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

Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (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-ballot
Draft as of 2024-12-19 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)

Usage:

Formal Views of Template Content

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

This structure is derived from Act

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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)
should-text-ref-value: SHOULD contain text/reference/@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
3250-16912: If @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 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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
..... @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.
should-value-att: SHOULD contain @value
.... @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 3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF: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 Base for all types and resources
... 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 3250-16914: If 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).
... 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 should-code: SHOULD contain 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 & Constraintsdoco
.. 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)
should-text-ref-value: SHOULD contain text/reference/@value
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @assigningAuthorityName 0..1 st
.... @displayable 0..1 bl
.... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1 st
.... templateId: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)
should-translation: SHOULD contain 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
3250-16912: If @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).
.... @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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
..... @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.
should-value-att: SHOULD contain @value
.... @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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: 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 C 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
ivl-ts-center: Center cannot co-exist with low or high
ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day.
ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component.
..... awarenessCode 0..1 CE
..... participantRole C 1..1 ParticipantRole 3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
...... id 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 II-1: An II instance must have either a root or an nullFlavor.
........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
........ @assigningAuthorityName 0..1 st
........ @displayable 0..1 bl
........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
........ @extension 1..1 st
....... templateId 0..* II
....... @classCode 0..1 cs Binding: EntityClassRoot (required)
....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
Fixed Value: INSTANCE
....... code 0..1 CE Binding: CDAEntityCode (example)
....... quantity 0..* PQ
....... name C 1..* USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
XML: birthTime (urn:hl7-org:sdtc)
....... desc 0..1 ED
...... scopingEntity 0..1 Entity
... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: x_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 II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 1..1 cs Binding: CDAActClass (required)
Fixed Value: ENC
...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
...... id C 1..* II 3250-16914: If 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).
...... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
..... seperatableInd 0..1 BL
..... externalAct 0..1 ExternalAct
..... externalObservation 0..1 ExternalObservation
..... externalProcedure 0..1 ExternalProcedure
..... externalDocument C 1..1 ExternalDocument should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 0..1 cs Binding: 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).
:
81-9371errorAct.participant:legalAuthenticator.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorAct.participant:legalAuthenticator.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
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()
ivl-ts-centererrorAct.participant:legalAuthenticator.timeCenter cannot co-exist with low or high
: center.empty() or (low.empty() and high.empty())
ivl-value-shallerrorAct.participant:legalAuthenticator.timeIf a time interval contains @value, then it shall be precise to at least the day.
: value.exists() implies value.toString().length() >= 10
ivl-value-shouldwarningAct.participant:legalAuthenticator.timeIf a time interval contains @value, then it SHOULD contain a time component.
: value.exists() implies value.toString().length() > 10
pn-no-lserrorAct.participant:legalAuthenticator.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
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 & Constraintsdoco
.. 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)
should-text-ref-value: SHOULD contain text/reference/@value
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @assigningAuthorityName 0..1 st
.... @displayable 0..1 bl
.... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1 st
.... templateId: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)
should-translation: SHOULD contain 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
3250-16912: If @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).
.... @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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
..... @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.
should-value-att: SHOULD contain @value
.... @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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: 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 C 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
ivl-ts-center: Center cannot co-exist with low or high
ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day.
ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component.
..... awarenessCode 0..1 CE
..... participantRole C 1..1 ParticipantRole 3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
...... id 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 II-1: An II instance must have either a root or an nullFlavor.
........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
........ @assigningAuthorityName 0..1 st
........ @displayable 0..1 bl
........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
........ @extension 1..1 st
....... templateId 0..* II
....... @classCode 0..1 cs Binding: EntityClassRoot (required)
....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
Fixed Value: INSTANCE
....... code 0..1 CE Binding: CDAEntityCode (example)
....... quantity 0..* PQ
....... name C 1..* USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
XML: birthTime (urn:hl7-org:sdtc)
....... desc 0..1 ED
...... scopingEntity 0..1 Entity
... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: x_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 II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 1..1 cs Binding: CDAActClass (required)
Fixed Value: ENC
...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
...... id C 1..* II 3250-16914: If 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).
...... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
..... seperatableInd 0..1 BL
..... externalAct 0..1 ExternalAct
..... externalObservation 0..1 ExternalObservation
..... externalProcedure 0..1 ExternalProcedure
..... externalDocument C 1..1 ExternalDocument should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 0..1 cs Binding: 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).
:
81-9371errorAct.participant:legalAuthenticator.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorAct.participant:legalAuthenticator.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
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()
ivl-ts-centererrorAct.participant:legalAuthenticator.timeCenter cannot co-exist with low or high
: center.empty() or (low.empty() and high.empty())
ivl-value-shallerrorAct.participant:legalAuthenticator.timeIf a time interval contains @value, then it shall be precise to at least the day.
: value.exists() implies value.toString().length() >= 10
ivl-value-shouldwarningAct.participant:legalAuthenticator.timeIf a time interval contains @value, then it SHOULD contain a time component.
: value.exists() implies value.toString().length() > 10
pn-no-lserrorAct.participant:legalAuthenticator.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
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 & Constraintsdoco
.. 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)
should-text-ref-value: SHOULD contain text/reference/@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
3250-16912: If @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 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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
..... @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.
should-value-att: SHOULD contain @value
.... @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 3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF: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 Base for all types and resources
... 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 3250-16914: If 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).
... 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 should-code: SHOULD contain 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 & Constraintsdoco
.. 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)
should-text-ref-value: SHOULD contain text/reference/@value
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @assigningAuthorityName 0..1 st
.... @displayable 0..1 bl
.... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1 st
.... templateId: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)
should-translation: SHOULD contain 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
3250-16912: If @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).
.... @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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
..... @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.
should-value-att: SHOULD contain @value
.... @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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: 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 C 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
ivl-ts-center: Center cannot co-exist with low or high
ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day.
ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component.
..... awarenessCode 0..1 CE
..... participantRole C 1..1 ParticipantRole 3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
...... id 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 II-1: An II instance must have either a root or an nullFlavor.
........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
........ @assigningAuthorityName 0..1 st
........ @displayable 0..1 bl
........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
........ @extension 1..1 st
....... templateId 0..* II
....... @classCode 0..1 cs Binding: EntityClassRoot (required)
....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
Fixed Value: INSTANCE
....... code 0..1 CE Binding: CDAEntityCode (example)
....... quantity 0..* PQ
....... name C 1..* USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
XML: birthTime (urn:hl7-org:sdtc)
....... desc 0..1 ED
...... scopingEntity 0..1 Entity
... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: x_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 II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 1..1 cs Binding: CDAActClass (required)
Fixed Value: ENC
...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
...... id C 1..* II 3250-16914: If 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).
...... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
..... seperatableInd 0..1 BL
..... externalAct 0..1 ExternalAct
..... externalObservation 0..1 ExternalObservation
..... externalProcedure 0..1 ExternalProcedure
..... externalDocument C 1..1 ExternalDocument should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 0..1 cs Binding: 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).
:
81-9371errorAct.participant:legalAuthenticator.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorAct.participant:legalAuthenticator.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
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()
ivl-ts-centererrorAct.participant:legalAuthenticator.timeCenter cannot co-exist with low or high
: center.empty() or (low.empty() and high.empty())
ivl-value-shallerrorAct.participant:legalAuthenticator.timeIf a time interval contains @value, then it shall be precise to at least the day.
: value.exists() implies value.toString().length() >= 10
ivl-value-shouldwarningAct.participant:legalAuthenticator.timeIf a time interval contains @value, then it SHOULD contain a time component.
: value.exists() implies value.toString().length() > 10
pn-no-lserrorAct.participant:legalAuthenticator.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
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 & Constraintsdoco
.. 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)
should-text-ref-value: SHOULD contain text/reference/@value
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @assigningAuthorityName 0..1 st
.... @displayable 0..1 bl
.... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1 st
.... templateId: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)
should-translation: SHOULD contain 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
3250-16912: If @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).
.... @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 value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
..... @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.
should-value-att: SHOULD contain @value
.... @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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
Fixed Value: 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 C 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
ivl-ts-center: Center cannot co-exist with low or high
ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day.
ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component.
..... awarenessCode 0..1 CE
..... participantRole C 1..1 ParticipantRole 3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
...... id 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 II-1: An II instance must have either a root or an nullFlavor.
........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
........ @assigningAuthorityName 0..1 st
........ @displayable 0..1 bl
........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
........ @extension 1..1 st
....... templateId 0..* II
....... @classCode 0..1 cs Binding: EntityClassRoot (required)
....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
Fixed Value: INSTANCE
....... code 0..1 CE Binding: CDAEntityCode (example)
....... quantity 0..* PQ
....... name C 1..* USRealmPersonNamePNUSFIELDED Base for all types and resources
pn-no-ls: No PN name part may have a qualifier of LS.
81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
XML: birthTime (urn:hl7-org:sdtc)
....... desc 0..1 ED
...... scopingEntity 0..1 Entity
... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: x_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 II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 1..1 cs Binding: CDAActClass (required)
Fixed Value: ENC
...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
...... id C 1..* II 3250-16914: If 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).
...... 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 II-1: An II instance must have either a root or an nullFlavor.
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... @assigningAuthorityName 0..1 st
...... @displayable 0..1 bl
...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
...... @extension 1..1 st
..... templateId 0..* II
..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
..... seperatableInd 0..1 BL
..... externalAct 0..1 ExternalAct
..... externalObservation 0..1 ExternalObservation
..... externalProcedure 0..1 ExternalProcedure
..... externalDocument C 1..1 ExternalDocument should-code: SHOULD contain code
...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
...... realmCode 0..* CS
...... typeId C 0..1 II II-1: An II instance must have either a root or an nullFlavor.
....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
....... @assigningAuthorityName 0..1 st
....... @displayable 0..1 bl
....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
....... @extension 1..1 st
...... templateId 0..* II
...... @classCode 0..1 cs Binding: 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).
:
81-9371errorAct.participant:legalAuthenticator.participantRole.playingEntity.nameThe content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371).
: conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372errorAct.participant:legalAuthenticator.participantRole.playingEntity.nameThe string **SHALL NOT** contain name parts (CONF:81-9372).
: item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
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()
ivl-ts-centererrorAct.participant:legalAuthenticator.timeCenter cannot co-exist with low or high
: center.empty() or (low.empty() and high.empty())
ivl-value-shallerrorAct.participant:legalAuthenticator.timeIf a time interval contains @value, then it shall be precise to at least the day.
: value.exists() implies value.toString().length() >= 10
ivl-value-shouldwarningAct.participant:legalAuthenticator.timeIf a time interval contains @value, then it SHOULD contain a time component.
: value.exists() implies value.toString().length() > 10
pn-no-lserrorAct.participant:legalAuthenticator.participantRole.playingEntity.nameNo PN name part may have a qualifier of LS.
: (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
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

 

Other representations of profile: CSV, Excel