Consolidated CDA (C-CDA)
4.0.0-ballot - STU4 Ballot 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-ballot built by the FHIR (HL7ยฎ FHIRยฎ 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-ballot
Draft as of 2024-12-19 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. This template provides details about the type of advance directive document and may also include information on the documentโ€™s author, as well as any individuals who verified its contents with the patient or their designated healthcare agent.

Usage:

Formal Views of Template Content

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

This structure is derived from Observation

NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain 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
should-translation: SHOULD contain 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 Directives Categories . (preferred)
... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
.... reference C 0..1 TEL value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1 CS
.... @code 1..1 cs Fixed Value: completed
... effectiveTime 1..1 IVL_TS
.... low 1..1 IVXB_TS
.... high C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... value 0..1 ANY, BL, ED, ST, CD, CV, CE, CO, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ
... author 0..* AuthorParticipation Base for all types and resources
... 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.
should-time: SHOULD contain 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 value-only: Interval fields SHALL NOT be present
...... @value 0..1 ts value should be used instead of low/high
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
...... addr 0..* USRealmAddress Base for all types and resources
...... playingEntity 1..1 PlayingEntity
....... name 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
.... 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 should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @classCode 1..1 cs Fixed Value: AGNT
...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
...... addr 0..1 USRealmAddress Base for all types and resources
...... telecom 0..* TEL
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain 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 Directives Categories . (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).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF: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)

PathConformanceValueSetURI
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
value-onlyerrorObservation.participant:verifier.timeInterval fields SHALL NOT be present
: (low | high | width | center).empty()
value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
: value.exists() implies value.startsWith('#')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
.... @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)
should-translation: SHOULD contain 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 Directives Categories . (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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
.... thumbnail 0..1 ED
... statusCode 1..1 CS Binding: ActStatus (required)
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @code 1..1 cs Fixed Value: completed
.... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
XML: valueSet (urn:hl7-org:sdtc)
.... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
XML: valueSetVersion (urn:hl7-org:sdtc)
... effectiveTime 1..1 IVL_TS
.... @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 C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... priorityCode 0..1 CE Binding: ActPriority (example)
... repeatNumber 0..1 IVL_INT
... languageCode 0..1 CS Binding: AllLanguages (required)
... value 0..1
.... value ANY
.... value BL
.... value ED
.... value ST
.... value CD
.... value CV
.... value CE
.... value CO
.... value SC
.... value II
.... value TEL
.... value AD
.... value EN
.... value INT
.... value REAL
.... value PQ
.... value MO
.... value TS
.... value IVL_PQ
.... value IVL_TS
.... value PIVL_TS
.... value EIVL_TS
.... value SXPR_TS
.... value RTO_PQ_PQ
... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
... methodCode 0..* CE Binding: ObservationMethod (example)
... targetSiteCode 0..* CD
... subject 0..1 Subject
... specimen 0..* Specimen
... performer 0..* Performer2
... author 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant 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.
should-time: SHOULD contain time
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
...... @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 value-only: Interval fields SHALL NOT be present
...... @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 should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @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 C 0..* USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... 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 II-1: An II instance must have either a root or an nullFlavor.
........ @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 C 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @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 should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @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 C 0..1 USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingDevice 0..1 Device
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... realmCode 0..* CS
....... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
........ @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 II-1: An II instance must have either a root or an nullFlavor.
...... @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 II-1: An II instance must have either a root or an nullFlavor.
....... @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 Directives Categories . (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).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF: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 II-1: An II instance must have either a root or an nullFlavor.
..... @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

PathConformanceValueSet / CodeURI
Observation.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.templateId:advance-directive-obs.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.classCoderequiredFixed Value: OBS
http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
Observation.moodCoderequiredFixed Value: EVN
http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
Observation.codeexampleObservationType
http://terminology.hl7.org/ValueSet/v3-ObservationType
Observation.code.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.statusCoderequiredActStatus
http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.statusCode.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.priorityCodeexampleActPriority
http://terminology.hl7.org/ValueSet/v3-ActPriority
Observation.languageCoderequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages
from the FHIR Standard
Observation.interpretationCoderequiredCDAObservationInterpretation
http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
Observation.methodCodeexampleObservationMethod
http://terminology.hl7.org/ValueSet/v3-ObservationMethod
Observation.participant:verifier.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.templateId:primary.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeCoderequiredFixed Value: VRF
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:verifier.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:verifier.time.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.time.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.participant:verifier.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.classCoderequiredCDARoleClassRoot
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:verifier.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:verifier.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:verifier.participantRole.playingEntity.codeexampleCDAEntityCode
http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
Observation.participant:custodian.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeCoderequiredFixed Value: CST
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:custodian.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:custodian.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.classCoderequiredFixed Value: AGNT
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:custodian.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeCoderequiredFixed Value: REFR
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Observation.reference:reference1.externalDocument.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.classCoderequiredActClassDocument
http://terminology.hl7.org/ValueSet/v3-ActClassDocument
Observation.reference:reference1.externalDocument.moodCoderequiredFixed Value: EVN
http://hl7.org/cda/stds/core/ValueSet/CDAActMood
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.reference:reference1.externalDocument.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.reference:reference1.externalDocument.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.reference:reference1.externalDocument.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.reference:reference1.externalDocument.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.referenceRange.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeCoderequiredFixed Value: REFV
http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
81-7296errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addr**SHALL NOT** have mixed content except for white space (CONF:81-7296)
: item.xmlText.empty()
81-9371errorObservation.participant:verifier.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorObservation.participant:verifier.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
81-10024errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state'))
81-10025errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?'))
II-1errorObservation.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.typeIdAn II instance must have either a root or an nullFlavor.
: root.exists() or nullFlavor.exists()
pn-no-lserrorObservation.participant:verifier.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
shall-cityerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain exactly one [1..1] city (CONF:81-7292).
: nullFlavor.exists() or item.city.count() = 1
shall-max-ad-partserrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL have at most one of each: state, city, postalCode, and country
: (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1)
shall-streetAddressLineerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
: nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4)
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-countrywarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain country
: nullFlavor.exists() or item.country.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
should-usewarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain @use
: nullFlavor.exists() or use.exists()
value-onlyerrorObservation.participant:verifier.timeInterval fields SHALL NOT be present
: (low | high | width | center).empty()
value-starts-octothorpeerrorObservation.text.referenceIf reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
: value.exists() implies value.startsWith('#')
NameFlagsCard.TypeDescription & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
.... @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)
should-translation: SHOULD contain 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 Directives Categories . (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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
.... thumbnail 0..1 ED
... statusCode 1..1 CS Binding: ActStatus (required)
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @code 1..1 cs Fixed Value: completed
.... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
XML: valueSet (urn:hl7-org:sdtc)
.... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
XML: valueSetVersion (urn:hl7-org:sdtc)
... effectiveTime 1..1 IVL_TS
.... @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 C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... priorityCode 0..1 CE Binding: ActPriority (example)
... repeatNumber 0..1 IVL_INT
... languageCode 0..1 CS Binding: AllLanguages (required)
... value 0..1
.... value ANY
.... value BL
.... value ED
.... value ST
.... value CD
.... value CV
.... value CE
.... value CO
.... value SC
.... value II
.... value TEL
.... value AD
.... value EN
.... value INT
.... value REAL
.... value PQ
.... value MO
.... value TS
.... value IVL_PQ
.... value IVL_TS
.... value PIVL_TS
.... value EIVL_TS
.... value SXPR_TS
.... value RTO_PQ_PQ
... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
... methodCode 0..* CE Binding: ObservationMethod (example)
... targetSiteCode 0..* CD
... subject 0..1 Subject
... specimen 0..* Specimen
... performer 0..* Performer2
... author 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant 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.
should-time: SHOULD contain time
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
...... @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 value-only: Interval fields SHALL NOT be present
...... @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 should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @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 C 0..* USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... 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 II-1: An II instance must have either a root or an nullFlavor.
........ @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 C 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @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 should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @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 C 0..1 USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingDevice 0..1 Device
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... realmCode 0..* CS
....... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
........ @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 II-1: An II instance must have either a root or an nullFlavor.
...... @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 II-1: An II instance must have either a root or an nullFlavor.
....... @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 Directives Categories . (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).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF: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 II-1: An II instance must have either a root or an nullFlavor.
..... @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

PathConformanceValueSet / CodeURI
Observation.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.templateId:advance-directive-obs.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.classCoderequiredFixed Value: OBS
http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
Observation.moodCoderequiredFixed Value: EVN
http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
Observation.codeexampleObservationType
http://terminology.hl7.org/ValueSet/v3-ObservationType
Observation.code.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.statusCoderequiredActStatus
http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.statusCode.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.priorityCodeexampleActPriority
http://terminology.hl7.org/ValueSet/v3-ActPriority
Observation.languageCoderequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages
from the FHIR Standard
Observation.interpretationCoderequiredCDAObservationInterpretation
http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
Observation.methodCodeexampleObservationMethod
http://terminology.hl7.org/ValueSet/v3-ObservationMethod
Observation.participant:verifier.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.templateId:primary.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeCoderequiredFixed Value: VRF
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:verifier.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:verifier.time.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.time.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.participant:verifier.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.classCoderequiredCDARoleClassRoot
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:verifier.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:verifier.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:verifier.participantRole.playingEntity.codeexampleCDAEntityCode
http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
Observation.participant:custodian.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeCoderequiredFixed Value: CST
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:custodian.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:custodian.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.classCoderequiredFixed Value: AGNT
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:custodian.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeCoderequiredFixed Value: REFR
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Observation.reference:reference1.externalDocument.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.classCoderequiredActClassDocument
http://terminology.hl7.org/ValueSet/v3-ActClassDocument
Observation.reference:reference1.externalDocument.moodCoderequiredFixed Value: EVN
http://hl7.org/cda/stds/core/ValueSet/CDAActMood
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.reference:reference1.externalDocument.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.reference:reference1.externalDocument.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.reference:reference1.externalDocument.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.reference:reference1.externalDocument.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.referenceRange.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeCoderequiredFixed Value: REFV
http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
81-7296errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addr**SHALL NOT** have mixed content except for white space (CONF:81-7296)
: item.xmlText.empty()
81-9371errorObservation.participant:verifier.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorObservation.participant:verifier.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
81-10024errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state'))
81-10025errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?'))
II-1errorObservation.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.typeIdAn II instance must have either a root or an nullFlavor.
: root.exists() or nullFlavor.exists()
pn-no-lserrorObservation.participant:verifier.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
shall-cityerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain exactly one [1..1] city (CONF:81-7292).
: nullFlavor.exists() or item.city.count() = 1
shall-max-ad-partserrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL have at most one of each: state, city, postalCode, and country
: (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1)
shall-streetAddressLineerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
: nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4)
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-countrywarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain country
: nullFlavor.exists() or item.country.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
should-usewarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain @use
: nullFlavor.exists() or use.exists()
value-onlyerrorObservation.participant:verifier.timeInterval fields SHALL NOT be present
: (low | high | width | center).empty()
value-starts-octothorpeerrorObservation.text.referenceIf 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 & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain 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
should-translation: SHOULD contain 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 Directives Categories . (preferred)
... text 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
.... reference C 0..1 TEL value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
... statusCode 1..1 CS
.... @code 1..1 cs Fixed Value: completed
... effectiveTime 1..1 IVL_TS
.... low 1..1 IVXB_TS
.... high C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... value 0..1 ANY, BL, ED, ST, CD, CV, CE, CO, SC, II, TEL, AD, EN, INT, REAL, PQ, MO, TS, IVL_PQ, IVL_TS, PIVL_TS, EIVL_TS, SXPR_TS, RTO_PQ_PQ
... author 0..* AuthorParticipation Base for all types and resources
... 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.
should-time: SHOULD contain 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 value-only: Interval fields SHALL NOT be present
...... @value 0..1 ts value should be used instead of low/high
..... participantRole C 1..1 ParticipantRole should-code: SHOULD contain code
...... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
...... addr 0..* USRealmAddress Base for all types and resources
...... playingEntity 1..1 PlayingEntity
....... name 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
.... 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 should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @classCode 1..1 cs Fixed Value: AGNT
...... code 0..1 CE Binding: Healthcare Agent or Proxy Choices . (preferred)
...... addr 0..1 USRealmAddress Base for all types and resources
...... telecom 0..* TEL
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain 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 Directives Categories . (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).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF: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)

PathConformanceValueSetURI
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
value-onlyerrorObservation.participant:verifier.timeInterval fields SHALL NOT be present
: (low | high | width | center).empty()
value-starts-octothorpeerrorObservation.text.referenceIf 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 & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
.... @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)
should-translation: SHOULD contain 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 Directives Categories . (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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
.... thumbnail 0..1 ED
... statusCode 1..1 CS Binding: ActStatus (required)
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @code 1..1 cs Fixed Value: completed
.... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
XML: valueSet (urn:hl7-org:sdtc)
.... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
XML: valueSetVersion (urn:hl7-org:sdtc)
... effectiveTime 1..1 IVL_TS
.... @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 C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... priorityCode 0..1 CE Binding: ActPriority (example)
... repeatNumber 0..1 IVL_INT
... languageCode 0..1 CS Binding: AllLanguages (required)
... value 0..1
.... value ANY
.... value BL
.... value ED
.... value ST
.... value CD
.... value CV
.... value CE
.... value CO
.... value SC
.... value II
.... value TEL
.... value AD
.... value EN
.... value INT
.... value REAL
.... value PQ
.... value MO
.... value TS
.... value IVL_PQ
.... value IVL_TS
.... value PIVL_TS
.... value EIVL_TS
.... value SXPR_TS
.... value RTO_PQ_PQ
... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
... methodCode 0..* CE Binding: ObservationMethod (example)
... targetSiteCode 0..* CD
... subject 0..1 Subject
... specimen 0..* Specimen
... performer 0..* Performer2
... author 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant 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.
should-time: SHOULD contain time
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
...... @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 value-only: Interval fields SHALL NOT be present
...... @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 should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @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 C 0..* USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... 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 II-1: An II instance must have either a root or an nullFlavor.
........ @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 C 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @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 should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @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 C 0..1 USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingDevice 0..1 Device
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... realmCode 0..* CS
....... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
........ @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 II-1: An II instance must have either a root or an nullFlavor.
...... @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 II-1: An II instance must have either a root or an nullFlavor.
....... @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 Directives Categories . (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).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF: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 II-1: An II instance must have either a root or an nullFlavor.
..... @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

PathConformanceValueSet / CodeURI
Observation.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.templateId:advance-directive-obs.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.classCoderequiredFixed Value: OBS
http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
Observation.moodCoderequiredFixed Value: EVN
http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
Observation.codeexampleObservationType
http://terminology.hl7.org/ValueSet/v3-ObservationType
Observation.code.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.statusCoderequiredActStatus
http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.statusCode.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.priorityCodeexampleActPriority
http://terminology.hl7.org/ValueSet/v3-ActPriority
Observation.languageCoderequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages
from the FHIR Standard
Observation.interpretationCoderequiredCDAObservationInterpretation
http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
Observation.methodCodeexampleObservationMethod
http://terminology.hl7.org/ValueSet/v3-ObservationMethod
Observation.participant:verifier.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.templateId:primary.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeCoderequiredFixed Value: VRF
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:verifier.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:verifier.time.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.time.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.participant:verifier.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.classCoderequiredCDARoleClassRoot
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:verifier.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:verifier.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:verifier.participantRole.playingEntity.codeexampleCDAEntityCode
http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
Observation.participant:custodian.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeCoderequiredFixed Value: CST
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:custodian.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:custodian.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.classCoderequiredFixed Value: AGNT
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:custodian.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeCoderequiredFixed Value: REFR
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Observation.reference:reference1.externalDocument.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.classCoderequiredActClassDocument
http://terminology.hl7.org/ValueSet/v3-ActClassDocument
Observation.reference:reference1.externalDocument.moodCoderequiredFixed Value: EVN
http://hl7.org/cda/stds/core/ValueSet/CDAActMood
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.reference:reference1.externalDocument.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.reference:reference1.externalDocument.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.reference:reference1.externalDocument.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.reference:reference1.externalDocument.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.referenceRange.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeCoderequiredFixed Value: REFV
http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
81-7296errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addr**SHALL NOT** have mixed content except for white space (CONF:81-7296)
: item.xmlText.empty()
81-9371errorObservation.participant:verifier.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorObservation.participant:verifier.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
81-10024errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state'))
81-10025errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?'))
II-1errorObservation.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.typeIdAn II instance must have either a root or an nullFlavor.
: root.exists() or nullFlavor.exists()
pn-no-lserrorObservation.participant:verifier.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
shall-cityerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain exactly one [1..1] city (CONF:81-7292).
: nullFlavor.exists() or item.city.count() = 1
shall-max-ad-partserrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL have at most one of each: state, city, postalCode, and country
: (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1)
shall-streetAddressLineerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
: nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4)
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-countrywarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain country
: nullFlavor.exists() or item.country.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
should-usewarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain @use
: nullFlavor.exists() or use.exists()
value-onlyerrorObservation.participant:verifier.timeInterval fields SHALL NOT be present
: (low | high | width | center).empty()
value-starts-octothorpeerrorObservation.text.referenceIf 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 & Constraintsdoco
.. Observation C 1..1 Observation XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, sdtcCategory, code, derivationExpr, text, statusCode, effectiveTime, priorityCode, repeatNumber, languageCode, value, interpretationCode, methodCode, targetSiteCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, referenceRange, sdtcInFulfillmentOf1
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
should-text-ref-value: SHOULD contain text/reference/@value
should-author: SHOULD contain author
should-informant: SHOULD contain informant
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
.... @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)
should-translation: SHOULD contain 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 Directives Categories . (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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
.... thumbnail 0..1 ED
... statusCode 1..1 CS Binding: ActStatus (required)
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @code 1..1 cs Fixed Value: completed
.... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
XML: valueSet (urn:hl7-org:sdtc)
.... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
XML: valueSetVersion (urn:hl7-org:sdtc)
... effectiveTime 1..1 IVL_TS
.... @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 C 1..1 IVXB_TS 1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
... priorityCode 0..1 CE Binding: ActPriority (example)
... repeatNumber 0..1 IVL_INT
... languageCode 0..1 CS Binding: AllLanguages (required)
... value 0..1
.... value ANY
.... value BL
.... value ED
.... value ST
.... value CD
.... value CV
.... value CE
.... value CO
.... value SC
.... value II
.... value TEL
.... value AD
.... value EN
.... value INT
.... value REAL
.... value PQ
.... value MO
.... value TS
.... value IVL_PQ
.... value IVL_TS
.... value PIVL_TS
.... value EIVL_TS
.... value SXPR_TS
.... value RTO_PQ_PQ
... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
... methodCode 0..* CE Binding: ObservationMethod (example)
... targetSiteCode 0..* CD
... subject 0..1 Subject
... specimen 0..* Specimen
... performer 0..* Performer2
... author 0..* AuthorParticipation Base for all types and resources
... informant 0..* Informant 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.
should-time: SHOULD contain time
..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
..... realmCode 0..* CS
..... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
...... @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 value-only: Interval fields SHALL NOT be present
...... @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 should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @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 C 0..* USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... 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 II-1: An II instance must have either a root or an nullFlavor.
........ @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 C 1..1 USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @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 should-code: SHOULD contain code
should-addr: SHOULD contain addr
should-telecom: SHOULD contain telecom
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @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 C 0..1 USRealmAddress Base for all types and resources
shall-city: SHALL contain exactly one [1..1] city (CONF:81-7292).
shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
should-use: SHOULD contain @use
should-country: SHOULD contain country
81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296)
81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country
...... telecom 0..* TEL
...... playingDevice 0..1 Device
...... playingEntity C 1..1 PlayingEntity should-code: SHOULD contain code
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... realmCode 0..* CS
....... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
........ @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 II-1: An II instance must have either a root or an nullFlavor.
...... @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 II-1: An II instance must have either a root or an nullFlavor.
....... @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 Directives Categories . (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).
1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF: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 II-1: An II instance must have either a root or an nullFlavor.
..... @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

PathConformanceValueSet / CodeURI
Observation.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.templateId:advance-directive-obs.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.classCoderequiredFixed Value: OBS
http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation
Observation.moodCoderequiredFixed Value: EVN
http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0
Observation.codeexampleObservationType
http://terminology.hl7.org/ValueSet/v3-ObservationType
Observation.code.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.code.translationpreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.statusCoderequiredActStatus
http://terminology.hl7.org/ValueSet/v3-ActStatus
Observation.statusCode.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.effectiveTime.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.priorityCodeexampleActPriority
http://terminology.hl7.org/ValueSet/v3-ActPriority
Observation.languageCoderequiredAllLanguages
http://hl7.org/fhir/ValueSet/all-languages
from the FHIR Standard
Observation.interpretationCoderequiredCDAObservationInterpretation
http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation
Observation.methodCodeexampleObservationMethod
http://terminology.hl7.org/ValueSet/v3-ObservationMethod
Observation.participant:verifier.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.templateId:primary.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.typeCoderequiredFixed Value: VRF
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:verifier.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:verifier.time.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.time.operatorrequiredCDASetOperator
http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Observation.participant:verifier.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.classCoderequiredCDARoleClassRoot
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:verifier.participantRole.codepreferredHealthcareProviderTaxonomy . (a valid code from http://nucc.org/provider-taxonomy)
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066
Observation.participant:verifier.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:verifier.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:verifier.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:verifier.participantRole.playingEntity.codeexampleCDAEntityCode
http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
Observation.participant:custodian.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.typeCoderequiredFixed Value: CST
http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Observation.participant:custodian.contextControlCoderequiredFixed Value: OP
http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Observation.participant:custodian.participantRole.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.classCoderequiredFixed Value: AGNT
http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Observation.participant:custodian.participantRole.codepreferredHealthcareAgentOrProxyChoices .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35
Observation.participant:custodian.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.participant:custodian.participantRole.playingEntity.classCoderequiredEntityClassRoot
http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Observation.participant:custodian.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Observation.participant:custodian.participantRole.playingEntity.codepreferredPersonalAndLegalRelationshipRoleType .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1
Observation.reference:reference1.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.typeCoderequiredFixed Value: REFR
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Observation.reference:reference1.externalDocument.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.classCoderequiredActClassDocument
http://terminology.hl7.org/ValueSet/v3-ActClassDocument
Observation.reference:reference1.externalDocument.moodCoderequiredFixed Value: EVN
http://hl7.org/cda/stds/core/ValueSet/CDAActMood
Observation.reference:reference1.externalDocument.codepreferredAdvanceDirectivesCategories .
http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4
Observation.reference:reference1.externalDocument.text.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.reference:reference1.externalDocument.text.compressionrequiredCDACompressionAlgorithm
http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Observation.reference:reference1.externalDocument.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Observation.reference:reference1.externalDocument.text.mediaTypeexampleMediaType
http://terminology.hl7.org/ValueSet/v3-MediaType
Observation.reference:reference1.externalDocument.text.representationrequiredBinaryDataEncoding
http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Observation.referenceRange.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Observation.referenceRange.typeCoderequiredFixed Value: REFV
http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType

Constraints

IdGradePath(s)DetailsRequirements
1198-8699warningObservation.reference:reference1.externalDocument.text.referenceIf a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).
:
1198-32449errorObservation.effectiveTime.highIf the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449).
: value.exists() or nullFlavor = 'NA'
81-7296errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addr**SHALL NOT** have mixed content except for white space (CONF:81-7296)
: item.xmlText.empty()
81-9371errorObservation.participant:verifier.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorObservation.participant:verifier.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
81-10024errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state'))
81-10025errorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
: nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?'))
II-1errorObservation.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.typeIdAn II instance must have either a root or an nullFlavor.
: root.exists() or nullFlavor.exists()
pn-no-lserrorObservation.participant:verifier.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
shall-cityerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain exactly one [1..1] city (CONF:81-7292).
: nullFlavor.exists() or item.city.count() = 1
shall-max-ad-partserrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL have at most one of each: state, city, postalCode, and country
: (item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1)
shall-streetAddressLineerrorObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291).
: nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4)
should-addrwarningObservation.participant:custodian.participantRoleSHOULD contain addr
: addr.exists()
should-authorwarningObservationSHOULD contain author
: author.exists()
should-codewarningObservation.participant:verifier.participantRole, Observation.participant:custodian.participantRole, Observation.participant:custodian.participantRole.playingEntitySHOULD contain code
: code.exists()
should-countrywarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain country
: nullFlavor.exists() or item.country.exists()
should-informantwarningObservationSHOULD contain informant
: informant.exists()
should-telecomwarningObservation.participant:custodian.participantRoleSHOULD contain telecom
: telecom.exists()
should-text-ref-valuewarningObservationSHOULD contain text/reference/@value
: text.reference.value.exists()
should-timewarningObservation.participant:verifierSHOULD contain time
: time.exists()
should-translationwarningObservation.codeSHOULD contain translation
: translation.exists()
should-usewarningObservation.participant:verifier.participantRole.addr, Observation.participant:custodian.participantRole.addrSHOULD contain @use
: nullFlavor.exists() or use.exists()
value-onlyerrorObservation.participant:verifier.timeInterval fields SHALL NOT be present
: (low | high | width | center).empty()
value-starts-octothorpeerrorObservation.text.referenceIf 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

 

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