservationMethod 📦3.0.0 THO v6.5
    Observation.participant:verifier.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​templateId:primary.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​time.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​time.operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Observation.participant:verifier.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Observation.participant:verifier.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Observation.participant:verifier.​participantRole.playingEntity.​code Base example CDAEntityCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.code Base preferred Healthcare Agent or Proxy Choices . 📦20221029 VSAC v0.23
    Observation.participant:custodian.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Observation.participant:custodian.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Observation.participant:custodian.​participantRole.playingEntity.​code Base preferred Personal And Legal Relationship Role Type . 📦20240606 VSAC v0.23
    Observation.reference:reference1.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​typeCode Base required x_ActRelationshipExternalReference 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.classCode Base required ActClassDocument 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.moodCode Base required CDAActMood 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.code Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.reference:reference1.​externalDocument.text.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.text.​compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.text.​integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.reference:reference1.​externalDocument.text.​mediaType Base example MediaType 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.text.​representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.1-sd Clinical Document Architecture v2.0

    Constraints

    Id Grade Path(s) Description Expression
    1198-8699 warning Observation.reference:reference1.externalDocument.text.reference If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
    II-1 error Observation.typeId, Observation.participant:verifier.typeId, Observation.participant:verifier.participantRole.typeId, Observation.participant:verifier.participantRole.playingEntity.typeId, Observation.participant:custodian.typeId, Observation.participant:custodian.participantRole.typeId, Observation.participant:custodian.participantRole.playingEntity.typeId, Observation.reference:reference1.typeId, Observation.reference:reference1.externalDocument.typeId, Observation.referenceRange.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-addr warning Observation.participant:custodian.participantRole SHOULD contain addr addr.exists()
    should-author warning Observation SHOULD contain author author.exists()
    should-code warning Observation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntity SHOULD contain code code.exists()
    should-informant warning Observation SHOULD contain informant informant.exists()
    should-telecom warning Observation.participant:custodian.participantRole SHOULD contain telecom telecom.exists()
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    should-time warning Observation.participant:verifier SHOULD contain time time.exists()
    should-translation warning Observation.code SHOULD contain translation translation.exists()
    value-only error Observation.participant:verifier.time Interval fields SHALL NOT be present (low | high | width | center).empty()
    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('#')
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @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:advance-directive-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: 2.16.840.1.113883.10.20.22.4.48
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @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
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ... code C 1..1 CD Advance Directive
    Binding: ObservationType (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @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
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... derivationExpr 0..1 ST
    ... text 1..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 Constraints: value-starts-octothorpe
    .... 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
    .... @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
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 1..1 IVXB_TS If the Advance Directive does not have a specified ending time, use a nullFlavor of *NA*. If the ending time is unknown, use a nullFlavor of *UNK*.
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... 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
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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
    ...... templateId:primary 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: 2.16.840.1.113883.10.20.1.58
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: VRF
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time C 0..1 IVL_TS Constraints: value-only
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    ...... @operator 0..1 cs Binding: CDASetOperator (required)
    ...... low 0..1 IVXB_TS
    ...... center 0..1 TS
    ...... width 0..1 PQ
    ...... high 0..1 IVXB_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 0..* II
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ...... addr 0..* USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 1..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @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
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..1 USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    .... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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: CDAParticipationType (required)
    Fixed Value: CST
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time 0..1 IVL_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code, should-addr, should-telecom
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 1..1 cs Binding: CDARoleClassRoot (required)
    Fixed Value: AGNT
    ...... id 0..* II
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
    ...... addr 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @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
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
    ....... quantity 0..* PQ
    ....... name 1..1 PN The name of the healthcare agent.
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... entryRelationship 0..* EntryRelationship
    ... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
    .... reference:reference1 1..* Reference
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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_ActRelationshipExternalReference (required)
    Fixed Value: REFR
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument 1..1 ExternalDocument 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..* II
    ...... code 1..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ...... text 0..1 ED
    ....... @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 The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
    Constraints: 1198-8699
    ....... thumbnail 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)
    ... 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 C 0..1 II Constraints: II-1
    ..... @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)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Observation.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.templateId:advance-directive-obs.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.classCode Base required CDAActClassObservation 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Observation.code Base example ObservationType 📦3.0.0 THO v6.5
    Observation.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.code.translation Base preferred Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
    Observation.text.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.text.compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.text.mediaType Base example MediaType 📦3.0.0 THO v6.5
    Observation.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.effectiveTime.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.effectiveTime.​operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Observation.value Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.methodCode Base example ObservationMethod 📦3.0.0 THO v6.5
    Observation.participant:verifier.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​templateId:primary.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​time.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​time.operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Observation.participant:verifier.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Observation.participant:verifier.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Observation.participant:verifier.​participantRole.playingEntity.​code Base example CDAEntityCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.code Base preferred Healthcare Agent or Proxy Choices . 📦20221029 VSAC v0.23
    Observation.participant:custodian.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Observation.participant:custodian.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Observation.participant:custodian.​participantRole.playingEntity.​code Base preferred Personal And Legal Relationship Role Type . 📦20240606 VSAC v0.23
    Observation.reference:reference1.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​typeCode Base required x_ActRelationshipExternalReference 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.classCode Base required ActClassDocument 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.moodCode Base required CDAActMood 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.code Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.reference:reference1.​externalDocument.text.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.text.​compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.text.​integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.reference:reference1.​externalDocument.text.​mediaType Base example MediaType 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.text.​representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.1-sd Clinical Document Architecture v2.0

    Constraints

    Id Grade Path(s) Description Expression
    1198-8699 warning Observation.reference:reference1.externalDocument.text.reference If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
    II-1 error Observation.typeId, Observation.participant:verifier.typeId, Observation.participant:verifier.participantRole.typeId, Observation.participant:verifier.participantRole.playingEntity.typeId, Observation.participant:custodian.typeId, Observation.participant:custodian.participantRole.typeId, Observation.participant:custodian.participantRole.playingEntity.typeId, Observation.reference:reference1.typeId, Observation.reference:reference1.externalDocument.typeId, Observation.referenceRange.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-addr warning Observation.participant:custodian.participantRole SHOULD contain addr addr.exists()
    should-author warning Observation SHOULD contain author author.exists()
    should-code warning Observation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntity SHOULD contain code code.exists()
    should-informant warning Observation SHOULD contain informant informant.exists()
    should-telecom warning Observation.participant:custodian.participantRole SHOULD contain telecom telecom.exists()
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    should-time warning Observation.participant:verifier SHOULD contain time time.exists()
    should-translation warning Observation.code SHOULD contain translation translation.exists()
    value-only error Observation.participant:verifier.time Interval fields SHALL NOT be present (low | high | width | center).empty()
    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: 18 elements(8 nested mandatory elements)
    Fixed: 7 elements
    Prohibited: 1 element

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 2 is sliced based on the values of Observation.templateId
    • The element 1 is sliced based on the value of Observation.participant
    • The element 1 is sliced based on the value of Observation.participant.templateId
    • The element 1 is sliced based on the value of Observation.reference

    Differential View

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-obs 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.48
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Fixed Value: OBS
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... code C 1..1 CD Advance Directive
    Constraints: should-translation
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS
    .... @code 1..1 cs Fixed Value: completed
    ... effectiveTime 1..1 IVL_TS
    .... low 1..1 IVXB_TS
    .... high 1..1 IVXB_TS If the Advance Directive does not have a specified ending time, use a nullFlavor of *NA*. If the ending time is unknown, use a nullFlavor of *UNK*.
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... author 0..* AuthorParticipation
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... Slices for templateId 1..* II Slice: Unordered, Open by value:root
    ...... templateId:primary 1..1 II
    ....... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.1.58
    ....... @extension 0..0
    ..... @typeCode 1..1 cs Fixed Value: VRF
    ..... time C 0..1 IVL_TS Constraints: value-only
    ...... @value 0..1 ts value should be used instead of low/high
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ...... addr 0..* USRealmAddress
    ...... playingEntity 1..1 PlayingEntity
    ....... name 1..1 USRealmPersonNamePNUSFIELDED
    .... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
    ..... @typeCode 1..1 cs Fixed Value: CST
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code, should-addr, should-telecom
    ...... @classCode 1..1 cs Fixed Value: AGNT
    ...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
    ...... addr 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
    ....... name 1..1 PN The name of the healthcare agent.
    ... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
    .... reference:reference1 1..* Reference
    ..... @typeCode 1..1 cs Fixed Value: REFR
    ..... externalDocument 1..1 ExternalDocument 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... id 1..* II
    ...... code 1..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ...... text 0..1 ED
    ....... reference C 0..1 TEL The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
    Constraints: 1198-8699
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Observation.code.translation Base preferred Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
    Observation.value Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.participant:verifier.​participantRole.code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Observation.participant:custodian.​participantRole.code Base preferred Healthcare Agent or Proxy Choices . 📦20221029 VSAC v0.23
    Observation.participant:custodian.​participantRole.playingEntity.​code Base preferred Personal And Legal Relationship Role Type . 📦20240606 VSAC v0.23
    Observation.reference:reference1.​externalDocument.code Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23

    Constraints

    Id Grade Path(s) Description Expression
    1198-8699 warning Observation.reference:reference1.externalDocument.text.reference If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
    should-addr warning Observation.participant:custodian.participantRole SHOULD contain addr addr.exists()
    should-author warning Observation SHOULD contain author author.exists()
    should-code warning Observation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntity SHOULD contain code code.exists()
    should-informant warning Observation SHOULD contain informant informant.exists()
    should-telecom warning Observation.participant:custodian.participantRole SHOULD contain telecom telecom.exists()
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    should-time warning Observation.participant:verifier SHOULD contain time time.exists()
    should-translation warning Observation.code SHOULD contain translation translation.exists()
    value-only error Observation.participant:verifier.time Interval fields SHALL NOT be present (low | high | width | center).empty()
    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

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @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:advance-directive-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: 2.16.840.1.113883.10.20.22.4.48
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @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
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ... code C 1..1 CD Advance Directive
    Binding: ObservationType (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @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
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... derivationExpr 0..1 ST
    ... text 1..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 Constraints: value-starts-octothorpe
    .... 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
    .... @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
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 1..1 IVXB_TS If the Advance Directive does not have a specified ending time, use a nullFlavor of *NA*. If the ending time is unknown, use a nullFlavor of *UNK*.
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... 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
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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
    ...... templateId:primary 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: 2.16.840.1.113883.10.20.1.58
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: VRF
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time C 0..1 IVL_TS Constraints: value-only
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    ...... @operator 0..1 cs Binding: CDASetOperator (required)
    ...... low 0..1 IVXB_TS
    ...... center 0..1 TS
    ...... width 0..1 PQ
    ...... high 0..1 IVXB_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 0..* II
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ...... addr 0..* USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 1..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @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
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..1 USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    .... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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: CDAParticipationType (required)
    Fixed Value: CST
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time 0..1 IVL_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code, should-addr, should-telecom
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 1..1 cs Binding: CDARoleClassRoot (required)
    Fixed Value: AGNT
    ...... id 0..* II
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
    ...... addr 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @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
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
    ....... quantity 0..* PQ
    ....... name 1..1 PN The name of the healthcare agent.
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... entryRelationship 0..* EntryRelationship
    ... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
    .... reference:reference1 1..* Reference
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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_ActRelationshipExternalReference (required)
    Fixed Value: REFR
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument 1..1 ExternalDocument 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..* II
    ...... code 1..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ...... text 0..1 ED
    ....... @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 The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
    Constraints: 1198-8699
    ....... thumbnail 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)
    ... 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 C 0..1 II Constraints: II-1
    ..... @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)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Observation.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.templateId:advance-directive-obs.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.classCode Base required CDAActClassObservation 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Observation.code Base example ObservationType 📦3.0.0 THO v6.5
    Observation.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.code.translation Base preferred Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
    Observation.text.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.text.compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.text.mediaType Base example MediaType 📦3.0.0 THO v6.5
    Observation.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.effectiveTime.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.effectiveTime.​operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Observation.value Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.methodCode Base example ObservationMethod 📦3.0.0 THO v6.5
    Observation.participant:verifier.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​templateId:primary.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​time.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​time.operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Observation.participant:verifier.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Observation.participant:verifier.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Observation.participant:verifier.​participantRole.playingEntity.​code Base example CDAEntityCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.code Base preferred Healthcare Agent or Proxy Choices . 📦20221029 VSAC v0.23
    Observation.participant:custodian.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Observation.participant:custodian.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Observation.participant:custodian.​participantRole.playingEntity.​code Base preferred Personal And Legal Relationship Role Type . 📦20240606 VSAC v0.23
    Observation.reference:reference1.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​typeCode Base required x_ActRelationshipExternalReference 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.classCode Base required ActClassDocument 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.moodCode Base required CDAActMood 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.code Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.reference:reference1.​externalDocument.text.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.text.​compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.text.​integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.reference:reference1.​externalDocument.text.​mediaType Base example MediaType 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.text.​representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.1-sd Clinical Document Architecture v2.0

    Constraints

    Id Grade Path(s) Description Expression
    1198-8699 warning Observation.reference:reference1.externalDocument.text.reference If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
    II-1 error Observation.typeId, Observation.participant:verifier.typeId, Observation.participant:verifier.participantRole.typeId, Observation.participant:verifier.participantRole.playingEntity.typeId, Observation.participant:custodian.typeId, Observation.participant:custodian.participantRole.typeId, Observation.participant:custodian.participantRole.playingEntity.typeId, Observation.reference:reference1.typeId, Observation.reference:reference1.externalDocument.typeId, Observation.referenceRange.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-addr warning Observation.participant:custodian.participantRole SHOULD contain addr addr.exists()
    should-author warning Observation SHOULD contain author author.exists()
    should-code warning Observation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntity SHOULD contain code code.exists()
    should-informant warning Observation SHOULD contain informant informant.exists()
    should-telecom warning Observation.participant:custodian.participantRole SHOULD contain telecom telecom.exists()
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    should-time warning Observation.participant:verifier SHOULD contain time time.exists()
    should-translation warning Observation.code SHOULD contain translation translation.exists()
    value-only error Observation.participant:verifier.time Interval fields SHALL NOT be present (low | high | width | center).empty()
    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

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value, should-author, should-informant
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @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:advance-directive-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: 2.16.840.1.113883.10.20.22.4.48
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @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
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ... code C 1..1 CD Advance Directive
    Binding: ObservationType (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 75320-2
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @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
    .... translation 0..* CD 𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... derivationExpr 0..1 ST
    ... text 1..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 Constraints: value-starts-octothorpe
    .... 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
    .... @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
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 1..1 IVXB_TS If the Advance Directive does not have a specified ending time, use a nullFlavor of *NA*. If the ending time is unknown, use a nullFlavor of *UNK*.
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value 0..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ... 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
    ... informant 0..* Informant SHOULD contain informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:verifier C 0..* Participant2 𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
    Constraints: should-time
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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
    ...... templateId:primary 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: 2.16.840.1.113883.10.20.1.58
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: VRF
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time C 0..1 IVL_TS Constraints: value-only
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    ...... @operator 0..1 cs Binding: CDASetOperator (required)
    ...... low 0..1 IVXB_TS
    ...... center 0..1 TS
    ...... width 0..1 PQ
    ...... high 0..1 IVXB_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 0..* II
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ...... addr 0..* USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 1..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @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
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..1 USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    .... participant:custodian 0..* Participant2 This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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: CDAParticipationType (required)
    Fixed Value: CST
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time 0..1 IVL_TS
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: should-code, should-addr, should-telecom
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 1..1 cs Binding: CDARoleClassRoot (required)
    Fixed Value: AGNT
    ...... id 0..* II
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
    ...... addr 0..1 USRealmAddress
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity C 1..1 PlayingEntity Constraints: should-code
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @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
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: Personal And Legal Relationship Role Type . (preferred)
    ....... quantity 0..* PQ
    ....... name 1..1 PN The name of the healthcare agent.
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... entryRelationship 0..* EntryRelationship
    ... Slices for reference 1..* Reference Slice: Unordered, Open by value:typeCode
    .... reference:reference1 1..* Reference
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @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_ActRelationshipExternalReference (required)
    Fixed Value: REFR
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument 1..1 ExternalDocument 𝗨𝗦𝗖𝗗𝗜: External Document
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @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
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..* II
    ...... code 1..1 CD Binding: Advance Healthcare Directive Document Types Grouper . (preferred)
    ...... text 0..1 ED
    ....... @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 The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
    Constraints: 1198-8699
    ....... thumbnail 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    𝗨𝗦𝗖𝗗𝗜: Author
    XML: author (urn:hl7-org:sdtc)
    ... 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 C 0..1 II Constraints: II-1
    ..... @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)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Observation.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.templateId:advance-directive-obs.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.classCode Base required CDAActClassObservation 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Observation.code Base example ObservationType 📦3.0.0 THO v6.5
    Observation.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.code.translation Base preferred Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.23
    Observation.text.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.text.compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.text.mediaType Base example MediaType 📦3.0.0 THO v6.5
    Observation.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.effectiveTime.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.effectiveTime.​operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Observation.value Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.methodCode Base example ObservationMethod 📦3.0.0 THO v6.5
    Observation.participant:verifier.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​templateId:primary.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​time.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​time.operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Observation.participant:verifier.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:verifier.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Observation.participant:verifier.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Observation.participant:verifier.​participantRole.playingEntity.​code Base example CDAEntityCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.code Base preferred Healthcare Agent or Proxy Choices . 📦20221029 VSAC v0.23
    Observation.participant:custodian.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.participant:custodian.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Observation.participant:custodian.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Observation.participant:custodian.​participantRole.playingEntity.​code Base preferred Personal And Legal Relationship Role Type . 📦20240606 VSAC v0.23
    Observation.reference:reference1.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​typeCode Base required x_ActRelationshipExternalReference 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.classCode Base required ActClassDocument 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.moodCode Base required CDAActMood 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.code Base preferred Advance Healthcare Directive Document Types Grouper . 📦20250407 VSAC v0.23
    Observation.reference:reference1.​externalDocument.text.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.text.​compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.reference:reference1.​externalDocument.text.​integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.reference:reference1.​externalDocument.text.​mediaType Base example MediaType 📦3.0.0 THO v6.5
    Observation.reference:reference1.​externalDocument.text.​representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.1-sd Clinical Document Architecture v2.0

    Constraints

    Id Grade Path(s) Description Expression
    1198-8699 warning Observation.reference:reference1.externalDocument.text.reference If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
    II-1 error Observation.typeId, Observation.participant:verifier.typeId, Observation.participant:verifier.participantRole.typeId, Observation.participant:verifier.participantRole.playingEntity.typeId, Observation.participant:custodian.typeId, Observation.participant:custodian.participantRole.typeId, Observation.participant:custodian.participantRole.playingEntity.typeId, Observation.reference:reference1.typeId, Observation.reference:reference1.externalDocument.typeId, Observation.referenceRange.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-addr warning Observation.participant:custodian.participantRole SHOULD contain addr addr.exists()
    should-author warning Observation SHOULD contain author author.exists()
    should-code warning Observation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntity SHOULD contain code code.exists()
    should-informant warning Observation SHOULD contain informant informant.exists()
    should-telecom warning Observation.participant:custodian.participantRole SHOULD contain telecom telecom.exists()
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    should-time warning Observation.participant:verifier SHOULD contain time time.exists()
    should-translation warning Observation.code SHOULD contain translation translation.exists()
    value-only error Observation.participant:verifier.time Interval fields SHALL NOT be present (low | high | width | center).empty()
    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: 18 elements(8 nested mandatory elements)
    Fixed: 7 elements
    Prohibited: 1 element

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 2 is sliced based on the values of Observation.templateId
    • The element 1 is sliced based on the value of Observation.participant
    • The element 1 is sliced based on the value of Observation.participant.templateId
    • The element 1 is sliced based on the value of Observation.reference

     

    Other representations of profile: CSV, Excel