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

Logical Model: PatientReferralAct - Detailed Descriptions

Draft as of 2024-12-19

Definitions for the PatientReferralAct logical model.

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

0. Act
Logical ContainerClinicalDocument (CDA Class)
ValidationInstance of this type are validated by templateId
XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
should-priorityCode: SHOULD contain priorityCode (priorityCode.exists())
should-author: SHOULD contain author (author.exists())
2. Act.templateId
Control1..?
SlicingThis element introduces a set of slices on Act.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ root
  • 4. Act.templateId:patient-referral-act
    Slice Namepatient-referral-act
    Control1..1
    6. Act.templateId:patient-referral-act.root
    Control1..?
    Pattern Value2.16.840.1.113883.10.20.22.4.140
    8. Act.templateId:patient-referral-act.extension
    Control0..0
    10. Act.classCode
    Comments

    SHALL contain exactly one [1..1] @classCode="PCPR" provision of care (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1098-30884).

    Fixed ValuePCPR
    12. Act.moodCode
    Comments

    SHALL contain exactly one [1..1] @moodCode, which SHALL be selected from ValueSet Patient Referral Act moodCode urn:oid:2.16.840.1.113883.11.20.9.66 STATIC 2014-09-01 (CONF:1098-30885).

    BindingThe codes SHALL be taken from Patient Referral Act moodCode .
    (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.66)
    14. Act.id
    ShortIn the case of a Consultation Note where this referral is being fulfilled by this consultation, this id would be referenced in the inFullfilmentOf/order/id of the Consultation Note.
    Comments

    SHALL contain at least one [1..*] id (CONF:1098-30888).

    Control1..?
    16. Act.code
    Comments

    SHALL contain exactly one [1..1] code, which SHALL be selected from ValueSet Referral Types urn:oid:2.16.840.1.113883.11.20.9.56 DYNAMIC (CONF:1098-30889).

    BindingThe codes SHALL be taken from Referral Types .
    (required to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.56)
    18. Act.text
    ShortSHOULD reference the portion of section narrative text corresponding to this entry
    20. Act.text.reference
    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
    22. Act.statusCode
    Comments

    SHALL contain exactly one [1..1] statusCode (CONF:1098-30892).

    Control1..?
    24. Act.statusCode.nullFlavor
    Control0..0
    26. Act.statusCode.code
    Control1..?
    BindingThe codes SHALL be taken from ActStatus
    (required to http://terminology.hl7.org/ValueSet/v3-ActStatus)
    28. Act.effectiveTime
    ShortThe effectiveTime represents the time when the future referral is intended to take place.
    Comments

    SHALL contain exactly one [1..1] effectiveTime (CONF:1098-30893).

    Control1..?
    30. Act.priorityCode
    Comments

    SHOULD contain zero or one [0..1] priorityCode (CONF:1098-32623).

    32. Act.author
    Comments

    SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1098-31612).

    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
    34. Act.participant
    Comments

    MAY contain zero or more [0..*] participant (CONF:1098-32635).

    36. Act.participant.typeCode
    Comments

    The participant, if present, SHALL contain exactly one [1..1] @typeCode. Use REFT to represent the referred-to provider.

    38. Act.participant.participantRole
    Comments

    The participant, if present, SHALL contain exactly one [1..1] participantRole (CONF:1098-32636).

    40. Act.participant.participantRole.code
    Comments

    This participantRole MAY contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1098-32637).

    BindingThe codes SHOULD be taken from Healthcare Provider Taxonomy .
    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
    42. Act.entryRelationship
    ShortThe following entryRelationship represents a reference to another act in the document instance representing the clinical reason for the referral (e.g., problem, concern, procedure).
    SlicingThis element introduces a set of slices on Act.entryRelationship. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • profile @ observation
    • 44. Act.entryRelationship:entryRelationship1
      Slice NameentryRelationship1
      ShortThe following entryRelationship represents whether the referral is for full or shared care.
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:1098-31604) such that it

      Control0..*
      46. Act.entryRelationship:entryRelationship1.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="SUBJ" has subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1098-31613).

      Fixed ValueSUBJ
      48. Act.entryRelationship:entryRelationship1.observation
      Comments

      SHALL contain exactly one [1..1] observation (CONF:1098-31605).

      Control1..?
      Invariantsshould-priorityCode: SHOULD contain priorityCode (priorityCode.exists())
      50. Act.entryRelationship:entryRelationship1.observation.classCode
      Comments

      This observation SHALL contain exactly one [1..1] @classCode="OBS" observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:1098-31606).

      Fixed ValueOBS
      52. Act.entryRelationship:entryRelationship1.observation.moodCode
      Comments

      This observation SHALL contain exactly one [1..1] @moodCode="RQO" request (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001) (CONF:1098-31607).

      Fixed ValueRQO
      54. Act.entryRelationship:entryRelationship1.observation.code
      Comments

      This observation SHALL contain exactly one [1..1] code (CONF:1098-31608).

      56. Act.entryRelationship:entryRelationship1.observation.code.code
      Comments

      This code SHALL contain exactly one [1..1] @code="ASSERTION" assertion (CONF:1098-31619).

      Control1..?
      Pattern ValueASSERTION
      58. Act.entryRelationship:entryRelationship1.observation.code.codeSystem
      Comments

      This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.4 " (CodeSystem: HL7ActCode urn:oid:2.16.840.1.113883.5.4) (CONF:1098-31620).

      Control1..?
      Pattern Value2.16.840.1.113883.5.4
      60. Act.entryRelationship:entryRelationship1.observation.statusCode
      Comments

      This observation SHALL contain exactly one [1..1] statusCode (CONF:1098-31614).

      Control1..?
      62. Act.entryRelationship:entryRelationship1.observation.statusCode.code
      Comments

      This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:1098-31615).

      Control1..?
      Fixed Valuecompleted
      64. Act.entryRelationship:entryRelationship1.observation.priorityCode
      Comments

      This observation SHOULD contain zero or one [0..1] priorityCode, which SHOULD be selected from ValueSet ActPriority urn:oid:2.16.840.1.113883.1.11.16866 DYNAMIC (CONF:1098-32443).

      BindingThe codes SHOULD be taken from ActPriority
      (preferred to http://terminology.hl7.org/ValueSet/v3-ActPriority)
      66. Act.entryRelationship:entryRelationship1.observation.value
      Comments

      This observation SHALL contain exactly one [1..1] value with @xsi:type="CD", where the code SHOULD be selected from ValueSet Care Model urn:oid:2.16.840.1.113883.11.20.9.61 DYNAMIC (CONF:1098-31611).

      Control1..1
      BindingThe codes SHOULD be taken from Care Model .
      (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.61)
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
      68. Act.entryRelationship:indication
      Slice Nameindication
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:1098-31635) such that it

      Control0..*
      70. Act.entryRelationship:indication.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="RSON" has reason (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1098-31636).

      Fixed ValueRSON
      72. Act.entryRelationship:indication.observation
      Comments

      SHALL contain exactly one [1..1] Indication (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.19:2014-06-09) (CONF:1098-32634).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Indication)