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: ProblemConcernAct - Detailed Descriptions

Draft as of 2024-12-19

Definitions for the ProblemConcernAct logical model.

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

0. Act
Logical ContainerClinicalDocument (CDA Class)
ValidationInstance of this type are validated by templateId
XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
should-author: SHOULD contain author (author.exists())
2. Act.templateId
Control1..?
SlicingThis element introduces a set of slices on Act.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ root
  • value @ extension
  • 4. Act.templateId:problem-concern-act
    Slice Nameproblem-concern-act
    Control1..1
    6. Act.templateId:problem-concern-act.root
    Control1..?
    Pattern Value2.16.840.1.113883.10.20.22.4.3
    8. Act.templateId:problem-concern-act.extension
    Control1..?
    Pattern Value2024-05-01
    10. Act.classCode
    Comments

    SHALL contain exactly one [1..1] @classCode="ACT" Act (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-9024).

    Fixed ValueACT
    12. Act.moodCode
    Comments

    SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-9025).

    Fixed ValueEVN
    14. Act.id
    Comments

    SHALL contain at least one [1..*] id (CONF:1198-9026).

    Control1..?
    16. Act.code
    Comments

    SHALL contain exactly one [1..1] code (CONF:1198-9027).

    18. Act.code.code
    Comments

    This code SHALL contain exactly one [1..1] @code="CONC" Concern (CONF:1198-19184).

    Control1..?
    Pattern ValueCONC
    20. Act.code.codeSystem
    Comments

    This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.5.6" (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:1198-32168).

    Control1..?
    Pattern Value2.16.840.1.113883.5.6
    22. Act.text
    ShortSHOULD reference the portion of section narrative text corresponding to this entry
    24. Act.text.reference
    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
    26. Act.statusCode
    ShortThe statusCode of the Problem Concern Act is the definitive indication of the status of the concern, whereas the effectiveTime of the nested Problem Observation is the definitive indication of whether or not the underlying condition is resolved.
    Comments

    SHALL contain exactly one [1..1] statusCode (CONF:1198-9029).

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

    SHALL contain exactly one [1..1] effectiveTime (CONF:1198-9030).

    Control1..?
    34. Act.effectiveTime.low
    ShortThe effectiveTime/low of the Problem Concern Act asserts when the concern became active.
    Comments

    This effectiveTime SHALL contain exactly one [1..1] low (CONF:1198-9032).

    Control1..?
    36. Act.effectiveTime.high
    ShortThe effectiveTime/high asserts when the concern was completed (e.g., when the clinician deemed there is no longer any need to track the underlying condition).
    Comments

    This effectiveTime MAY contain zero or one [0..1] high (CONF:1198-9033).

    38. 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:1198-31146).

    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
    40. Act.entryRelationship
    ShortThe following entryRelationship represents the importance of the concern to a provider.
    Control1..?
    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
    • 42. Act.entryRelationship:problem
      Slice Nameproblem
      Comments

      SHALL contain exactly one [1..1] entryRelationship (CONF:1198-9034) such that it

      Control1..1
      44. Act.entryRelationship:problem.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="SUBJ" Has subject (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-9035).

      Fixed ValueSUBJ
      46. Act.entryRelationship:problem.observation
      Comments

      SHALL contain exactly one [1..1] Problem Observation (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.4:2015-08-01) (CONF:1198-15980).

      Control1..?
      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Observation(Problem Observation)
      48. Act.entryRelationship:priority
      Slice Namepriority
      Comments

      MAY contain zero or more [0..*] entryRelationship (CONF:1198-31638) such that it

      Control0..*
      50. Act.entryRelationship:priority.typeCode
      Comments

      SHALL contain exactly one [1..1] @typeCode="REFR" refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002) (CONF:1198-31639).

      Fixed ValueREFR
      52. Act.entryRelationship:priority.observation
      Comments

      SHALL contain exactly one [1..1] Priority Preference (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.143) (CONF:1198-31640).

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