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: Referral Act

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/ReferralAct Version: 4.0.0
Draft as of 2025-10-02 Computable Name: ReferralAct
Other Identifiers: OID:2.16.840.1.113883.10.20.22.4.140

This template represents the type of referral (e.g., for dental care, to a specialist, for aging problems) and represents whether the referral is for full care or shared care. It may contain a reference to another act in the document instance representing the clinical reason for the referral (e.g., problem, concern, procedure).

Templates Used

Although open templates may contain any valid CDA content, the following templates are specifically called out by this template:

Optional EntryRelationships: Indication

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, should-priorityCode, should-author
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root
    .... templateId:referral-act 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.140
    ..... @extension 0..0
    ... @classCode 1..1 cs Fixed Value: PCPR
    ... @moodCode 1..1 cs Binding: Patient Referral Act moodCode . (required)
    ... code 1..1 CD Binding: Referral Types . (required)
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS
    .... @nullFlavor 0..0
    .... @code 1..1 cs Binding: ActStatus (required)
    ... effectiveTime 1..1 IVL_TS The effectiveTime represents the time when the future referral is intended to take place.
    ... priorityCode 0..1 CE
    ... author 0..* AuthorParticipation
    ... participant 0..* Participant2
    .... @typeCode 1..1 cs
    .... participantRole 1..1 ParticipantRole
    ..... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ... Slices for entryRelationship 0..* EntryRelationship The following entryRelationship represents a reference to another act in the document instance representing the clinical reason for the referral (e.g., problem, concern, procedure).
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:careModel 0..* EntryRelationship The following entryRelationship represents whether the referral is for full or shared care.
    ..... @typeCode 1..1 cs Fixed Value: SUBJ
    ..... observation C 1..1 Observation Constraints: should-priorityCode
    ...... @classCode 1..1 cs Fixed Value: OBS
    ...... @moodCode 1..1 cs Fixed Value: RQO
    ...... code 1..1 CD
    ....... @code 1..1 cs Required Pattern: ASSERTION
    ....... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.4
    ...... statusCode 1..1 CS
    ....... @code 1..1 cs Fixed Value: completed
    ...... priorityCode 0..1 CE Binding: ActPriority (preferred)
    ...... value 1..1 CD Binding: Care Model . (preferred)
    .... entryRelationship:indication 0..* EntryRelationship
    ..... @typeCode 1..1 cs Fixed Value: RSON
    ..... observation 1..1 Indication

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Act.moodCode Base required Patient Referral Act moodCode . 📦20240606 VSAC v0.23
    Act.code Base required Referral Types . 📦20240606 VSAC v0.23
    Act.statusCode.code Base required ActStatus 📦3.0.0 THO v6.5
    Act.participant.participantRole.​code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​observation.priorityCode Base preferred ActPriority 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.value Base preferred Care Model . 📦20240606 VSAC v0.23

    Constraints

    Id Grade Path(s) Description Expression
    should-author warning Act SHOULD contain author author.exists()
    should-priorityCode warning Act, Act.entryRelationship:careModel.observation SHOULD contain priorityCode priorityCode.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.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, should-priorityCode, should-author
    ... @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:referral-act 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: 2.16.840.1.113883.10.20.22.4.140
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: PCPR
    ... @moodCode 1..1 cs Binding: Patient Referral Act moodCode . (required)
    ... @negationInd 0..1 bl
    ... id 1..* II In 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.
    ... code 1..1 CD Binding: Referral Types . (required)
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @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 Binding: MediaType (example)
    .... @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 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @code 1..1 cs Binding: ActStatus (required)
    .... @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)
    ... effectiveTime 1..1 IVL_TS The effectiveTime represents the time when the future referral is intended to take place.
    ... 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 0..* AuthorParticipation
    ... informant 0..* Informant
    ... participant 0..* Participant2
    .... @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)
    .... @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 0..1 IVL_TS
    .... awarenessCode 0..1 CE
    .... participantRole 1..1 ParticipantRole
    ..... @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 0..* II
    ..... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ..... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ..... addr 0..* AD
    ..... telecom 0..* TEL
    ..... playingDevice 0..1 Device
    ..... playingEntity 0..1 PlayingEntity
    ..... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship The following entryRelationship represents a reference to another act in the document instance representing the clinical reason for the referral (e.g., problem, concern, procedure).
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:careModel 0..* EntryRelationship The following entryRelationship represents whether the referral is for full or shared care.
    ..... @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: SUBJ
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation C 1..1 Observation Constraints: should-priorityCode
    ...... @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: CDAActClassObservation (required)
    Fixed Value: OBS
    ...... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: RQO
    ...... @negationInd 0..1 bl
    ...... id 0..* II
    ...... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ...... code 1..1 CD Binding: ObservationType (example)
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @code 1..1 cs Required Pattern: ASSERTION
    ....... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.4
    ....... @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
    ...... derivationExpr 0..1 ST
    ...... text 0..1 ED
    ...... statusCode 1..1 CS Binding: ActStatus (required)
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @code 1..1 cs Fixed Value: completed
    ....... @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)
    ...... effectiveTime 0..1 IVL_TS
    ...... priorityCode 0..1 CE Binding: ActPriority (preferred)
    ...... repeatNumber 0..1 IVL_INT
    ...... languageCode 0..1 CS Binding: AllLanguages (required)
    ...... value 1..1 CD Binding: Care Model . (preferred)
    ...... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
    ...... methodCode 0..* CE Binding: ObservationMethod (example)
    ...... targetSiteCode 0..* CD
    ...... 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)
    ...... referenceRange 0..* InfrastructureRoot
    ....... @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 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    ....... observationRange 1..1 ObservationRange
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    .... entryRelationship:indication 0..* EntryRelationship
    ..... @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: RSON
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 Indication
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... 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)

    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:referral-act.​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 Patient Referral Act moodCode . 📦20240606 VSAC v0.23
    Act.code Base required Referral 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 example MediaType 📦3.0.0 THO v6.5
    Act.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.statusCode.code Base required ActStatus 📦3.0.0 THO v6.5
    Act.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.participant.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.classCode Base required CDAActClassObservation 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Act.entryRelationship:careModel.​observation.code Base example ObservationType 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.priorityCode Base preferred ActPriority 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.entryRelationship:careModel.​observation.value Base preferred Care Model . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.methodCode Base example ObservationMethod 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5

    Constraints

    Id Grade Path(s) Description Expression
    II-1 error Act.typeId, Act.participant.typeId, Act.participant.participantRole.typeId, Act.entryRelationship:careModel.typeId, Act.entryRelationship:careModel.observation.typeId, Act.entryRelationship:careModel.observation.referenceRange.typeId, Act.entryRelationship:indication.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-author warning Act SHOULD contain author author.exists()
    should-priorityCode warning Act, Act.entryRelationship:careModel.observation SHOULD contain priorityCode priorityCode.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.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, should-priorityCode, should-author
    ... @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:referral-act 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: 2.16.840.1.113883.10.20.22.4.140
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: PCPR
    ... @moodCode 1..1 cs Binding: Patient Referral Act moodCode . (required)
    ... @negationInd 0..1 bl
    ... id 1..* II In 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.
    ... code 1..1 CD Binding: Referral Types . (required)
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @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 Binding: MediaType (example)
    .... @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 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @code 1..1 cs Binding: ActStatus (required)
    .... @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)
    ... effectiveTime 1..1 IVL_TS The effectiveTime represents the time when the future referral is intended to take place.
    ... 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 0..* AuthorParticipation
    ... informant 0..* Informant
    ... participant 0..* Participant2
    .... @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)
    .... @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 0..1 IVL_TS
    .... awarenessCode 0..1 CE
    .... participantRole 1..1 ParticipantRole
    ..... @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 0..* II
    ..... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ..... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ..... addr 0..* AD
    ..... telecom 0..* TEL
    ..... playingDevice 0..1 Device
    ..... playingEntity 0..1 PlayingEntity
    ..... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship The following entryRelationship represents a reference to another act in the document instance representing the clinical reason for the referral (e.g., problem, concern, procedure).
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:careModel 0..* EntryRelationship The following entryRelationship represents whether the referral is for full or shared care.
    ..... @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: SUBJ
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation C 1..1 Observation Constraints: should-priorityCode
    ...... @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: CDAActClassObservation (required)
    Fixed Value: OBS
    ...... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: RQO
    ...... @negationInd 0..1 bl
    ...... id 0..* II
    ...... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ...... code 1..1 CD Binding: ObservationType (example)
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @code 1..1 cs Required Pattern: ASSERTION
    ....... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.4
    ....... @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
    ...... derivationExpr 0..1 ST
    ...... text 0..1 ED
    ...... statusCode 1..1 CS Binding: ActStatus (required)
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @code 1..1 cs Fixed Value: completed
    ....... @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)
    ...... effectiveTime 0..1 IVL_TS
    ...... priorityCode 0..1 CE Binding: ActPriority (preferred)
    ...... repeatNumber 0..1 IVL_INT
    ...... languageCode 0..1 CS Binding: AllLanguages (required)
    ...... value 1..1 CD Binding: Care Model . (preferred)
    ...... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
    ...... methodCode 0..* CE Binding: ObservationMethod (example)
    ...... targetSiteCode 0..* CD
    ...... 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)
    ...... referenceRange 0..* InfrastructureRoot
    ....... @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 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    ....... observationRange 1..1 ObservationRange
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    .... entryRelationship:indication 0..* EntryRelationship
    ..... @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: RSON
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 Indication
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... 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)

    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:referral-act.​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 Patient Referral Act moodCode . 📦20240606 VSAC v0.23
    Act.code Base required Referral 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 example MediaType 📦3.0.0 THO v6.5
    Act.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.statusCode.code Base required ActStatus 📦3.0.0 THO v6.5
    Act.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.participant.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.classCode Base required CDAActClassObservation 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Act.entryRelationship:careModel.​observation.code Base example ObservationType 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.priorityCode Base preferred ActPriority 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.entryRelationship:careModel.​observation.value Base preferred Care Model . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.methodCode Base example ObservationMethod 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5

    Constraints

    Id Grade Path(s) Description Expression
    II-1 error Act.typeId, Act.participant.typeId, Act.participant.participantRole.typeId, Act.entryRelationship:careModel.typeId, Act.entryRelationship:careModel.observation.typeId, Act.entryRelationship:careModel.observation.referenceRange.typeId, Act.entryRelationship:indication.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-author warning Act SHOULD contain author author.exists()
    should-priorityCode warning Act, Act.entryRelationship:careModel.observation SHOULD contain priorityCode priorityCode.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.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: 7 elements(7 nested mandatory elements)
    Fixed: 6 elements
    Prohibited: 2 elements

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 1 is sliced based on the value of Act.templateId
    • The element 1 is sliced based on the value of Act.entryRelationship

    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, should-priorityCode, should-author
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root
    .... templateId:referral-act 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.140
    ..... @extension 0..0
    ... @classCode 1..1 cs Fixed Value: PCPR
    ... @moodCode 1..1 cs Binding: Patient Referral Act moodCode . (required)
    ... code 1..1 CD Binding: Referral Types . (required)
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... reference C 0..1 TEL Constraints: value-starts-octothorpe
    ... statusCode 1..1 CS
    .... @nullFlavor 0..0
    .... @code 1..1 cs Binding: ActStatus (required)
    ... effectiveTime 1..1 IVL_TS The effectiveTime represents the time when the future referral is intended to take place.
    ... priorityCode 0..1 CE
    ... author 0..* AuthorParticipation
    ... participant 0..* Participant2
    .... @typeCode 1..1 cs
    .... participantRole 1..1 ParticipantRole
    ..... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ... Slices for entryRelationship 0..* EntryRelationship The following entryRelationship represents a reference to another act in the document instance representing the clinical reason for the referral (e.g., problem, concern, procedure).
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:careModel 0..* EntryRelationship The following entryRelationship represents whether the referral is for full or shared care.
    ..... @typeCode 1..1 cs Fixed Value: SUBJ
    ..... observation C 1..1 Observation Constraints: should-priorityCode
    ...... @classCode 1..1 cs Fixed Value: OBS
    ...... @moodCode 1..1 cs Fixed Value: RQO
    ...... code 1..1 CD
    ....... @code 1..1 cs Required Pattern: ASSERTION
    ....... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.4
    ...... statusCode 1..1 CS
    ....... @code 1..1 cs Fixed Value: completed
    ...... priorityCode 0..1 CE Binding: ActPriority (preferred)
    ...... value 1..1 CD Binding: Care Model . (preferred)
    .... entryRelationship:indication 0..* EntryRelationship
    ..... @typeCode 1..1 cs Fixed Value: RSON
    ..... observation 1..1 Indication

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Act.moodCode Base required Patient Referral Act moodCode . 📦20240606 VSAC v0.23
    Act.code Base required Referral Types . 📦20240606 VSAC v0.23
    Act.statusCode.code Base required ActStatus 📦3.0.0 THO v6.5
    Act.participant.participantRole.​code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​observation.priorityCode Base preferred ActPriority 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.value Base preferred Care Model . 📦20240606 VSAC v0.23

    Constraints

    Id Grade Path(s) Description Expression
    should-author warning Act SHOULD contain author author.exists()
    should-priorityCode warning Act, Act.entryRelationship:careModel.observation SHOULD contain priorityCode priorityCode.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.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, should-priorityCode, should-author
    ... @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:referral-act 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: 2.16.840.1.113883.10.20.22.4.140
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: PCPR
    ... @moodCode 1..1 cs Binding: Patient Referral Act moodCode . (required)
    ... @negationInd 0..1 bl
    ... id 1..* II In 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.
    ... code 1..1 CD Binding: Referral Types . (required)
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @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 Binding: MediaType (example)
    .... @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 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @code 1..1 cs Binding: ActStatus (required)
    .... @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)
    ... effectiveTime 1..1 IVL_TS The effectiveTime represents the time when the future referral is intended to take place.
    ... 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 0..* AuthorParticipation
    ... informant 0..* Informant
    ... participant 0..* Participant2
    .... @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)
    .... @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 0..1 IVL_TS
    .... awarenessCode 0..1 CE
    .... participantRole 1..1 ParticipantRole
    ..... @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 0..* II
    ..... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ..... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ..... addr 0..* AD
    ..... telecom 0..* TEL
    ..... playingDevice 0..1 Device
    ..... playingEntity 0..1 PlayingEntity
    ..... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship The following entryRelationship represents a reference to another act in the document instance representing the clinical reason for the referral (e.g., problem, concern, procedure).
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:careModel 0..* EntryRelationship The following entryRelationship represents whether the referral is for full or shared care.
    ..... @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: SUBJ
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation C 1..1 Observation Constraints: should-priorityCode
    ...... @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: CDAActClassObservation (required)
    Fixed Value: OBS
    ...... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: RQO
    ...... @negationInd 0..1 bl
    ...... id 0..* II
    ...... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ...... code 1..1 CD Binding: ObservationType (example)
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @code 1..1 cs Required Pattern: ASSERTION
    ....... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.4
    ....... @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
    ...... derivationExpr 0..1 ST
    ...... text 0..1 ED
    ...... statusCode 1..1 CS Binding: ActStatus (required)
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @code 1..1 cs Fixed Value: completed
    ....... @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)
    ...... effectiveTime 0..1 IVL_TS
    ...... priorityCode 0..1 CE Binding: ActPriority (preferred)
    ...... repeatNumber 0..1 IVL_INT
    ...... languageCode 0..1 CS Binding: AllLanguages (required)
    ...... value 1..1 CD Binding: Care Model . (preferred)
    ...... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
    ...... methodCode 0..* CE Binding: ObservationMethod (example)
    ...... targetSiteCode 0..* CD
    ...... 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)
    ...... referenceRange 0..* InfrastructureRoot
    ....... @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 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    ....... observationRange 1..1 ObservationRange
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    .... entryRelationship:indication 0..* EntryRelationship
    ..... @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: RSON
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 Indication
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... 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)

    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:referral-act.​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 Patient Referral Act moodCode . 📦20240606 VSAC v0.23
    Act.code Base required Referral 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 example MediaType 📦3.0.0 THO v6.5
    Act.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.statusCode.code Base required ActStatus 📦3.0.0 THO v6.5
    Act.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.participant.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.classCode Base required CDAActClassObservation 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Act.entryRelationship:careModel.​observation.code Base example ObservationType 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.priorityCode Base preferred ActPriority 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.entryRelationship:careModel.​observation.value Base preferred Care Model . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.methodCode Base example ObservationMethod 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5

    Constraints

    Id Grade Path(s) Description Expression
    II-1 error Act.typeId, Act.participant.typeId, Act.participant.participantRole.typeId, Act.entryRelationship:careModel.typeId, Act.entryRelationship:careModel.observation.typeId, Act.entryRelationship:careModel.observation.referenceRange.typeId, Act.entryRelationship:indication.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-author warning Act SHOULD contain author author.exists()
    should-priorityCode warning Act, Act.entryRelationship:careModel.observation SHOULD contain priorityCode priorityCode.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.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, should-priorityCode, should-author
    ... @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:referral-act 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: 2.16.840.1.113883.10.20.22.4.140
    ... @classCode 1..1 cs Binding: XActClassDocumentEntryAct (2.0.0) (required)
    Fixed Value: PCPR
    ... @moodCode 1..1 cs Binding: Patient Referral Act moodCode . (required)
    ... @negationInd 0..1 bl
    ... id 1..* II In 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.
    ... code 1..1 CD Binding: Referral Types . (required)
    ... text 0..1 ED SHOULD reference the portion of section narrative text corresponding to this entry
    .... @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 Binding: MediaType (example)
    .... @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 0..1 TEL Constraints: value-starts-octothorpe
    .... thumbnail 0..1 ED
    ... statusCode 1..1 CS Binding: ActStatus (required)
    .... @code 1..1 cs Binding: ActStatus (required)
    .... @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)
    ... effectiveTime 1..1 IVL_TS The effectiveTime represents the time when the future referral is intended to take place.
    ... 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 0..* AuthorParticipation
    ... informant 0..* Informant
    ... participant 0..* Participant2
    .... @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)
    .... @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 0..1 IVL_TS
    .... awarenessCode 0..1 CE
    .... participantRole 1..1 ParticipantRole
    ..... @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 0..* II
    ..... sdtcIdentifiedBy 0..* IdentifiedBy XML Namespace: urn:hl7-org:sdtc
    XML: identifiedBy (urn:hl7-org:sdtc)
    ..... code 0..1 CE Binding: Healthcare Provider Taxonomy . (preferred)
    ..... addr 0..* AD
    ..... telecom 0..* TEL
    ..... playingDevice 0..1 Device
    ..... playingEntity 0..1 PlayingEntity
    ..... scopingEntity 0..1 Entity
    ... Slices for entryRelationship 0..* EntryRelationship The following entryRelationship represents a reference to another act in the document instance representing the clinical reason for the referral (e.g., problem, concern, procedure).
    Slice: Unordered, Open by profile:observation
    .... entryRelationship:careModel 0..* EntryRelationship The following entryRelationship represents whether the referral is for full or shared care.
    ..... @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: SUBJ
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation C 1..1 Observation Constraints: should-priorityCode
    ...... @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: CDAActClassObservation (required)
    Fixed Value: OBS
    ...... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: RQO
    ...... @negationInd 0..1 bl
    ...... id 0..* II
    ...... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    ...... code 1..1 CD Binding: ObservationType (example)
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @code 1..1 cs Required Pattern: ASSERTION
    ....... @codeSystem 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.5.4
    ....... @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
    ...... derivationExpr 0..1 ST
    ...... text 0..1 ED
    ...... statusCode 1..1 CS Binding: ActStatus (required)
    ....... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    ....... @code 1..1 cs Fixed Value: completed
    ....... @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)
    ...... effectiveTime 0..1 IVL_TS
    ...... priorityCode 0..1 CE Binding: ActPriority (preferred)
    ...... repeatNumber 0..1 IVL_INT
    ...... languageCode 0..1 CS Binding: AllLanguages (required)
    ...... value 1..1 CD Binding: Care Model . (preferred)
    ...... interpretationCode 0..* CE Binding: CDAObservationInterpretation (required)
    ...... methodCode 0..* CE Binding: ObservationMethod (example)
    ...... targetSiteCode 0..* CD
    ...... 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)
    ...... referenceRange 0..* InfrastructureRoot
    ....... @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 0..1 cs Binding: CDAActRelationshipType (required)
    Fixed Value: REFV
    ....... observationRange 1..1 ObservationRange
    ...... sdtcInFulfillmentOf1 0..* InFulfillmentOf1 XML Namespace: urn:hl7-org:sdtc
    XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    .... entryRelationship:indication 0..* EntryRelationship
    ..... @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: RSON
    ..... @inversionInd 0..1 bl
    ..... @contextConductionInd 0..1 bl
    ..... @negationInd 0..1 bl
    ..... sequenceNumber 0..1 INT
    ..... seperatableInd 0..1 BL
    ..... act 0..1 Act
    ..... encounter 0..1 Encounter
    ..... observation 1..1 Indication
    ..... observationMedia 0..1 ObservationMedia
    ..... organizer 0..1 Organizer
    ..... procedure 0..1 Procedure
    ..... regionOfInterest 0..1 RegionOfInterest
    ..... substanceAdministration 0..1 SubstanceAdministration
    ..... supply 0..1 Supply
    ... 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)

    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:referral-act.​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 Patient Referral Act moodCode . 📦20240606 VSAC v0.23
    Act.code Base required Referral 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 example MediaType 📦3.0.0 THO v6.5
    Act.text.representation Base required CDABinaryDataEncoding 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.statusCode.code Base required ActStatus 📦3.0.0 THO v6.5
    Act.priorityCode Base example ActPriority 📦3.0.0 THO v6.5
    Act.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.participant.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.typeId.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.typeCode Base required CDAParticipationType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.contextControlCode Base required CDAContextControl 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​classCode Base required CDARoleClassRoot 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.participant.participantRole.​code Base preferred Healthcare Provider Taxonomy . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.classCode Base required CDAActClassObservation 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Act.entryRelationship:careModel.​observation.code Base example ObservationType 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.code.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.statusCode Base required ActStatus 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.priorityCode Base preferred ActPriority 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Act.entryRelationship:careModel.​observation.value Base preferred Care Model . 📦20240606 VSAC v0.23
    Act.entryRelationship:careModel.​observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.methodCode Base example ObservationMethod 📦3.0.0 THO v6.5
    Act.entryRelationship:careModel.​observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:careModel.​observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.1-sd Clinical Document Architecture v2.0
    Act.entryRelationship:indication.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v6.5

    Constraints

    Id Grade Path(s) Description Expression
    II-1 error Act.typeId, Act.participant.typeId, Act.participant.participantRole.typeId, Act.entryRelationship:careModel.typeId, Act.entryRelationship:careModel.observation.typeId, Act.entryRelationship:careModel.observation.referenceRange.typeId, Act.entryRelationship:indication.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    should-author warning Act SHOULD contain author author.exists()
    should-priorityCode warning Act, Act.entryRelationship:careModel.observation SHOULD contain priorityCode priorityCode.exists()
    should-text-ref-value warning Act SHOULD contain text/reference/@value text.reference.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: 7 elements(7 nested mandatory elements)
    Fixed: 6 elements
    Prohibited: 2 elements

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 1 is sliced based on the value of Act.templateId
    • The element 1 is sliced based on the value of Act.entryRelationship

     

    Other representations of profile: CSV, Excel