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

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

Logical Model: Note Activity

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/NoteActivity Version: 4.0.0
Draft as of 2025-10-02 Computable Name: NoteActivity
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.10.20.22.4.202:2016-11-01

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

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

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

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 3.0.0:

  • New Content
  • Formal Views of Template Content

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

    This structure is derived from Act

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

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Act.code.translation Base preferred Note Types . 📦20240606 VSAC v0.23
    Act.text.mediaType Base preferred SupportedFileFormats . 📦20240606 VSAC v0.23

    Constraints

    Id Grade Path(s) Description Expression
    3250-16912 error Act.text 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.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914 error Act.entryRelationship:encounter.encounter.id 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).
    3250-16930 error Act.participant:legalAuthenticator.participantRole If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    should-code warning Act.reference:externalDocument.externalDocument SHOULD contain code code.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.value.exists()
    should-translation warning Act.code SHOULD contain translation translation.exists()
    should-value-att warning Act.effectiveTime SHOULD contain @value value.exists()
    value-starts-octothorpe error Act.text.reference If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative value.exists() implies value.startsWith('#')
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:note-activity 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 0..* II
    ... code C 1..1 CD Binding: v3 Code System ActCode (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 1..1 TEL Constraints: value-starts-octothorpe
    ..... @value 1..1 url
    ..... useablePeriod 0..*
    ...... useablePeriod IVL_TS
    ...... useablePeriod EIVL_TS
    ...... useablePeriod PIVL_TS
    ...... useablePeriod SXPR_TS
    ..... @use 0..* cs Binding: TelecommunicationAddressUse (2.0.0) (required)
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Binding: ActStatus (required)
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... informant 0..* Informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: LA
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: CDARoleCode (example)
    ...... addr 0..* AD
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 0..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 1..1 Encounter
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 1..1 cs Binding: CDAActClass (required)
    Fixed Value: ENC
    ...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
    ...... id C 1..* II Constraints: 3250-16914
    ...... code 0..1 CD Binding: ActEncounterCode (example)
    ...... text 0..1 ED
    ...... statusCode 0..1 CS Binding: ActStatus (required)
    ...... effectiveTime 0..1 IVL_TS
    ...... sdtcDischargeDispositionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: dischargeDispositionCode (urn:hl7-org:sdtc)
    ...... priorityCode 0..1 CE Binding: ActPriority (example)
    ...... subject 0..1 Subject
    ...... specimen 0..* Specimen
    ...... performer 0..* Performer2
    ...... author 0..* Author
    ...... informant 0..* Informant
    ...... participant 0..* Participant2
    ...... entryRelationship 0..* EntryRelationship
    ...... reference 0..* Reference
    ...... precondition 0..* Precondition
    ...... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observation 0..1 Observation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..1 II
    ...... code 0..1 CD Binding: FHIRDocumentTypeCodes (example)
    ...... text 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Act.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.templateId:note-activity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.classCode Base required x_ActClassDocumentEntryAct 📍2.0.0 THO v5.2
    Act.moodCode Base required x_DocumentActMood 📍2.0.0 THO v5.2
    Act.code Base example v3 Code System ActCode 📦3.0.0 THO v6.5
    Act.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.code.translation Base preferred Note Types . 📦20240606 VSAC v0.23
    Act.text.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Act.text.mediaType Base preferred SupportedFileFormats . 📦20240606 VSAC v0.23
    Act.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.reference.use Base required TelecommunicationAddressUse 📍2.0.0 THO v5.2
    Act.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.effectiveTime.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.effectiveTime.operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.participant:legalAuthenticator.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.code Base example CDARoleCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​code Base example CDAEntityCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.classCode Base required CDAActClass 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.moodCode Base required x_DocumentEncounterMood 📍2.0.0 THO v5.2
    Act.entryRelationship:encounter.​encounter.code Base example ActEncounterCode 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​typeCode Base required x_ActRelationshipExternalReference 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​externalDocument.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.classCode Base required ActClassDocument 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​externalDocument.moodCode Base required CDAActMood 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.code Base example FHIR Document Type Codes 📦5.0.0 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    3250-16912 error Act.text 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.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914 error Act.entryRelationship:encounter.encounter.id 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).
    3250-16930 error Act.participant:legalAuthenticator.participantRole If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    II-1 error Act.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.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-code warning Act.reference:externalDocument.externalDocument SHOULD contain code code.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.value.exists()
    should-translation warning Act.code SHOULD contain translation translation.exists()
    should-value-att warning Act.effectiveTime SHOULD contain @value value.exists()
    value-starts-octothorpe error Act.text.reference If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative value.exists() implies value.startsWith('#')
    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:note-activity 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 0..* II
    ... code C 1..1 CD Binding: v3 Code System ActCode (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 1..1 TEL Constraints: value-starts-octothorpe
    ..... @value 1..1 url
    ..... useablePeriod 0..*
    ...... useablePeriod IVL_TS
    ...... useablePeriod EIVL_TS
    ...... useablePeriod PIVL_TS
    ...... useablePeriod SXPR_TS
    ..... @use 0..* cs Binding: TelecommunicationAddressUse (2.0.0) (required)
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Binding: ActStatus (required)
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... informant 0..* Informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: LA
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: CDARoleCode (example)
    ...... addr 0..* AD
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 0..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 1..1 Encounter
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 1..1 cs Binding: CDAActClass (required)
    Fixed Value: ENC
    ...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
    ...... id C 1..* II Constraints: 3250-16914
    ...... code 0..1 CD Binding: ActEncounterCode (example)
    ...... text 0..1 ED
    ...... statusCode 0..1 CS Binding: ActStatus (required)
    ...... effectiveTime 0..1 IVL_TS
    ...... sdtcDischargeDispositionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: dischargeDispositionCode (urn:hl7-org:sdtc)
    ...... priorityCode 0..1 CE Binding: ActPriority (example)
    ...... subject 0..1 Subject
    ...... specimen 0..* Specimen
    ...... performer 0..* Performer2
    ...... author 0..* Author
    ...... informant 0..* Informant
    ...... participant 0..* Participant2
    ...... entryRelationship 0..* EntryRelationship
    ...... reference 0..* Reference
    ...... precondition 0..* Precondition
    ...... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observation 0..1 Observation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..1 II
    ...... code 0..1 CD Binding: FHIRDocumentTypeCodes (example)
    ...... text 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Act.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.templateId:note-activity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.classCode Base required x_ActClassDocumentEntryAct 📍2.0.0 THO v5.2
    Act.moodCode Base required x_DocumentActMood 📍2.0.0 THO v5.2
    Act.code Base example v3 Code System ActCode 📦3.0.0 THO v6.5
    Act.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.code.translation Base preferred Note Types . 📦20240606 VSAC v0.23
    Act.text.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Act.text.mediaType Base preferred SupportedFileFormats . 📦20240606 VSAC v0.23
    Act.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.reference.use Base required TelecommunicationAddressUse 📍2.0.0 THO v5.2
    Act.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.effectiveTime.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.effectiveTime.operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.participant:legalAuthenticator.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.code Base example CDARoleCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​code Base example CDAEntityCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.classCode Base required CDAActClass 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.moodCode Base required x_DocumentEncounterMood 📍2.0.0 THO v5.2
    Act.entryRelationship:encounter.​encounter.code Base example ActEncounterCode 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​typeCode Base required x_ActRelationshipExternalReference 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​externalDocument.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.classCode Base required ActClassDocument 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​externalDocument.moodCode Base required CDAActMood 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.code Base example FHIR Document Type Codes 📦5.0.0 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    3250-16912 error Act.text 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.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914 error Act.entryRelationship:encounter.encounter.id 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).
    3250-16930 error Act.participant:legalAuthenticator.participantRole If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    II-1 error Act.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.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-code warning Act.reference:externalDocument.externalDocument SHOULD contain code code.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.value.exists()
    should-translation warning Act.code SHOULD contain translation translation.exists()
    should-value-att warning Act.effectiveTime SHOULD contain @value value.exists()
    value-starts-octothorpe error Act.text.reference If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative value.exists() implies value.startsWith('#')

    This structure is derived from Act

    Summary

    Mandatory: 12 elements(8 nested mandatory elements)
    Fixed: 5 elements
    Prohibited: 1 element

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

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

    Differential View

    This structure is derived from Act

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

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Act.code.translation Base preferred Note Types . 📦20240606 VSAC v0.23
    Act.text.mediaType Base preferred SupportedFileFormats . 📦20240606 VSAC v0.23

    Constraints

    Id Grade Path(s) Description Expression
    3250-16912 error Act.text 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.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914 error Act.entryRelationship:encounter.encounter.id 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).
    3250-16930 error Act.participant:legalAuthenticator.participantRole If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    should-code warning Act.reference:externalDocument.externalDocument SHOULD contain code code.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.value.exists()
    should-translation warning Act.code SHOULD contain translation translation.exists()
    should-value-att warning Act.effectiveTime SHOULD contain @value value.exists()
    value-starts-octothorpe error Act.text.reference If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative value.exists() implies value.startsWith('#')

    Key Elements View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:note-activity 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 0..* II
    ... code C 1..1 CD Binding: v3 Code System ActCode (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 1..1 TEL Constraints: value-starts-octothorpe
    ..... @value 1..1 url
    ..... useablePeriod 0..*
    ...... useablePeriod IVL_TS
    ...... useablePeriod EIVL_TS
    ...... useablePeriod PIVL_TS
    ...... useablePeriod SXPR_TS
    ..... @use 0..* cs Binding: TelecommunicationAddressUse (2.0.0) (required)
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Binding: ActStatus (required)
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... informant 0..* Informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: LA
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: CDARoleCode (example)
    ...... addr 0..* AD
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 0..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 1..1 Encounter
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 1..1 cs Binding: CDAActClass (required)
    Fixed Value: ENC
    ...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
    ...... id C 1..* II Constraints: 3250-16914
    ...... code 0..1 CD Binding: ActEncounterCode (example)
    ...... text 0..1 ED
    ...... statusCode 0..1 CS Binding: ActStatus (required)
    ...... effectiveTime 0..1 IVL_TS
    ...... sdtcDischargeDispositionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: dischargeDispositionCode (urn:hl7-org:sdtc)
    ...... priorityCode 0..1 CE Binding: ActPriority (example)
    ...... subject 0..1 Subject
    ...... specimen 0..* Specimen
    ...... performer 0..* Performer2
    ...... author 0..* Author
    ...... informant 0..* Informant
    ...... participant 0..* Participant2
    ...... entryRelationship 0..* EntryRelationship
    ...... reference 0..* Reference
    ...... precondition 0..* Precondition
    ...... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observation 0..1 Observation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..1 II
    ...... code 0..1 CD Binding: FHIRDocumentTypeCodes (example)
    ...... text 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Act.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.templateId:note-activity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.classCode Base required x_ActClassDocumentEntryAct 📍2.0.0 THO v5.2
    Act.moodCode Base required x_DocumentActMood 📍2.0.0 THO v5.2
    Act.code Base example v3 Code System ActCode 📦3.0.0 THO v6.5
    Act.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.code.translation Base preferred Note Types . 📦20240606 VSAC v0.23
    Act.text.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Act.text.mediaType Base preferred SupportedFileFormats . 📦20240606 VSAC v0.23
    Act.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.reference.use Base required TelecommunicationAddressUse 📍2.0.0 THO v5.2
    Act.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.effectiveTime.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.effectiveTime.operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.participant:legalAuthenticator.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.code Base example CDARoleCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​code Base example CDAEntityCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.classCode Base required CDAActClass 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.moodCode Base required x_DocumentEncounterMood 📍2.0.0 THO v5.2
    Act.entryRelationship:encounter.​encounter.code Base example ActEncounterCode 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​typeCode Base required x_ActRelationshipExternalReference 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​externalDocument.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.classCode Base required ActClassDocument 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​externalDocument.moodCode Base required CDAActMood 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.code Base example FHIR Document Type Codes 📦5.0.0 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    3250-16912 error Act.text 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.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914 error Act.entryRelationship:encounter.encounter.id 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).
    3250-16930 error Act.participant:legalAuthenticator.participantRole If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    II-1 error Act.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.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-code warning Act.reference:externalDocument.externalDocument SHOULD contain code code.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.value.exists()
    should-translation warning Act.code SHOULD contain translation translation.exists()
    should-value-att warning Act.effectiveTime SHOULD contain @value value.exists()
    value-starts-octothorpe error Act.text.reference If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative value.exists() implies value.startsWith('#')

    Snapshot View

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Act C 1..1 Act XML Namespace: urn:hl7-org:v3
    Base for all types and resources
    Instance of this type are validated by templateId
    Logical Container: ClinicalDocument (CDA Class)
    Constraints: should-text-ref-value
    ... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ... realmCode 0..* CS
    ... typeId C 0..1 II Constraints: II-1
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @assigningAuthorityName 0..1 st
    .... @displayable 0..1 bl
    .... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    .... @extension 1..1 st
    .... templateId:note-activity 1..1 II
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... @assigningAuthorityName 0..1 st
    ..... @displayable 0..1 bl
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.202
    ..... @extension 1..1 st Required Pattern: 2016-11-01
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: ACT
    ... @moodCode 1..1 cs Binding: XDocumentActMood (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 0..* II
    ... code C 1..1 CD Binding: v3 Code System ActCode (example)
    Constraints: should-translation
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 34109-9
    .... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942).
    Binding: Note Types . (preferred)
    ... text C 1..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    Constraints: 3250-16912
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @compression 0..1 cs Binding: CDACompressionAlgorithm (required)
    .... @integrityCheck 0..1 bin
    .... @integrityCheckAlgorithm 0..1 cs Binding: IntegrityCheckAlgorithm (2.0.0) (required)
    .... @language 0..1 cs
    .... @mediaType 0..1 cs If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative.
    Binding: SupportedFileFormats . (preferred)
    .... @representation 0..1 cs Binding: CDABinaryDataEncoding (required)
    .... xmlText 0..1 st Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
    .... reference C 1..1 TEL Constraints: value-starts-octothorpe
    ..... @value 1..1 url
    ..... useablePeriod 0..*
    ...... useablePeriod IVL_TS
    ...... useablePeriod EIVL_TS
    ...... useablePeriod PIVL_TS
    ...... useablePeriod SXPR_TS
    ..... @use 0..* cs Binding: TelecommunicationAddressUse (2.0.0) (required)
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
    Binding: ActStatus (required)
    ... effectiveTime C 1..1 IVL_TS The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time.
    Constraints: should-value-att
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... subject 0..1 Subject
    ... specimen 0..* Specimen
    ... performer 0..* Performer2
    ... author 1..* AuthorParticipation Represents the person(s) who wrote the note.
    ... informant 0..* Informant
    ... Slices for participant 0..* Participant2 Slice: Unordered, Open by value:typeCode
    .... participant:legalAuthenticator 0..* Participant2 Represents the person(s) legally responsible for the contents of the note.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: CDAParticipationType (required)
    Fixed Value: LA
    ..... @contextControlCode 0..1 cs Binding: CDAContextControl (required)
    Fixed Value: OP
    ..... sdtcFunctionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: functionCode (urn:hl7-org:sdtc)
    ..... time 1..1 USRealmDateTimeInterval Indicates the time of signing the note.
    ..... awarenessCode 0..1 CE
    ..... participantRole C 1..1 ParticipantRole Constraints: 3250-16930
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: CDARoleClassRoot (required)
    ...... id 1..* II This may be the ID of the note author. If so, no additional information in this participant is required.
    ...... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ...... code 0..1 CE Binding: CDARoleCode (example)
    ...... addr 0..* AD
    ...... telecom 0..* TEL
    ...... playingDevice 0..1 Device
    ...... playingEntity 0..1 PlayingEntity
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... realmCode 0..* CS
    ....... typeId C 0..1 II Constraints: II-1
    ........ @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ........ @assigningAuthorityName 0..1 st
    ........ @displayable 0..1 bl
    ........ @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ........ @extension 1..1 st
    ....... templateId 0..* II
    ....... @classCode 0..1 cs Binding: EntityClassRoot (required)
    ....... @determinerCode 0..1 cs Binding: EntityDeterminer (required)
    Fixed Value: INSTANCE
    ....... code 0..1 CE Binding: CDAEntityCode (example)
    ....... quantity 0..* PQ
    ....... name 1..* USRealmPersonNamePNUSFIELDED
    ....... sdtcBirthTime 0..1 TS XML Namespace: urn:hl7-org:sdtc
    XML: birthTime (urn:hl7-org:sdtc)
    ....... desc 0..1 ED
    ...... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship Slice: Unordered, Open by exists:encounter
    .... entryRelationship:encounter 0..* EntryRelationship Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipEntryRelationship (required)
    Fixed Value: COMP
    ..... @inversionInd 1..1 bl Fixed Value: true
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 1..1 Encounter
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 1..1 cs Binding: CDAActClass (required)
    Fixed Value: ENC
    ...... @moodCode 1..1 cs Binding: XDocumentEncounterMood (2.0.0) (required)
    ...... id C 1..* II Constraints: 3250-16914
    ...... code 0..1 CD Binding: ActEncounterCode (example)
    ...... text 0..1 ED
    ...... statusCode 0..1 CS Binding: ActStatus (required)
    ...... effectiveTime 0..1 IVL_TS
    ...... sdtcDischargeDispositionCode 0..1 CE XML Namespace: urn:hl7-org:sdtc
    XML: dischargeDispositionCode (urn:hl7-org:sdtc)
    ...... priorityCode 0..1 CE Binding: ActPriority (example)
    ...... subject 0..1 Subject
    ...... specimen 0..* Specimen
    ...... performer 0..* Performer2
    ...... author 0..* Author
    ...... informant 0..* Informant
    ...... participant 0..* Participant2
    ...... entryRelationship 0..* EntryRelationship
    ...... reference 0..* Reference
    ...... precondition 0..* Precondition
    ...... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observation 0..1 Observation
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... Slices for reference 0..* Reference Slice: Unordered, Open by exists:externalDocument
    .... reference:externalDocument 0..* Reference Represents an unstructured C-CDA document containing the original contents of the note in the original format.
    ..... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ..... realmCode 0..* CS
    ..... typeId C 0..1 II Constraints: II-1
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... @assigningAuthorityName 0..1 st
    ...... @displayable 0..1 bl
    ...... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ...... @extension 1..1 st
    ..... templateId 0..* II
    ..... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
    ..... seperatableInd 0..1 BL
    ..... externalAct 0..1 ExternalAct
    ..... externalObservation 0..1 ExternalObservation
    ..... externalProcedure 0..1 ExternalProcedure
    ..... externalDocument C 1..1 ExternalDocument Constraints: should-code
    ...... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ...... realmCode 0..* CS
    ...... typeId C 0..1 II Constraints: II-1
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @assigningAuthorityName 0..1 st
    ....... @displayable 0..1 bl
    ....... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
    ....... @extension 1..1 st
    ...... templateId 0..* II
    ...... @classCode 0..1 cs Binding: ActClassDocument (required)
    ...... @moodCode 0..1 cs Binding: CDAActMood (required)
    Fixed Value: EVN
    ...... id 1..1 II
    ...... code 0..1 CD Binding: FHIRDocumentTypeCodes (example)
    ...... text 0..1 ED
    ...... setId 0..1 II
    ...... versionNumber 0..1 INT
    ...... sdtcAuthor 0..* Author XML Namespace: urn:hl7-org:sdtc
    XML: author (urn:hl7-org:sdtc)
    ... precondition 0..* Precondition
    ... sdtcPrecondition2 0..* Precondition2 XML Namespace: urn:hl7-org:sdtc
    XML: precondition2 (urn:hl7-org:sdtc)
    ... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Act.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.templateId:note-activity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.classCode Base required x_ActClassDocumentEntryAct 📍2.0.0 THO v5.2
    Act.moodCode Base required x_DocumentActMood 📍2.0.0 THO v5.2
    Act.code Base example v3 Code System ActCode 📦3.0.0 THO v6.5
    Act.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.code.translation Base preferred Note Types . 📦20240606 VSAC v0.23
    Act.text.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.compression Base required CDACompressionAlgorithm 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Act.text.mediaType Base preferred SupportedFileFormats . 📦20240606 VSAC v0.23
    Act.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.text.reference.use Base required TelecommunicationAddressUse 📍2.0.0 THO v5.2
    Act.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.effectiveTime.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.effectiveTime.operator Base required CDASetOperator 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.participant:legalAuthenticator.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.code Base example CDARoleCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​classCode Base required EntityClassRoot 📦3.0.0 THO v6.5
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​determinerCode Base required EntityDeterminer 📦3.0.0 THO v6.5
    Act.participant:legalAuthenticator.​participantRole.playingEntity.​code Base example CDAEntityCode 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.classCode Base required CDAActClass 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:encounter.​encounter.moodCode Base required x_DocumentEncounterMood 📍2.0.0 THO v5.2
    Act.entryRelationship:encounter.​encounter.code Base example ActEncounterCode 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.entryRelationship:encounter.​encounter.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​typeCode Base required x_ActRelationshipExternalReference 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​externalDocument.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.classCode Base required ActClassDocument 📦3.0.0 THO v6.5
    Act.reference:externalDocument.​externalDocument.moodCode Base required CDAActMood 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.reference:externalDocument.​externalDocument.code Base example FHIR Document Type Codes 📦5.0.0 FHIR Std.

    Constraints

    Id Grade Path(s) Description Expression
    3250-16912 error Act.text 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.exists() implies (representation = 'B64' and xmlText.exists())
    3250-16914 error Act.entryRelationship:encounter.encounter.id 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).
    3250-16930 error Act.participant:legalAuthenticator.participantRole If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
    II-1 error Act.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.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-code warning Act.reference:externalDocument.externalDocument SHOULD contain code code.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.value.exists()
    should-translation warning Act.code SHOULD contain translation translation.exists()
    should-value-att warning Act.effectiveTime SHOULD contain @value value.exists()
    value-starts-octothorpe error Act.text.reference If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative value.exists() implies value.startsWith('#')

    This structure is derived from 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