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

Logical Model: HealthConcernAct - Detailed Descriptions

Draft as of 2024-12-19

Definitions for the HealthConcernAct logical model.

Guidance on how to interpret the contents of this table can be found here

0. Act
Logical ContainerClinicalDocument (CDA Class)
ValidationInstance of this type are validated by templateId
XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
should-author: SHOULD contain author (author.exists())
2. Act.templateId
Control1..?
SlicingThis element introduces a set of slices on Act.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ root
  • value @ extension
  • 4. Act.templateId:health-concern-act
    Slice Namehealth-concern-act
    Control1..1
    6. Act.templateId:health-concern-act.root
    Control1..?
    Pattern Value2.16.840.1.113883.10.20.22.4.132
    8. Act.templateId:health-concern-act.extension
    Control1..?
    Pattern Value2022-06-01
    10. Act.classCode
    Comments

    SHALL contain exactly one [1..1] @classCode="ACT" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:4515-30750).

    Fixed ValueACT
    12. Act.moodCode
    Comments

    SHALL contain exactly one [1..1] @moodCode="EVN" (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001) (CONF:4515-30751).

    Fixed ValueEVN
    14. Act.id
    Comments

    SHALL contain at least one [1..*] id (CONF:4515-30754).

    Control1..?
    16. Act.code
    ShortFunctional status assessment note
    Comments

    SHALL contain exactly one [1..1] code (CONF:4515-32310).

    18. Act.code.code
    Control1..?
    Pattern Value75310-3
    20. Act.code.codeSystem
    ShortLOINC
    Control1..?
    Pattern Value2.16.840.1.113883.6.1
    22. Act.text
    ShortSHOULD reference the portion of section narrative text corresponding to this entry
    24. Act.text.reference
    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
    26. Act.statusCode
    Comments

    SHALL contain exactly one [1..1] statusCode (CONF:4515-30758).

    Control1..?
    28. Act.statusCode.nullFlavor
    Control0..0
    30. Act.statusCode.code
    Control1..?
    BindingThe codes SHALL be taken from ProblemAct statusCode .
    (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.19)
    32. Act.effectiveTime
    Comments

    MAY contain zero or one [0..1] effectiveTime (CONF:4515-30759).

    34. Act.author
    ShortA health concern may be a patient or provider concern. If the author is set to the recordTarget (patient), this is a patient concern. If the author is set to a provider, this is a provider concern. If both patient and provider are set as authors, this is a concern of both the patient and the provider.
    Comments

    SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:4515-31546).

    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
    36. Act.entryRelationship
    ShortWhen this Health Concern Act is a Social Determinant of Health Health Concern it **SHOULD** contain zero or more [0..*] entryRelationship subentries such that it contains an observation with an observation/value selected from ValueSet [Social Determinant of Health Conditions 2.16.840.1.113762.1.4.1196.788](https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1196.788/expansion) **DYNAMIC** (CONF:4515-32962).
    Comments

    MAY contain zero or more [0..*] entryRelationship (CONF:4515-31549) such that it

    SlicingThis element introduces a set of slices on Act.entryRelationship. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • profile @ act
    • profile @ observation
    • profile @ organizer
    • value @ typeCode
    • 38. Act.entryRelationship:observations
      Slice Nameobservations
      Control0..*
      40. Act.entryRelationship:observations.typeCode
      Fixed ValueREFR
      42. Act.entryRelationship:observations.observation
      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Problem Observation, Allergy - Intolerance Observation, Assessment Scale Observation, Self-Care Activities (ADL and IADL), Mental Status Observation, Smoking Status - Meaningful Use (Deprecated), Functional Status Observation, Nutrition Assessment, Pregnancy Status Observation, Reaction Observation, Result Observation, Sensory Status, Social History Observation, Substance or Device Allergy - Intolerance Observation, Tobacco Use (Deprecated), Vital Sign Observation, Longitudinal Care Wound Observation, Problem Observation, Caregiver Characteristics, Cultural and Religious Observation, Characteristics of Home Environment, Nutritional Status Observation, Priority Preference)
      44. Act.entryRelationship:acts
      Slice Nameacts
      Control0..*
      46. Act.entryRelationship:acts.typeCode
      Fixed ValueREFR
      48. Act.entryRelationship:acts.act
      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act(Encounter Diagnosis, Hospital Admission Diagnosis, Postprocedure Diagnosis, Preoperative Diagnosis, Entry Reference)
      50. Act.entryRelationship:organizers
      Slice Nameorganizers
      Control0..*
      52. Act.entryRelationship:organizers.typeCode
      Fixed ValueREFR
      54. Act.entryRelationship:organizers.organizer
      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Organizer(Family History Organizer, Result Organizer)
      56. Act.entryRelationship:related-entries
      Slice Namerelated-entries
      ShortWhere a Health Concern needs to reference another entry already described in the CDA document instance, rather than repeating the full content of the entry, the Entry Reference template may be used to reference this entry. This may also be used to refer to other Health Concern Acts where there is a general relationship between the source and the target (Health Concern REFERS TO Health Concern). For example, a patient has 2 health concerns identified in a CARE Plan: Failure to Thrive and Poor Feeding; while it could be that one may have caused the other, at the time of care planning and documentation it is not necessary, nor desirable to have to assert what caused what. The Entry Reference template is used here because the target Health Concern Act will be defined elsewhere in the Health Concerns Section and thus a reference to that template is all that is required.
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:4515-31157) such that it

      Control0..*
      58. Act.entryRelationship:related-entries.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:4515-31158).

      Fixed ValueREFR
      60. Act.entryRelationship:related-entries.act
      Comments

      SHALL contain exactly one [1..1] Entry Reference (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.122) (CONF:4515-32106).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act(Entry Reference)
      62. Act.entryRelationship:component-health-concern-acts
      Slice Namecomponent-health-concern-acts
      ShortThe following entryRelationship represents the relationship between two Health Concern Acts where the target is a component of the source (Health Concern HAS COMPONENT Health Concern). For example, a patient has an Impaired Mobility Health Concern. There may then be the need to document several component health concerns, such as "Unable to Transfer Bed to Chair","Unable to Rise from Commode", "Short of Breath Walking with Walker". The Entry Reference template is used here because the target Health Concern Act will be defined elsewhere in the Health Concerns Section and thus a reference to that template is all that is required.
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:4515-31160) such that it

      Control0..*
      Invariants4515-32745: The Entry Reference template **SHALL** contain an id that references a Health Concern Act (CONF:4515-32745). (%resource.descendants().ofType(CDA.Act).where(templateId.exists($this.root = '2.16.840.1.113883.10.20.22.4.132' and $this.extension = '2022-06-01') and id.exists($this.root = %context.act.id.first().root and $this.extension ~ %context.act.id.first().extension)))
      64. Act.entryRelationship:component-health-concern-acts.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="COMP" Has component (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:4515-31161).

      Fixed ValueCOMP
      66. Act.entryRelationship:component-health-concern-acts.act
      Comments

      SHALL contain exactly one [1..1] Entry Reference (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.122) (CONF:4515-32107).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Act(Entry Reference)
      68. Act.reference
      ShortWhere it is necessary to reference an external clinical document such as a Referral document, Discharge Summary document etc., the External Document Reference template can be used to reference this document. However, if this Care Plan document is replacing or appending another Care Plan document in the same set, that relationship is set in the header, using ClinicalDocument/relatedDocument.
      Comments

      MAY contain zero or more [0..*] reference (CONF:4515-32757).

      70. Act.reference.typeCode
      Comments

      The reference, if present, SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:4515-32758).

      Fixed ValueREFR
      72. Act.reference.externalDocument
      Comments

      The reference, if present, SHALL contain exactly one [1..1] External Document Reference (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.115:2014-06-09) (CONF:4515-32759).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalDocument(External Document Reference)