Consolidated CDA (C-CDA)
5.0.0-ballot - STU5 Ballot 1 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 5.0.0-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: Advance Directive Existence Observation

Official URL: http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveExistenceObservation Version: 5.0.0-ballot
Draft as of 2026-03-10 Computable Name: AdvanceDirectiveExistenceObservation
Other Identifiers: urn:ietf:rfc:3986#Uniform Resource Identifier (URI)#urn:hl7ii:2.16.840.1.113883.10.20.22.4.513:2025-05-01

This observation represents a simple observation indicating whether a person has any advance healthcare directive documents. When documents are available, a system can nest the needed references to the documents inside this Advance Directive Existence Observation.

Advance healthcare directive documents include person-authored advance directives as well as provider-authored portable medical order types of documents.

Templates Used

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

Optional EntryRelationships: AdvanceDirectiveObservation

Usages:

You can also check for usages in the FHIR IG Statistics

Changes since version 4.0.0:

  • New Content

    • Formal Views of Template Content

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

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation 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, no-obs-if-existence-false
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Fixed Value: OBS
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... sdtcCategory 0..* CD Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    ... text C 1..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
    .... @code 1..1 cs Fixed Value: completed
    ... effectiveTime C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @value 0..1 ts value should be used instead of low/high
    ... value C 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... author 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... entryRelationship C 0..* EntryRelationship
    .... @typeCode 1..1 cs Fixed Value: REFR
    .... observation 1..1 AdvanceDirectiveObservation

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Observation.sdtcCategory Base preferred Advance Healthcare Directive Categories LOINC . ⏿20250402 tx.fhir.org
    Observation.value Base required Answer Set with Yes No and Unknowns . ⏿20241005 tx.fhir.org

    Constraints

    Id Grade Path(s) Description Expression
    no-obs-if-existence-false error Observation If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. (entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001')
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    value-only error Observation.effectiveTime Interval fields SHALL NOT be present (low | high | width | center).empty()
    value-starts-octothorpe error Observation.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
    .. Observation C 1..1 Observation 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, no-obs-if-existence-false
    ... @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
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 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: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    Binding: ObservationType (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... derivationExpr 0..1 ST
    ... text C 1..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 C 0..1 ED Constraints: ED-1
    ... 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 C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value C 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... 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 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... participant 0..* Participant2
    ... entryRelationship C 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: REFR
    .... @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 AdvanceDirectiveObservation
    .... 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)
    ... 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)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Observation.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.templateId:advance-directive-exist-obs.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.classCode Base required CDAActClassObservation 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Observation.sdtcCategory Base preferred Advance Healthcare Directive Categories LOINC . ⏿20250402 tx.fhir.org
    Observation.code Base example ObservationType 📦3.0.0 THO v7.1
    Observation.code.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.compression Base required CDACompressionAlgorithm 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.text.mediaType Base example MediaType 📦3.0.0 THO v7.1
    Observation.text.representation Base required CDABinaryDataEncoding 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.statusCode Base required ActStatus 📦3.0.0 THO v7.1
    Observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.effectiveTime.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.effectiveTime.​operator Base required CDASetOperator 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.priorityCode Base example ActPriority 📦3.0.0 THO v7.1
    Observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Observation.value Base required Answer Set with Yes No and Unknowns . ⏿20241005 tx.fhir.org
    Observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.methodCode Base example ObservationMethod 📦3.0.0 THO v7.1
    Observation.entryRelationship.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.entryRelationship.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.entryRelationship.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v7.1
    Observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.2-sd Clinical Document Architecture vnull

    Constraints

    Id Grade Path(s) Description Expression
    ED-1 error Observation.text.thumbnail Thumbnails cannot contain their own thumbnails thumbnail.empty()
    II-1 error Observation.typeId, Observation.entryRelationship.typeId, Observation.referenceRange.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    no-obs-if-existence-false error Observation If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. (entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001')
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    value-only error Observation.effectiveTime Interval fields SHALL NOT be present (low | high | width | center).empty()
    value-starts-octothorpe error Observation.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
    .. Observation C 1..1 Observation 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, no-obs-if-existence-false
    ... @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
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 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: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    Binding: ObservationType (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... derivationExpr 0..1 ST
    ... text C 1..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 C 0..1 ED Constraints: ED-1
    ... 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 C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value C 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... 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 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... participant 0..* Participant2
    ... entryRelationship C 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: REFR
    .... @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 AdvanceDirectiveObservation
    .... 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)
    ... 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)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Observation.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.templateId:advance-directive-exist-obs.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.classCode Base required CDAActClassObservation 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Observation.sdtcCategory Base preferred Advance Healthcare Directive Categories LOINC . ⏿20250402 tx.fhir.org
    Observation.code Base example ObservationType 📦3.0.0 THO v7.1
    Observation.code.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.compression Base required CDACompressionAlgorithm 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.text.mediaType Base example MediaType 📦3.0.0 THO v7.1
    Observation.text.representation Base required CDABinaryDataEncoding 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.statusCode Base required ActStatus 📦3.0.0 THO v7.1
    Observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.effectiveTime.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.effectiveTime.​operator Base required CDASetOperator 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.priorityCode Base example ActPriority 📦3.0.0 THO v7.1
    Observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Observation.value Base required Answer Set with Yes No and Unknowns . ⏿20241005 tx.fhir.org
    Observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.methodCode Base example ObservationMethod 📦3.0.0 THO v7.1
    Observation.entryRelationship.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.entryRelationship.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.entryRelationship.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v7.1
    Observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.2-sd Clinical Document Architecture vnull

    Constraints

    Id Grade Path(s) Description Expression
    ED-1 error Observation.text.thumbnail Thumbnails cannot contain their own thumbnails thumbnail.empty()
    II-1 error Observation.typeId, Observation.entryRelationship.typeId, Observation.referenceRange.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    no-obs-if-existence-false error Observation If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. (entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001')
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    value-only error Observation.effectiveTime Interval fields SHALL NOT be present (low | high | width | center).empty()
    value-starts-octothorpe error Observation.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 Observation

    Summary

    Mandatory: 13 elements(1 nested mandatory element)
    Fixed: 4 elements

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 2 is sliced based on the values of Observation.templateId

    Differential View

    This structure is derived from Observation

    NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
    .. Observation C 1..1 Observation 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, no-obs-if-existence-false
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 1..1 II
    ..... @root 1..1 oid, uuid, ruid Required Pattern: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Fixed Value: OBS
    ... @moodCode 1..1 cs Fixed Value: EVN
    ... sdtcCategory 0..* CD Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    ... text C 1..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
    .... @code 1..1 cs Fixed Value: completed
    ... effectiveTime C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @value 0..1 ts value should be used instead of low/high
    ... value C 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... author 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... entryRelationship C 0..* EntryRelationship
    .... @typeCode 1..1 cs Fixed Value: REFR
    .... observation 1..1 AdvanceDirectiveObservation

    doco Documentation for this format

    Terminology Bindings (Differential)

    Path Status Usage ValueSet Version Source
    Observation.sdtcCategory Base preferred Advance Healthcare Directive Categories LOINC . ⏿20250402 tx.fhir.org
    Observation.value Base required Answer Set with Yes No and Unknowns . ⏿20241005 tx.fhir.org

    Constraints

    Id Grade Path(s) Description Expression
    no-obs-if-existence-false error Observation If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. (entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001')
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    value-only error Observation.effectiveTime Interval fields SHALL NOT be present (low | high | width | center).empty()
    value-starts-octothorpe error Observation.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
    .. Observation C 1..1 Observation 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, no-obs-if-existence-false
    ... @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
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 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: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    Binding: ObservationType (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... derivationExpr 0..1 ST
    ... text C 1..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 C 0..1 ED Constraints: ED-1
    ... 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 C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value C 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... 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 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... participant 0..* Participant2
    ... entryRelationship C 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: REFR
    .... @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 AdvanceDirectiveObservation
    .... 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)
    ... 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)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Observation.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.templateId:advance-directive-exist-obs.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.classCode Base required CDAActClassObservation 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Observation.sdtcCategory Base preferred Advance Healthcare Directive Categories LOINC . ⏿20250402 tx.fhir.org
    Observation.code Base example ObservationType 📦3.0.0 THO v7.1
    Observation.code.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.compression Base required CDACompressionAlgorithm 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.text.mediaType Base example MediaType 📦3.0.0 THO v7.1
    Observation.text.representation Base required CDABinaryDataEncoding 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.statusCode Base required ActStatus 📦3.0.0 THO v7.1
    Observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.effectiveTime.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.effectiveTime.​operator Base required CDASetOperator 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.priorityCode Base example ActPriority 📦3.0.0 THO v7.1
    Observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Observation.value Base required Answer Set with Yes No and Unknowns . ⏿20241005 tx.fhir.org
    Observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.methodCode Base example ObservationMethod 📦3.0.0 THO v7.1
    Observation.entryRelationship.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.entryRelationship.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.entryRelationship.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v7.1
    Observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.2-sd Clinical Document Architecture vnull

    Constraints

    Id Grade Path(s) Description Expression
    ED-1 error Observation.text.thumbnail Thumbnails cannot contain their own thumbnails thumbnail.empty()
    II-1 error Observation.typeId, Observation.entryRelationship.typeId, Observation.referenceRange.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    no-obs-if-existence-false error Observation If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. (entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001')
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    value-only error Observation.effectiveTime Interval fields SHALL NOT be present (low | high | width | center).empty()
    value-starts-octothorpe error Observation.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
    .. Observation C 1..1 Observation 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, no-obs-if-existence-false
    ... @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
    ... Slices for templateId 1..* II Slice: Unordered, Open by value:root, value:extension
    .... templateId:advance-directive-exist-obs 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: 2.16.840.1.113883.10.20.22.4.513
    ..... @extension 1..1 st Required Pattern: 2025-05-01
    ... @classCode 1..1 cs Binding: CDAActClassObservation (required)
    Fixed Value: OBS
    ... @moodCode 1..1 cs Binding: XActMoodDocumentObservation (2.0.0) (required)
    Fixed Value: EVN
    ... @negationInd 0..1 bl
    ... id 1..* II
    ... sdtcCategory 0..* CD XML Namespace: urn:hl7-org:sdtc
    XML: category (urn:hl7-org:sdtc)
    Binding: Advance Healthcare Directive Categories LOINC . (preferred)
    ... code 1..1 CD Advance directive/living will completed
    Binding: ObservationType (example)
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @code 1..1 cs Required Pattern: 45473-6
    .... @codeSystem 1..1 oid, uuid, ruid LOINC
    Required Pattern: 2.16.840.1.113883.6.1
    .... @codeSystemName 0..1 st
    .... @codeSystemVersion 0..1 st
    .... @displayName 0..1 st
    .... @sdtcValueSet 0..1 oid XML Namespace: urn:hl7-org:sdtc
    XML: valueSet (urn:hl7-org:sdtc)
    .... @sdtcValueSetVersion 0..1 st XML Namespace: urn:hl7-org:sdtc
    XML: valueSetVersion (urn:hl7-org:sdtc)
    .... originalText 0..1 ED
    .... qualifier 0..* CR
    .... translation 0..* CD
    ... derivationExpr 0..1 ST
    ... text C 1..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 C 0..1 ED Constraints: ED-1
    ... 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 C 1..1 IVL_TS Note: This template represents a "snapshot in time" observation. As a result, the effectiveTime is constrained to just a time stamp.
    Constraints: value-only
    .... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
    .... @value 0..1 ts value should be used instead of low/high
    Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
    .... @operator 0..1 cs Binding: CDASetOperator (required)
    .... low 0..1 IVXB_TS
    .... center 0..1 TS
    .... width 0..1 PQ
    .... high 0..1 IVXB_TS
    ... priorityCode 0..1 CE Binding: ActPriority (example)
    ... repeatNumber 0..1 IVL_INT
    ... languageCode 0..1 CS Binding: AllLanguages (required)
    ... value C 1..1 CD Binding: Answer Set with Yes No and Unknowns . (required)
    ... 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 1..1 ProvenanceAuthorParticipation
    ... informant 0..1 Informant MAY contain zero or one [0..1] informant
    ... participant 0..* Participant2
    ... entryRelationship C 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: REFR
    .... @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 AdvanceDirectiveObservation
    .... 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)
    ... 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)

    doco Documentation for this format

    Terminology Bindings

    Path Status Usage ValueSet Version Source
    Observation.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.templateId:advance-directive-exist-obs.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.classCode Base required CDAActClassObservation 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.moodCode Base required x_ActMoodDocumentObservation 📍2.0.0 THO v5.2
    Observation.sdtcCategory Base preferred Advance Healthcare Directive Categories LOINC . ⏿20250402 tx.fhir.org
    Observation.code Base example ObservationType 📦3.0.0 THO v7.1
    Observation.code.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.compression Base required CDACompressionAlgorithm 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.text.integrityCheckAlgorithm Base required IntegrityCheckAlgorithm 📍2.0.0 THO v5.2
    Observation.text.mediaType Base example MediaType 📦3.0.0 THO v7.1
    Observation.text.representation Base required CDABinaryDataEncoding 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.statusCode Base required ActStatus 📦3.0.0 THO v7.1
    Observation.statusCode.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.effectiveTime.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.effectiveTime.​operator Base required CDASetOperator 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.priorityCode Base example ActPriority 📦3.0.0 THO v7.1
    Observation.languageCode Base required All Languages 📦5.0.0 FHIR Std.
    Observation.value Base required Answer Set with Yes No and Unknowns . ⏿20241005 tx.fhir.org
    Observation.interpretationCode Base required CDAObservationInterpretation 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.methodCode Base example ObservationMethod 📦3.0.0 THO v7.1
    Observation.entryRelationship.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.entryRelationship.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.entryRelationship.​typeCode Base required x_ActRelationshipEntryRelationship 📦3.0.0 THO v7.1
    Observation.referenceRange.​nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.referenceRange.​typeId.nullFlavor Base required CDANullFlavor 📦2.0.2-sd Clinical Document Architecture vnull
    Observation.referenceRange.​typeCode Base required CDAActRelationshipType 📦2.0.2-sd Clinical Document Architecture vnull

    Constraints

    Id Grade Path(s) Description Expression
    ED-1 error Observation.text.thumbnail Thumbnails cannot contain their own thumbnails thumbnail.empty()
    II-1 error Observation.typeId, Observation.entryRelationship.typeId, Observation.referenceRange.typeId An II instance must have either a root or an nullFlavor. root.exists() or nullFlavor.exists()
    no-obs-if-existence-false error Observation If Advance Directive Observation entries are be present, then the observation value must be 'Yes'. (entryRelationship.observation.where(templateId.where(root='2.16.840.1.113883.10.20.22.4.48').count() > 0).count() > 0) implies (value.code = '373066001')
    should-text-ref-value warning Observation SHOULD contain text/reference/@value text.reference.value.exists()
    value-only error Observation.effectiveTime Interval fields SHALL NOT be present (low | high | width | center).empty()
    value-starts-octothorpe error Observation.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 Observation

    Summary

    Mandatory: 13 elements(1 nested mandatory element)
    Fixed: 4 elements

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 2 is sliced based on the values of Observation.templateId

     

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