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

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

Logical Model: Note Activity

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/NoteActivity Version: 4.0.0
Draft as of 2025-09-16 Computable Name: NoteActivity
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.10.20.22.4.202:2016-11-01

The Note Activity represents a clinical note. Notes require authorship, authentication, timing information, and references to other discrete data such as encounters. Similar to the Comment Activity, the Note Activity permits a more specific code to characterize the type of information available in the note. The Note Activity template SHOULD NOT be used in place of a more specific C-CDA entry. Note information included needs to be relevant and pertinent to the information being communicated in the document. When the note information augments data represented in a more specific entry template, the Note Activity can be used in an entryRelationship to the associated standard C-CDA entry. For example, a Procedure Note added as an entryRelationship to a Procedure Activity Procedure entry). The Note Activity template can be used as a standalone entry within a standard C-CDA section (e.g., a note about various procedures which have occurred during a visit as an entry in the Procedures Section) when it does not augment another standard entry. It may also be used to provide additional data about the source of a currently narrative-only section, such as Hospital Course. Finally, if the type of data in the note is not known or no single C-CDA section is appropriate enough, the Note Activity should be placed in a Notes Section. (e.g., a free-text consultation note or a note which includes subjective, objective, assessment, and plan information combined). An alternative is to place the Note Activity as an entryRelationship to an Encounter Activity entry in the Encounters Section, but implementers may wish to group notes categorically into a separate location in CDA documents rather than overloading the Encounters Section.

The narrative Clinical Notes required in USCDI, along with their associated LOINC codes, are outlined below. These note types are included in the Note Types Value Set, which is bound to Act.code.translation.

  • Consultation Note (LOINC: 11488-4)
  • Discharge Summary (LOINC: 18842-5)
  • History & Physical Note (LOINC: 34117-2)
  • Procedures Note (LOINC: 28570-0)
  • Progress Note (LOINC: 11506-3)
  • Surgical Operation Note (Operative Note) (LOINC: 11504-8)
  • Emergency Department Note (LOINC: 34111-5)

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 3.0.0:

  • New Content

    • Formal Views of Template Content

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

    This structure is derived from Act

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:note-activity 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Fixed Value: ACT
    ... @moodCode 1..1 cs Fixed Value: EVN
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.6.1
    .... translation 0..* CD If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @mediaType 0..1 cs If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... reference C 1..1 TEL Constraints: value-starts-octothorpe
    ..... @nullFlavor 0..0
    ..... @value 1..1 url
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @value 0..1 ts
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @typeCode 1..1 cs Fixed Value: LA
    ..... time 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... playingEntity 0..1 PlayingEntity
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @typeCode 1..1 cs Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... encounter 1..1 Encounter
    ...... id C 1..* II Constraints: 3250-16914
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... id 1..1 II
    ...... code 0..1 CD

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Act.code.translationpreferredNoteTypes .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68
    Act.text.mediaTypepreferredSupportedFileFormats .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1

    Constraints

    IdGradePath(s)DetailsRequirements
    3250-16912errorAct.textIf @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
    : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914errorAct.entryRelationship:encounter.encounter.idIf the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
    :
    3250-16930errorAct.participant:legalAuthenticator.participantRoleIf no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    :
    should-codewarningAct.reference:externalDocument.externalDocumentSHOULD contain code
    : code.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    should-translationwarningAct.codeSHOULD contain translation
    : translation.exists()
    should-value-attwarningAct.effectiveTimeSHOULD contain @value
    : value.exists()
    value-starts-octothorpeerrorAct.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 & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:note-activity 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: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 0..* II
    ... code C 1..1 CD Binding: v3 Code System ActCode (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid 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 If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @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 If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... @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 1..1 TEL Constraints: value-starts-octothorpe
    ..... @value 1..1 url
    ..... useablePeriod 0..*
    ...... useablePeriod IVL_TS
    ...... useablePeriod EIVL_TS
    ...... useablePeriod PIVL_TS
    ...... useablePeriod SXPR_TS
    ..... @use 0..* cs Binding: TelecommunicationAddressUse (2.0.0) (required)
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Binding: ActStatus (required)
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts 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
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... informant 0..* Informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: LA
    ..... @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 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: CDARoleCode (example)
    ...... addr 0..* AD
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 0..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 1..1 Encounter
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 1..1 cs Binding: CDAActClass (required)
    Fixed Value: ENC
    ...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
    ...... id C 1..* II Constraints: 3250-16914
    ...... code 0..1 CD Binding: ActEncounterCode (example)
    ...... text 0..1 ED
    ...... statusCode 0..1 CS Binding: ActStatus (required)
    ...... effectiveTime 0..1 IVL_TS
    ...... sdtcDischargeDispositionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: dischargeDispositionCode (urn:hl7-org:sdtc)
    ...... priorityCode 0..1 CE Binding: ActPriority (example)
    ...... subject 0..1 Subject
    ...... specimen 0..* Specimen
    ...... performer 0..* Performer2
    ...... author 0..* Author
    ...... informant 0..* Informant
    ...... participant 0..* Participant2
    ...... entryRelationship 0..* EntryRelationship
    ...... reference 0..* Reference
    ...... precondition 0..* Precondition
    ...... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observation 0..1 Observation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..1 II
    ...... code 0..1 CD Binding: FHIRDocumentTypeCodes (example)
    ...... text 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.templateId:note-activity.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.classCoderequiredFixed Value: ACT
    http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
    Act.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
    Act.codeexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    Act.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.code.translationpreferredNoteTypes .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68
    Act.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Act.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Act.text.mediaTypepreferredSupportedFileFormats .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1
    Act.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Act.text.reference.userequiredTelecommunicationAddressUse
    http://terminology.hl7.org/ValueSet/v3-TelecommunicationAddressUse|2.0.0
    Act.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Act.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Act.participant:legalAuthenticator.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.typeCoderequiredFixed Value: LA
    http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
    Act.participant:legalAuthenticator.contextControlCoderequiredFixed Value: OP
    http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
    Act.participant:legalAuthenticator.participantRole.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.classCoderequiredCDARoleClassRoot
    http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
    Act.participant:legalAuthenticator.participantRole.codeexampleCDARoleCode
    http://hl7.org/cda/stds/core/ValueSet/CDARoleCode
    Act.participant:legalAuthenticator.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.playingEntity.classCoderequiredEntityClassRoot
    http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
    Act.participant:legalAuthenticator.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
    http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
    Act.participant:legalAuthenticator.participantRole.playingEntity.codeexampleCDAEntityCode
    http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
    Act.entryRelationship:encounter.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.typeCoderequiredFixed Value: COMP
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Act.entryRelationship:encounter.encounter.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.encounter.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.encounter.classCoderequiredFixed Value: ENC
    http://hl7.org/cda/stds/core/ValueSet/CDAActClass
    Act.entryRelationship:encounter.encounter.moodCoderequiredXDocumentEncounterMood
    http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0
    Act.entryRelationship:encounter.encounter.codeexampleActEncounterCode
    http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
    Act.entryRelationship:encounter.encounter.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.entryRelationship:encounter.encounter.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.reference:externalDocument.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.typeCoderequiredXActRelationshipExternalReference
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
    Act.reference:externalDocument.externalDocument.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.externalDocument.classCoderequiredActClassDocument
    http://terminology.hl7.org/ValueSet/v3-ActClassDocument
    Act.reference:externalDocument.externalDocument.moodCoderequiredFixed Value: EVN
    http://hl7.org/cda/stds/core/ValueSet/CDAActMood
    Act.reference:externalDocument.externalDocument.codeexampleFHIRDocumentTypeCodes
    http://hl7.org/fhir/ValueSet/doc-typecodes
    From the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    3250-16912errorAct.textIf @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
    : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914errorAct.entryRelationship:encounter.encounter.idIf the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
    :
    3250-16930errorAct.participant:legalAuthenticator.participantRoleIf no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    :
    II-1errorAct.typeId, Act.participant:legalAuthenticator.typeId, Act.participant:legalAuthenticator.participantRole.typeId, Act.participant:legalAuthenticator.participantRole.playingEntity.typeId, Act.entryRelationship:encounter.typeId, Act.entryRelationship:encounter.encounter.typeId, Act.reference:externalDocument.typeId, Act.reference:externalDocument.externalDocument.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    should-codewarningAct.reference:externalDocument.externalDocumentSHOULD contain code
    : code.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    should-translationwarningAct.codeSHOULD contain translation
    : translation.exists()
    should-value-attwarningAct.effectiveTimeSHOULD contain @value
    : value.exists()
    value-starts-octothorpeerrorAct.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 & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:note-activity 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: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 0..* II
    ... code C 1..1 CD Binding: v3 Code System ActCode (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid 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 If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @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 If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... @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 1..1 TEL Constraints: value-starts-octothorpe
    ..... @value 1..1 url
    ..... useablePeriod 0..*
    ...... useablePeriod IVL_TS
    ...... useablePeriod EIVL_TS
    ...... useablePeriod PIVL_TS
    ...... useablePeriod SXPR_TS
    ..... @use 0..* cs Binding: TelecommunicationAddressUse (2.0.0) (required)
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Binding: ActStatus (required)
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts 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
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... informant 0..* Informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: LA
    ..... @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 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: CDARoleCode (example)
    ...... addr 0..* AD
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 0..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 1..1 Encounter
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 1..1 cs Binding: CDAActClass (required)
    Fixed Value: ENC
    ...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
    ...... id C 1..* II Constraints: 3250-16914
    ...... code 0..1 CD Binding: ActEncounterCode (example)
    ...... text 0..1 ED
    ...... statusCode 0..1 CS Binding: ActStatus (required)
    ...... effectiveTime 0..1 IVL_TS
    ...... sdtcDischargeDispositionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: dischargeDispositionCode (urn:hl7-org:sdtc)
    ...... priorityCode 0..1 CE Binding: ActPriority (example)
    ...... subject 0..1 Subject
    ...... specimen 0..* Specimen
    ...... performer 0..* Performer2
    ...... author 0..* Author
    ...... informant 0..* Informant
    ...... participant 0..* Participant2
    ...... entryRelationship 0..* EntryRelationship
    ...... reference 0..* Reference
    ...... precondition 0..* Precondition
    ...... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observation 0..1 Observation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..1 II
    ...... code 0..1 CD Binding: FHIRDocumentTypeCodes (example)
    ...... text 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.templateId:note-activity.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.classCoderequiredFixed Value: ACT
    http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
    Act.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
    Act.codeexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    Act.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.code.translationpreferredNoteTypes .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68
    Act.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Act.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Act.text.mediaTypepreferredSupportedFileFormats .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1
    Act.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Act.text.reference.userequiredTelecommunicationAddressUse
    http://terminology.hl7.org/ValueSet/v3-TelecommunicationAddressUse|2.0.0
    Act.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Act.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Act.participant:legalAuthenticator.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.typeCoderequiredFixed Value: LA
    http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
    Act.participant:legalAuthenticator.contextControlCoderequiredFixed Value: OP
    http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
    Act.participant:legalAuthenticator.participantRole.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.classCoderequiredCDARoleClassRoot
    http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
    Act.participant:legalAuthenticator.participantRole.codeexampleCDARoleCode
    http://hl7.org/cda/stds/core/ValueSet/CDARoleCode
    Act.participant:legalAuthenticator.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.playingEntity.classCoderequiredEntityClassRoot
    http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
    Act.participant:legalAuthenticator.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
    http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
    Act.participant:legalAuthenticator.participantRole.playingEntity.codeexampleCDAEntityCode
    http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
    Act.entryRelationship:encounter.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.typeCoderequiredFixed Value: COMP
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Act.entryRelationship:encounter.encounter.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.encounter.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.encounter.classCoderequiredFixed Value: ENC
    http://hl7.org/cda/stds/core/ValueSet/CDAActClass
    Act.entryRelationship:encounter.encounter.moodCoderequiredXDocumentEncounterMood
    http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0
    Act.entryRelationship:encounter.encounter.codeexampleActEncounterCode
    http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
    Act.entryRelationship:encounter.encounter.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.entryRelationship:encounter.encounter.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.reference:externalDocument.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.typeCoderequiredXActRelationshipExternalReference
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
    Act.reference:externalDocument.externalDocument.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.externalDocument.classCoderequiredActClassDocument
    http://terminology.hl7.org/ValueSet/v3-ActClassDocument
    Act.reference:externalDocument.externalDocument.moodCoderequiredFixed Value: EVN
    http://hl7.org/cda/stds/core/ValueSet/CDAActMood
    Act.reference:externalDocument.externalDocument.codeexampleFHIRDocumentTypeCodes
    http://hl7.org/fhir/ValueSet/doc-typecodes
    From the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    3250-16912errorAct.textIf @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
    : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914errorAct.entryRelationship:encounter.encounter.idIf the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
    :
    3250-16930errorAct.participant:legalAuthenticator.participantRoleIf no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    :
    II-1errorAct.typeId, Act.participant:legalAuthenticator.typeId, Act.participant:legalAuthenticator.participantRole.typeId, Act.participant:legalAuthenticator.participantRole.playingEntity.typeId, Act.entryRelationship:encounter.typeId, Act.entryRelationship:encounter.encounter.typeId, Act.reference:externalDocument.typeId, Act.reference:externalDocument.externalDocument.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    should-codewarningAct.reference:externalDocument.externalDocumentSHOULD contain code
    : code.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    should-translationwarningAct.codeSHOULD contain translation
    : translation.exists()
    should-value-attwarningAct.effectiveTimeSHOULD contain @value
    : value.exists()
    value-starts-octothorpeerrorAct.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 Act

    Summary

    Mandatory: 12 elements(8 nested mandatory elements)
    Fixed: 5 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 Act.templateId
    • The element 1 is sliced based on the value of Act.participant
    • The element 1 is sliced based on the value of Act.entryRelationship
    • The element 1 is sliced based on the value of Act.reference

    Differential View

    This structure is derived from Act

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:note-activity 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Fixed Value: ACT
    ... @moodCode 1..1 cs Fixed Value: EVN
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.6.1
    .... translation 0..* CD If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @mediaType 0..1 cs If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... reference C 1..1 TEL Constraints: value-starts-octothorpe
    ..... @nullFlavor 0..0
    ..... @value 1..1 url
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @value 0..1 ts
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @typeCode 1..1 cs Fixed Value: LA
    ..... time 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... playingEntity 0..1 PlayingEntity
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @typeCode 1..1 cs Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... encounter 1..1 Encounter
    ...... id C 1..* II Constraints: 3250-16914
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... id 1..1 II
    ...... code 0..1 CD

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    Act.code.translationpreferredNoteTypes .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68
    Act.text.mediaTypepreferredSupportedFileFormats .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1

    Constraints

    IdGradePath(s)DetailsRequirements
    3250-16912errorAct.textIf @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
    : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914errorAct.entryRelationship:encounter.encounter.idIf the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
    :
    3250-16930errorAct.participant:legalAuthenticator.participantRoleIf no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    :
    should-codewarningAct.reference:externalDocument.externalDocumentSHOULD contain code
    : code.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    should-translationwarningAct.codeSHOULD contain translation
    : translation.exists()
    should-value-attwarningAct.effectiveTimeSHOULD contain @value
    : value.exists()
    value-starts-octothorpeerrorAct.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 & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:note-activity 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: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 0..* II
    ... code C 1..1 CD Binding: v3 Code System ActCode (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid 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 If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @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 If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... @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 1..1 TEL Constraints: value-starts-octothorpe
    ..... @value 1..1 url
    ..... useablePeriod 0..*
    ...... useablePeriod IVL_TS
    ...... useablePeriod EIVL_TS
    ...... useablePeriod PIVL_TS
    ...... useablePeriod SXPR_TS
    ..... @use 0..* cs Binding: TelecommunicationAddressUse (2.0.0) (required)
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Binding: ActStatus (required)
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts 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
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... informant 0..* Informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: LA
    ..... @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 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: CDARoleCode (example)
    ...... addr 0..* AD
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 0..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 1..1 Encounter
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 1..1 cs Binding: CDAActClass (required)
    Fixed Value: ENC
    ...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
    ...... id C 1..* II Constraints: 3250-16914
    ...... code 0..1 CD Binding: ActEncounterCode (example)
    ...... text 0..1 ED
    ...... statusCode 0..1 CS Binding: ActStatus (required)
    ...... effectiveTime 0..1 IVL_TS
    ...... sdtcDischargeDispositionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: dischargeDispositionCode (urn:hl7-org:sdtc)
    ...... priorityCode 0..1 CE Binding: ActPriority (example)
    ...... subject 0..1 Subject
    ...... specimen 0..* Specimen
    ...... performer 0..* Performer2
    ...... author 0..* Author
    ...... informant 0..* Informant
    ...... participant 0..* Participant2
    ...... entryRelationship 0..* EntryRelationship
    ...... reference 0..* Reference
    ...... precondition 0..* Precondition
    ...... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observation 0..1 Observation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..1 II
    ...... code 0..1 CD Binding: FHIRDocumentTypeCodes (example)
    ...... text 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.templateId:note-activity.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.classCoderequiredFixed Value: ACT
    http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
    Act.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
    Act.codeexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    Act.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.code.translationpreferredNoteTypes .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68
    Act.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Act.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Act.text.mediaTypepreferredSupportedFileFormats .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1
    Act.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Act.text.reference.userequiredTelecommunicationAddressUse
    http://terminology.hl7.org/ValueSet/v3-TelecommunicationAddressUse|2.0.0
    Act.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Act.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Act.participant:legalAuthenticator.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.typeCoderequiredFixed Value: LA
    http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
    Act.participant:legalAuthenticator.contextControlCoderequiredFixed Value: OP
    http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
    Act.participant:legalAuthenticator.participantRole.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.classCoderequiredCDARoleClassRoot
    http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
    Act.participant:legalAuthenticator.participantRole.codeexampleCDARoleCode
    http://hl7.org/cda/stds/core/ValueSet/CDARoleCode
    Act.participant:legalAuthenticator.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.playingEntity.classCoderequiredEntityClassRoot
    http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
    Act.participant:legalAuthenticator.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
    http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
    Act.participant:legalAuthenticator.participantRole.playingEntity.codeexampleCDAEntityCode
    http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
    Act.entryRelationship:encounter.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.typeCoderequiredFixed Value: COMP
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Act.entryRelationship:encounter.encounter.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.encounter.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.encounter.classCoderequiredFixed Value: ENC
    http://hl7.org/cda/stds/core/ValueSet/CDAActClass
    Act.entryRelationship:encounter.encounter.moodCoderequiredXDocumentEncounterMood
    http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0
    Act.entryRelationship:encounter.encounter.codeexampleActEncounterCode
    http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
    Act.entryRelationship:encounter.encounter.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.entryRelationship:encounter.encounter.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.reference:externalDocument.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.typeCoderequiredXActRelationshipExternalReference
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
    Act.reference:externalDocument.externalDocument.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.externalDocument.classCoderequiredActClassDocument
    http://terminology.hl7.org/ValueSet/v3-ActClassDocument
    Act.reference:externalDocument.externalDocument.moodCoderequiredFixed Value: EVN
    http://hl7.org/cda/stds/core/ValueSet/CDAActMood
    Act.reference:externalDocument.externalDocument.codeexampleFHIRDocumentTypeCodes
    http://hl7.org/fhir/ValueSet/doc-typecodes
    From the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    3250-16912errorAct.textIf @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
    : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914errorAct.entryRelationship:encounter.encounter.idIf the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
    :
    3250-16930errorAct.participant:legalAuthenticator.participantRoleIf no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    :
    II-1errorAct.typeId, Act.participant:legalAuthenticator.typeId, Act.participant:legalAuthenticator.participantRole.typeId, Act.participant:legalAuthenticator.participantRole.playingEntity.typeId, Act.entryRelationship:encounter.typeId, Act.entryRelationship:encounter.encounter.typeId, Act.reference:externalDocument.typeId, Act.reference:externalDocument.externalDocument.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    should-codewarningAct.reference:externalDocument.externalDocumentSHOULD contain code
    : code.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    should-translationwarningAct.codeSHOULD contain translation
    : translation.exists()
    should-value-attwarningAct.effectiveTimeSHOULD contain @value
    : value.exists()
    value-starts-octothorpeerrorAct.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 & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:note-activity 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: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 0..* II
    ... code C 1..1 CD Binding: v3 Code System ActCode (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid 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 If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @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 If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... @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 1..1 TEL Constraints: value-starts-octothorpe
    ..... @value 1..1 url
    ..... useablePeriod 0..*
    ...... useablePeriod IVL_TS
    ...... useablePeriod EIVL_TS
    ...... useablePeriod PIVL_TS
    ...... useablePeriod SXPR_TS
    ..... @use 0..* cs Binding: TelecommunicationAddressUse (2.0.0) (required)
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Binding: ActStatus (required)
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts 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
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... informant 0..* Informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: LA
    ..... @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 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: CDARoleCode (example)
    ...... addr 0..* AD
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 0..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 1..1 Encounter
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 1..1 cs Binding: CDAActClass (required)
    Fixed Value: ENC
    ...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
    ...... id C 1..* II Constraints: 3250-16914
    ...... code 0..1 CD Binding: ActEncounterCode (example)
    ...... text 0..1 ED
    ...... statusCode 0..1 CS Binding: ActStatus (required)
    ...... effectiveTime 0..1 IVL_TS
    ...... sdtcDischargeDispositionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: dischargeDispositionCode (urn:hl7-org:sdtc)
    ...... priorityCode 0..1 CE Binding: ActPriority (example)
    ...... subject 0..1 Subject
    ...... specimen 0..* Specimen
    ...... performer 0..* Performer2
    ...... author 0..* Author
    ...... informant 0..* Informant
    ...... participant 0..* Participant2
    ...... entryRelationship 0..* EntryRelationship
    ...... reference 0..* Reference
    ...... precondition 0..* Precondition
    ...... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observation 0..1 Observation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..1 II
    ...... code 0..1 CD Binding: FHIRDocumentTypeCodes (example)
    ...... text 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    Act.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.templateId:note-activity.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.classCoderequiredFixed Value: ACT
    http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
    Act.moodCoderequiredFixed Value: EVN
    http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
    Act.codeexampleActCode
    http://terminology.hl7.org/ValueSet/v3-ActCode
    Act.code.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.code.translationpreferredNoteTypes .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68
    Act.text.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.text.compressionrequiredCDACompressionAlgorithm
    http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
    Act.text.integrityCheckAlgorithmrequiredIntegrityCheckAlgorithm
    http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
    Act.text.mediaTypepreferredSupportedFileFormats .
    http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1
    Act.text.representationrequiredBinaryDataEncoding
    http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
    Act.text.reference.userequiredTelecommunicationAddressUse
    http://terminology.hl7.org/ValueSet/v3-TelecommunicationAddressUse|2.0.0
    Act.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.effectiveTime.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.effectiveTime.operatorrequiredCDASetOperator
    http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
    Act.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.languageCoderequiredAllLanguages
    http://hl7.org/fhir/ValueSet/all-languages
    From the FHIR Standard
    Act.participant:legalAuthenticator.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.typeCoderequiredFixed Value: LA
    http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
    Act.participant:legalAuthenticator.contextControlCoderequiredFixed Value: OP
    http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
    Act.participant:legalAuthenticator.participantRole.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.classCoderequiredCDARoleClassRoot
    http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
    Act.participant:legalAuthenticator.participantRole.codeexampleCDARoleCode
    http://hl7.org/cda/stds/core/ValueSet/CDARoleCode
    Act.participant:legalAuthenticator.participantRole.playingEntity.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.playingEntity.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.participant:legalAuthenticator.participantRole.playingEntity.classCoderequiredEntityClassRoot
    http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
    Act.participant:legalAuthenticator.participantRole.playingEntity.determinerCoderequiredFixed Value: INSTANCE
    http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
    Act.participant:legalAuthenticator.participantRole.playingEntity.codeexampleCDAEntityCode
    http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
    Act.entryRelationship:encounter.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.typeCoderequiredFixed Value: COMP
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
    Act.entryRelationship:encounter.encounter.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.encounter.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.entryRelationship:encounter.encounter.classCoderequiredFixed Value: ENC
    http://hl7.org/cda/stds/core/ValueSet/CDAActClass
    Act.entryRelationship:encounter.encounter.moodCoderequiredXDocumentEncounterMood
    http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0
    Act.entryRelationship:encounter.encounter.codeexampleActEncounterCode
    http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
    Act.entryRelationship:encounter.encounter.statusCoderequiredActStatus
    http://terminology.hl7.org/ValueSet/v3-ActStatus
    Act.entryRelationship:encounter.encounter.priorityCodeexampleActPriority
    http://terminology.hl7.org/ValueSet/v3-ActPriority
    Act.reference:externalDocument.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.typeCoderequiredXActRelationshipExternalReference
    http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
    Act.reference:externalDocument.externalDocument.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.externalDocument.typeId.nullFlavorrequiredCDANullFlavor
    http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
    Act.reference:externalDocument.externalDocument.classCoderequiredActClassDocument
    http://terminology.hl7.org/ValueSet/v3-ActClassDocument
    Act.reference:externalDocument.externalDocument.moodCoderequiredFixed Value: EVN
    http://hl7.org/cda/stds/core/ValueSet/CDAActMood
    Act.reference:externalDocument.externalDocument.codeexampleFHIRDocumentTypeCodes
    http://hl7.org/fhir/ValueSet/doc-typecodes
    From the FHIR Standard

    Constraints

    IdGradePath(s)DetailsRequirements
    3250-16912errorAct.textIf @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
    : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914errorAct.entryRelationship:encounter.encounter.idIf the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
    :
    3250-16930errorAct.participant:legalAuthenticator.participantRoleIf no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    :
    II-1errorAct.typeId, Act.participant:legalAuthenticator.typeId, Act.participant:legalAuthenticator.participantRole.typeId, Act.participant:legalAuthenticator.participantRole.playingEntity.typeId, Act.entryRelationship:encounter.typeId, Act.entryRelationship:encounter.encounter.typeId, Act.reference:externalDocument.typeId, Act.reference:externalDocument.externalDocument.typeIdAn II instance must have either a root or an nullFlavor.
    : root.exists() or nullFlavor.exists()
    should-codewarningAct.reference:externalDocument.externalDocumentSHOULD contain code
    : code.exists()
    should-text-ref-valuewarningActSHOULD contain text/reference/@value
    : text.reference.value.exists()
    should-translationwarningAct.codeSHOULD contain translation
    : translation.exists()
    should-value-attwarningAct.effectiveTimeSHOULD contain @value
    : value.exists()
    value-starts-octothorpeerrorAct.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 Act

    Summary

    Mandatory: 12 elements(8 nested mandatory elements)
    Fixed: 5 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 Act.templateId
    • The element 1 is sliced based on the value of Act.participant
    • The element 1 is sliced based on the value of Act.entryRelationship
    • The element 1 is sliced based on the value of Act.reference

     

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