Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 3.0.0 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

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON

Logical Model: Note Activity

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

Usage:

• Use this Logical Model: Care Team Member Act, Care Team Organizer and Notes Section

Formal Views of Template Content

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

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from Act

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:note-activity		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.202
@extension		1..1	st	Required Pattern: 2016-11-01
@classCode		1..1	cs	Fixed Value: ACT
@moodCode		1..1	cs	Fixed Value: EVN
code	C	1..1	CD	should-translation: SHOULD contain translation
@code		1..1	cs	Required Pattern: 34109-9
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
translation		0..*	CD	If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942). Binding: Note Types (preferred)
text	C	1..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry 3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
@mediaType		0..1	cs	If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative. Binding: SupportedFileFormats (preferred)
reference	C	1..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
@nullFlavor		0..0
@value		1..1	url
statusCode		1..1	CS	Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
effectiveTime	C	1..1	IVL_TS	The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time. should-value-att: SHOULD contain @value
@value		0..1	ts
author		1..*	AuthorParticipation	Represents the person(s) who wrote the note.
Slices for participant		0..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:legalAuthenticator		0..*	Participant2	Represents the person(s) legally responsible for the contents of the note.
@typeCode		1..1	cs	Fixed Value: LA
time		1..1	USRealmDateTimeInterval	Indicates the time of signing the note.
participantRole	C	1..1	ParticipantRole	3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
id		1..*	II	This may be the ID of the note author. If so, no additional information in this participant is required.
playingEntity		0..1	PlayingEntity
name		1..*	USRealmPersonNamePNUSFIELDED	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by exists:encounter
entryRelationship:encounter		0..*	EntryRelationship	Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
@typeCode		1..1	cs	Fixed Value: COMP
@inversionInd		1..1	bl	Fixed Value: true
@negationInd		0..1	bl	To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
encounter		1..1	Encounter
id	C	1..*	II	3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
Slices for reference		0..*	Reference	Slice: Unordered, Open by exists:externalDocument
reference:externalDocument		0..*	Reference	Represents an unstructured C-CDA document containing the original contents of the note in the original format.
externalDocument	C	1..1	ExternalDocument	should-code: SHOULD contain code
id		1..1	II
code		0..1	CD
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Act.code.translation	preferred	NoteTypes http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68 from https://vsac.nlm.nih.gov
Act.text.mediaType	preferred	SupportedFileFormats http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1 from https://vsac.nlm.nih.gov

Constraints

Id	Grade	Path(s)	Details	Requirements
3250-16912	error	Act.text	If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
3250-16914	error	Act.entryRelationship:encounter.encounter.id	If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). :
3250-16930	error	Act.participant:legalAuthenticator.participantRole	If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). :
should-code	warning	Act.reference:externalDocument.externalDocument	SHOULD contain code : code.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-translation	warning	Act.code	SHOULD contain translation : translation.exists()
should-value-att	warning	Act.effectiveTime	SHOULD contain @value : value.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:note-activity		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.202
@extension		1..1	st	Required Pattern: 2016-11-01
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN
code	C	1..1	CD	Binding: v3 Code System ActCode (example) should-translation: SHOULD contain translation
@code		1..1	cs	Required Pattern: 34109-9
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
translation		0..*	CD	If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942). Binding: Note Types (preferred)
text	C	1..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry 3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
@mediaType		0..1	cs	If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative. Binding: SupportedFileFormats (preferred)
reference	C	1..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
@value		1..1	url
statusCode		1..1	CS	Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized. Binding: ActStatus (required)
effectiveTime	C	1..1	IVL_TS	The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time. should-value-att: SHOULD contain @value
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
author		1..*	AuthorParticipation	Represents the person(s) who wrote the note.
Slices for participant		0..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:legalAuthenticator		0..*	Participant2	Represents the person(s) legally responsible for the contents of the note.
@typeCode		1..1	cs	Binding: CDAParticipationType (required) Fixed Value: LA
time	C	1..1	USRealmDateTimeInterval	Indicates the time of signing the note. ivl-ts-center: Center cannot co-exist with low or high ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day. ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component.
participantRole	C	1..1	ParticipantRole	3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
id		1..*	II	This may be the ID of the note author. If so, no additional information in this participant is required.
playingEntity		0..1	PlayingEntity
name	C	1..*	USRealmPersonNamePNUSFIELDED	Base for all types and resources pn-no-ls: No PN name part may have a qualifier of LS. 81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). 81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by exists:encounter
entryRelationship:encounter		0..*	EntryRelationship	Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: COMP
@inversionInd		1..1	bl	Fixed Value: true
@negationInd		0..1	bl	To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
encounter		1..1	Encounter
@classCode		1..1	cs	Binding: CDAActClass (required) Fixed Value: ENC
@moodCode		1..1	cs	Binding: XDocumentEncounterMood (2.0.0) (required)
id	C	1..*	II	3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
Slices for reference		0..*	Reference	Slice: Unordered, Open by exists:externalDocument
reference:externalDocument		0..*	Reference	Represents an unstructured C-CDA document containing the original contents of the note in the original format.
@typeCode		1..1	cs	Binding: x_ActRelationshipExternalReference (required)
externalDocument	C	1..1	ExternalDocument	should-code: SHOULD contain code
id		1..1	II
code		0..1	CD	Binding: FHIRDocumentTypeCodes (example)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Act.classCode	required	Fixed Value: ACT http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
Act.moodCode	required	Fixed Value: EVN http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
Act.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Act.code.translation	preferred	NoteTypes http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68 from https://vsac.nlm.nih.gov
Act.text.mediaType	preferred	SupportedFileFormats http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1 from https://vsac.nlm.nih.gov
Act.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Act.participant:legalAuthenticator.typeCode	required	Fixed Value: LA http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Act.entryRelationship:encounter.typeCode	required	Fixed Value: COMP http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Act.entryRelationship:encounter.encounter.classCode	required	Fixed Value: ENC http://hl7.org/cda/stds/core/ValueSet/CDAActClass
Act.entryRelationship:encounter.encounter.moodCode	required	XDocumentEncounterMood http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0
Act.reference:externalDocument.typeCode	required	XActRelationshipExternalReference http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Act.reference:externalDocument.externalDocument.code	example	FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
3250-16912	error	Act.text	If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
3250-16914	error	Act.entryRelationship:encounter.encounter.id	If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). :
3250-16930	error	Act.participant:legalAuthenticator.participantRole	If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). :
81-9371	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	The string **SHALL NOT** contain name parts (CONF:81-9372). : item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
ivl-ts-center	error	Act.participant:legalAuthenticator.time	Center cannot co-exist with low or high : center.empty() or (low.empty() and high.empty())
ivl-value-shall	error	Act.participant:legalAuthenticator.time	If a time interval contains @value, then it shall be precise to at least the day. : value.exists() implies value.toString().length() >= 10
ivl-value-should	warning	Act.participant:legalAuthenticator.time	If a time interval contains @value, then it SHOULD contain a time component. : value.exists() implies value.toString().length() > 10
pn-no-ls	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	No PN name part may have a qualifier of LS. : (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
should-code	warning	Act.reference:externalDocument.externalDocument	SHOULD contain code : code.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-translation	warning	Act.code	SHOULD contain translation : translation.exists()
should-value-att	warning	Act.effectiveTime	SHOULD contain @value : value.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@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:note-activity		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.202
@extension		1..1	st	Required Pattern: 2016-11-01
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl
id		0..*	II
code	C	1..1	CD	Binding: v3 Code System ActCode (example) should-translation: SHOULD contain translation
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Required Pattern: 34109-9
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
@codeSystemName		0..1	st
@codeSystemVersion		0..1	st
@displayName		0..1	st
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
originalText		0..1	ED
qualifier		0..*	CR
translation		0..*	CD	If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942). Binding: Note Types (preferred)
text	C	1..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry 3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CDACompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative. Binding: SupportedFileFormats (preferred)
@representation		0..1	cs	Binding: CDABinaryDataEncoding (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	1..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
@value		1..1	url
useablePeriod		0..*
useablePeriod			IVL_TS
useablePeriod			EIVL_TS
useablePeriod			PIVL_TS
useablePeriod			SXPR_TS
@use		0..*	cs	Binding: TelecommunicationAddressUse (2.0.0) (required)
thumbnail		0..1	ED
statusCode		1..1	CS	Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized. Binding: ActStatus (required)
effectiveTime	C	1..1	IVL_TS	The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time. should-value-att: SHOULD contain @value
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
@operator		0..1	cs	Binding: CDASetOperator (required)
low		0..1	IVXB_TS
center		0..1	TS
width		0..1	PQ
high		0..1	IVXB_TS
priorityCode		0..1	CE	Binding: ActPriority (example)
languageCode		0..1	CS	Binding: AllLanguages (required)
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		1..*	AuthorParticipation	Represents the person(s) who wrote the note.
informant		0..*	Informant
Slices for participant		0..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:legalAuthenticator		0..*	Participant2	Represents the person(s) legally responsible for the contents of the note.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: CDAParticipationType (required) Fixed Value: LA
@contextControlCode		0..1	cs	Binding: CDAContextControl (required) Fixed Value: OP
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time	C	1..1	USRealmDateTimeInterval	Indicates the time of signing the note. ivl-ts-center: Center cannot co-exist with low or high ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day. ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component.
awarenessCode		0..1	CE
participantRole	C	1..1	ParticipantRole	3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@classCode		0..1	cs	Binding: CDARoleClassRoot (required)
id		1..*	II	This may be the ID of the note author. If so, no additional information in this participant is required.
sdtcIdentifiedBy		0..*	IdentifiedBy	XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc)
code		0..1	CE	Binding: CDARoleCode (example)
addr		0..*	AD
telecom		0..*	TEL
playingDevice		0..1	Device
playingEntity		0..1	PlayingEntity
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@classCode		0..1	cs	Binding: EntityClassRoot (required)
@determinerCode		0..1	cs	Binding: EntityDeterminer (required) Fixed Value: INSTANCE
code		0..1	CE	Binding: CDAEntityCode (example)
quantity		0..*	PQ
name	C	1..*	USRealmPersonNamePNUSFIELDED	Base for all types and resources pn-no-ls: No PN name part may have a qualifier of LS. 81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). 81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
sdtcBirthTime		0..1	TS	XML Namespace: urn:hl7-org:sdtc XML: birthTime (urn:hl7-org:sdtc)
desc		0..1	ED
scopingEntity		0..1	Entity
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by exists:encounter
entryRelationship:encounter		0..*	EntryRelationship	Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: COMP
@inversionInd		1..1	bl	Fixed Value: true
@contextConductionInd		0..1	bl
@negationInd		0..1	bl	To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		1..1	Encounter
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@classCode		1..1	cs	Binding: CDAActClass (required) Fixed Value: ENC
@moodCode		1..1	cs	Binding: XDocumentEncounterMood (2.0.0) (required)
id	C	1..*	II	3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
code		0..1	CD	Binding: ActEncounterCode (example)
text		0..1	ED
statusCode		0..1	CS	Binding: ActStatus (required)
effectiveTime		0..1	IVL_TS
sdtcDischargeDispositionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: dischargeDispositionCode (urn:hl7-org:sdtc)
priorityCode		0..1	CE	Binding: ActPriority (example)
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	Author
informant		0..*	Informant
participant		0..*	Participant2
entryRelationship		0..*	EntryRelationship
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
Slices for reference		0..*	Reference	Slice: Unordered, Open by exists:externalDocument
reference:externalDocument		0..*	Reference	Represents an unstructured C-CDA document containing the original contents of the note in the original format.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipExternalReference (required)
seperatableInd		0..1	BL
externalAct		0..1	ExternalAct
externalObservation		0..1	ExternalObservation
externalProcedure		0..1	ExternalProcedure
externalDocument	C	1..1	ExternalDocument	should-code: SHOULD contain code
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@classCode		0..1	cs	Binding: ActClassDocument (required)
@moodCode		0..1	cs	Binding: CDAActMood (required) Fixed Value: EVN
id		1..1	II
code		0..1	CD	Binding: FHIRDocumentTypeCodes (example)
text		0..1	ED
setId		0..1	II
versionNumber		0..1	INT
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)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Act.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.templateId:note-activity.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.classCode	required	Fixed Value: ACT http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
Act.moodCode	required	Fixed Value: EVN http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
Act.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Act.code.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.code.translation	preferred	NoteTypes http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68 from https://vsac.nlm.nih.gov
Act.text.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.text.compression	required	CDACompressionAlgorithm http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Act.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Act.text.mediaType	preferred	SupportedFileFormats http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1 from https://vsac.nlm.nih.gov
Act.text.representation	required	BinaryDataEncoding http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Act.text.reference.use	required	TelecommunicationAddressUse http://terminology.hl7.org/ValueSet/v3-TelecommunicationAddressUse|2.0.0
Act.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Act.effectiveTime.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.effectiveTime.operator	required	CDASetOperator http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Act.priorityCode	example	ActPriority http://terminology.hl7.org/ValueSet/v3-ActPriority
Act.languageCode	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages from the FHIR Standard
Act.participant:legalAuthenticator.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.typeCode	required	Fixed Value: LA http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Act.participant:legalAuthenticator.contextControlCode	required	Fixed Value: OP http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Act.participant:legalAuthenticator.participantRole.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.participantRole.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.participantRole.classCode	required	CDARoleClassRoot http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Act.participant:legalAuthenticator.participantRole.code	example	CDARoleCode http://hl7.org/cda/stds/core/ValueSet/CDARoleCode
Act.participant:legalAuthenticator.participantRole.playingEntity.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.participantRole.playingEntity.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.participantRole.playingEntity.classCode	required	EntityClassRoot http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Act.participant:legalAuthenticator.participantRole.playingEntity.determinerCode	required	Fixed Value: INSTANCE http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Act.participant:legalAuthenticator.participantRole.playingEntity.code	example	CDAEntityCode http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
Act.entryRelationship:encounter.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.entryRelationship:encounter.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.entryRelationship:encounter.typeCode	required	Fixed Value: COMP http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Act.entryRelationship:encounter.encounter.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.entryRelationship:encounter.encounter.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.entryRelationship:encounter.encounter.classCode	required	Fixed Value: ENC http://hl7.org/cda/stds/core/ValueSet/CDAActClass
Act.entryRelationship:encounter.encounter.moodCode	required	XDocumentEncounterMood http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0
Act.entryRelationship:encounter.encounter.code	example	ActEncounterCode http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
Act.entryRelationship:encounter.encounter.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Act.entryRelationship:encounter.encounter.priorityCode	example	ActPriority http://terminology.hl7.org/ValueSet/v3-ActPriority
Act.reference:externalDocument.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.reference:externalDocument.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.reference:externalDocument.typeCode	required	XActRelationshipExternalReference http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Act.reference:externalDocument.externalDocument.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.reference:externalDocument.externalDocument.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.reference:externalDocument.externalDocument.classCode	required	ActClassDocument http://terminology.hl7.org/ValueSet/v3-ActClassDocument
Act.reference:externalDocument.externalDocument.moodCode	required	Fixed Value: EVN http://hl7.org/cda/stds/core/ValueSet/CDAActMood
Act.reference:externalDocument.externalDocument.code	example	FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
3250-16912	error	Act.text	If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
3250-16914	error	Act.entryRelationship:encounter.encounter.id	If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). :
3250-16930	error	Act.participant:legalAuthenticator.participantRole	If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). :
81-9371	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	The string **SHALL NOT** contain name parts (CONF:81-9372). : item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
ivl-ts-center	error	Act.participant:legalAuthenticator.time	Center cannot co-exist with low or high : center.empty() or (low.empty() and high.empty())
ivl-value-shall	error	Act.participant:legalAuthenticator.time	If a time interval contains @value, then it shall be precise to at least the day. : value.exists() implies value.toString().length() >= 10
ivl-value-should	warning	Act.participant:legalAuthenticator.time	If a time interval contains @value, then it SHOULD contain a time component. : value.exists() implies value.toString().length() > 10
pn-no-ls	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	No PN name part may have a qualifier of LS. : (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
should-code	warning	Act.reference:externalDocument.externalDocument	SHOULD contain code : code.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-translation	warning	Act.code	SHOULD contain translation : translation.exists()
should-value-att	warning	Act.effectiveTime	SHOULD contain @value : value.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

This structure is derived from Act

Summary

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

Structures

This structure refers to these other structures:

• Author Participation (http://hl7.org/cda/us/ccda/StructureDefinition/AuthorParticipation)
• US Realm Date and Time - Interval (http://hl7.org/cda/us/ccda/StructureDefinition/USRealmDateTimeInterval)
• US Realm Person Name (PN.US.FIELDED) (http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPersonNamePNUSFIELDED)

Slices

This structure defines the following Slices:

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

Differential View

This structure is derived from Act

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:note-activity		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.202
@extension		1..1	st	Required Pattern: 2016-11-01
@classCode		1..1	cs	Fixed Value: ACT
@moodCode		1..1	cs	Fixed Value: EVN
code	C	1..1	CD	should-translation: SHOULD contain translation
@code		1..1	cs	Required Pattern: 34109-9
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
translation		0..*	CD	If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942). Binding: Note Types (preferred)
text	C	1..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry 3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
@mediaType		0..1	cs	If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative. Binding: SupportedFileFormats (preferred)
reference	C	1..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
@nullFlavor		0..0
@value		1..1	url
statusCode		1..1	CS	Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized.
effectiveTime	C	1..1	IVL_TS	The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time. should-value-att: SHOULD contain @value
@value		0..1	ts
author		1..*	AuthorParticipation	Represents the person(s) who wrote the note.
Slices for participant		0..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:legalAuthenticator		0..*	Participant2	Represents the person(s) legally responsible for the contents of the note.
@typeCode		1..1	cs	Fixed Value: LA
time		1..1	USRealmDateTimeInterval	Indicates the time of signing the note.
participantRole	C	1..1	ParticipantRole	3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
id		1..*	II	This may be the ID of the note author. If so, no additional information in this participant is required.
playingEntity		0..1	PlayingEntity
name		1..*	USRealmPersonNamePNUSFIELDED	Base for all types and resources
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by exists:encounter
entryRelationship:encounter		0..*	EntryRelationship	Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
@typeCode		1..1	cs	Fixed Value: COMP
@inversionInd		1..1	bl	Fixed Value: true
@negationInd		0..1	bl	To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
encounter		1..1	Encounter
id	C	1..*	II	3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
Slices for reference		0..*	Reference	Slice: Unordered, Open by exists:externalDocument
reference:externalDocument		0..*	Reference	Represents an unstructured C-CDA document containing the original contents of the note in the original format.
externalDocument	C	1..1	ExternalDocument	should-code: SHOULD contain code
id		1..1	II
code		0..1	CD
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Act.code.translation	preferred	NoteTypes http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68 from https://vsac.nlm.nih.gov
Act.text.mediaType	preferred	SupportedFileFormats http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1 from https://vsac.nlm.nih.gov

Constraints

Id	Grade	Path(s)	Details	Requirements
3250-16912	error	Act.text	If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
3250-16914	error	Act.entryRelationship:encounter.encounter.id	If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). :
3250-16930	error	Act.participant:legalAuthenticator.participantRole	If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). :
should-code	warning	Act.reference:externalDocument.externalDocument	SHOULD contain code : code.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-translation	warning	Act.code	SHOULD contain translation : translation.exists()
should-value-att	warning	Act.effectiveTime	SHOULD contain @value : value.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value
Slices for templateId		1..*	II	Slice: Unordered, Open by value:root, value:extension
templateId:note-activity		1..1	II
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.202
@extension		1..1	st	Required Pattern: 2016-11-01
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN
code	C	1..1	CD	Binding: v3 Code System ActCode (example) should-translation: SHOULD contain translation
@code		1..1	cs	Required Pattern: 34109-9
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
translation		0..*	CD	If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942). Binding: Note Types (preferred)
text	C	1..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry 3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
@mediaType		0..1	cs	If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative. Binding: SupportedFileFormats (preferred)
reference	C	1..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
@value		1..1	url
statusCode		1..1	CS	Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized. Binding: ActStatus (required)
effectiveTime	C	1..1	IVL_TS	The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time. should-value-att: SHOULD contain @value
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
author		1..*	AuthorParticipation	Represents the person(s) who wrote the note.
Slices for participant		0..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:legalAuthenticator		0..*	Participant2	Represents the person(s) legally responsible for the contents of the note.
@typeCode		1..1	cs	Binding: CDAParticipationType (required) Fixed Value: LA
time	C	1..1	USRealmDateTimeInterval	Indicates the time of signing the note. ivl-ts-center: Center cannot co-exist with low or high ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day. ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component.
participantRole	C	1..1	ParticipantRole	3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
id		1..*	II	This may be the ID of the note author. If so, no additional information in this participant is required.
playingEntity		0..1	PlayingEntity
name	C	1..*	USRealmPersonNamePNUSFIELDED	Base for all types and resources pn-no-ls: No PN name part may have a qualifier of LS. 81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). 81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by exists:encounter
entryRelationship:encounter		0..*	EntryRelationship	Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: COMP
@inversionInd		1..1	bl	Fixed Value: true
@negationInd		0..1	bl	To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
encounter		1..1	Encounter
@classCode		1..1	cs	Binding: CDAActClass (required) Fixed Value: ENC
@moodCode		1..1	cs	Binding: XDocumentEncounterMood (2.0.0) (required)
id	C	1..*	II	3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
Slices for reference		0..*	Reference	Slice: Unordered, Open by exists:externalDocument
reference:externalDocument		0..*	Reference	Represents an unstructured C-CDA document containing the original contents of the note in the original format.
@typeCode		1..1	cs	Binding: x_ActRelationshipExternalReference (required)
externalDocument	C	1..1	ExternalDocument	should-code: SHOULD contain code
id		1..1	II
code		0..1	CD	Binding: FHIRDocumentTypeCodes (example)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Act.classCode	required	Fixed Value: ACT http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
Act.moodCode	required	Fixed Value: EVN http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
Act.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Act.code.translation	preferred	NoteTypes http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68 from https://vsac.nlm.nih.gov
Act.text.mediaType	preferred	SupportedFileFormats http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1 from https://vsac.nlm.nih.gov
Act.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Act.participant:legalAuthenticator.typeCode	required	Fixed Value: LA http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Act.entryRelationship:encounter.typeCode	required	Fixed Value: COMP http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Act.entryRelationship:encounter.encounter.classCode	required	Fixed Value: ENC http://hl7.org/cda/stds/core/ValueSet/CDAActClass
Act.entryRelationship:encounter.encounter.moodCode	required	XDocumentEncounterMood http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0
Act.reference:externalDocument.typeCode	required	XActRelationshipExternalReference http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Act.reference:externalDocument.externalDocument.code	example	FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
3250-16912	error	Act.text	If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
3250-16914	error	Act.entryRelationship:encounter.encounter.id	If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). :
3250-16930	error	Act.participant:legalAuthenticator.participantRole	If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). :
81-9371	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	The string **SHALL NOT** contain name parts (CONF:81-9372). : item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
ivl-ts-center	error	Act.participant:legalAuthenticator.time	Center cannot co-exist with low or high : center.empty() or (low.empty() and high.empty())
ivl-value-shall	error	Act.participant:legalAuthenticator.time	If a time interval contains @value, then it shall be precise to at least the day. : value.exists() implies value.toString().length() >= 10
ivl-value-should	warning	Act.participant:legalAuthenticator.time	If a time interval contains @value, then it SHOULD contain a time component. : value.exists() implies value.toString().length() > 10
pn-no-ls	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	No PN name part may have a qualifier of LS. : (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
should-code	warning	Act.reference:externalDocument.externalDocument	SHOULD contain code : code.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-translation	warning	Act.code	SHOULD contain translation : translation.exists()
should-value-att	warning	Act.effectiveTime	SHOULD contain @value : value.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Act	C	1..1	Act	XML Namespace: urn:hl7-org:v3 Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId, @classCode, @moodCode, @negationInd, id, code, text, statusCode, effectiveTime, priorityCode, languageCode, subject, specimen, performer, author, informant, participant, entryRelationship, reference, precondition, sdtcPrecondition2, sdtcInFulfillmentOf1 Base for all types and resources Instance of this type are validated by templateId Logical Container: ClinicalDocument (CDA Class) should-text-ref-value: SHOULD contain text/reference/@value
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@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:note-activity		1..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.10.20.22.4.202
@extension		1..1	st	Required Pattern: 2016-11-01
@classCode		1..1	cs	Binding: XActClassDocumentEntryAct (2.0.0) (required) Fixed Value: ACT
@moodCode		1..1	cs	Binding: XDocumentActMood (2.0.0) (required) Fixed Value: EVN
@negationInd		0..1	bl
id		0..*	II
code	C	1..1	CD	Binding: v3 Code System ActCode (example) should-translation: SHOULD contain translation
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@code		1..1	cs	Required Pattern: 34109-9
@codeSystem		1..1	oid, uuid, ruid	Required Pattern: 2.16.840.1.113883.6.1
@codeSystemName		0..1	st
@codeSystemVersion		0..1	st
@displayName		0..1	st
@sdtcValueSet		0..1	oid	XML Namespace: urn:hl7-org:sdtc XML: valueSet (urn:hl7-org:sdtc)
@sdtcValueSetVersion		0..1	st	XML Namespace: urn:hl7-org:sdtc XML: valueSetVersion (urn:hl7-org:sdtc)
originalText		0..1	ED
qualifier		0..*	CR
translation		0..*	CD	If the Note Activity is within a narrative-only section (e.g. Hospital Course), the translation MAY match the section code (CONF:3250-16943). If the Note Activity is within a Note Section, the translation SHOULD match or specialize the section code (CONF:3250-16942). Binding: Note Types (preferred)
text	C	1..1	ED	SHOULD reference the portion of section narrative text corresponding to this entry 3250-16912: If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912).
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@compression		0..1	cs	Binding: CDACompressionAlgorithm (required)
@integrityCheck		0..1	bin
@integrityCheckAlgorithm		0..1	cs	Binding: IntegrityCheckAlgorithm (2.0.0) (required)
@language		0..1	cs
@mediaType		0..1	cs	If the note was originally in another format, such as RTF, this element may also contain the base-64-encoded raw data of the note in addition to a reference to the narrative. Binding: SupportedFileFormats (preferred)
@representation		0..1	cs	Binding: CDABinaryDataEncoding (required)
xmlText		0..1	st	Allows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
reference	C	1..1	TEL	value-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative
@value		1..1	url
useablePeriod		0..*
useablePeriod			IVL_TS
useablePeriod			EIVL_TS
useablePeriod			PIVL_TS
useablePeriod			SXPR_TS
@use		0..*	cs	Binding: TelecommunicationAddressUse (2.0.0) (required)
thumbnail		0..1	ED
statusCode		1..1	CS	Indicates the status of the note. The most common statusCode is completed indicating the note is signed and finalized. Binding: ActStatus (required)
effectiveTime	C	1..1	IVL_TS	The effectiveTime represents the clinically relevant time of the note. The precise timestamp of creation / updating should be conveyed in author/time. should-value-att: SHOULD contain @value
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@value		0..1	ts	Date Format: YYYYMMDDHHMMSS.UUUU[+|-ZZzz]
@operator		0..1	cs	Binding: CDASetOperator (required)
low		0..1	IVXB_TS
center		0..1	TS
width		0..1	PQ
high		0..1	IVXB_TS
priorityCode		0..1	CE	Binding: ActPriority (example)
languageCode		0..1	CS	Binding: AllLanguages (required)
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		1..*	AuthorParticipation	Represents the person(s) who wrote the note.
informant		0..*	Informant
Slices for participant		0..*	Participant2	Slice: Unordered, Open by value:typeCode
participant:legalAuthenticator		0..*	Participant2	Represents the person(s) legally responsible for the contents of the note.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: CDAParticipationType (required) Fixed Value: LA
@contextControlCode		0..1	cs	Binding: CDAContextControl (required) Fixed Value: OP
sdtcFunctionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: functionCode (urn:hl7-org:sdtc)
time	C	1..1	USRealmDateTimeInterval	Indicates the time of signing the note. ivl-ts-center: Center cannot co-exist with low or high ivl-value-shall: If a time interval contains @value, then it shall be precise to at least the day. ivl-value-should: If a time interval contains @value, then it SHOULD contain a time component.
awarenessCode		0..1	CE
participantRole	C	1..1	ParticipantRole	3250-16930: If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930).
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@classCode		0..1	cs	Binding: CDARoleClassRoot (required)
id		1..*	II	This may be the ID of the note author. If so, no additional information in this participant is required.
sdtcIdentifiedBy		0..*	IdentifiedBy	XML Namespace: urn:hl7-org:sdtc XML: identifiedBy (urn:hl7-org:sdtc)
code		0..1	CE	Binding: CDARoleCode (example)
addr		0..*	AD
telecom		0..*	TEL
playingDevice		0..1	Device
playingEntity		0..1	PlayingEntity
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@classCode		0..1	cs	Binding: EntityClassRoot (required)
@determinerCode		0..1	cs	Binding: EntityDeterminer (required) Fixed Value: INSTANCE
code		0..1	CE	Binding: CDAEntityCode (example)
quantity		0..*	PQ
name	C	1..*	USRealmPersonNamePNUSFIELDED	Base for all types and resources pn-no-ls: No PN name part may have a qualifier of LS. 81-9371: The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). 81-9372: The string **SHALL NOT** contain name parts (CONF:81-9372).
sdtcBirthTime		0..1	TS	XML Namespace: urn:hl7-org:sdtc XML: birthTime (urn:hl7-org:sdtc)
desc		0..1	ED
scopingEntity		0..1	Entity
Slices for entryRelationship		0..*	EntryRelationship	Slice: Unordered, Open by exists:encounter
entryRelationship:encounter		0..*	EntryRelationship	Links the note to an encounter. If the Note Activity is present within a document containing an encompassingEncounter, then this entryRelationship is optional and the note is associated with the encounter represented by the encompassingEncounter.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipEntryRelationship (required) Fixed Value: COMP
@inversionInd		1..1	bl	Fixed Value: true
@contextConductionInd		0..1	bl
@negationInd		0..1	bl	To communicate that the note is not associated with any encounter, this entryRelationship MAY be included with @negationInd="true" and encounter/id/@nullFlavor="NA". The negationInd + encounter indicate this note is not associated with any encounter.
sequenceNumber		0..1	INT
seperatableInd		0..1	BL
act		0..1	Act
encounter		1..1	Encounter
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@classCode		1..1	cs	Binding: CDAActClass (required) Fixed Value: ENC
@moodCode		1..1	cs	Binding: XDocumentEncounterMood (2.0.0) (required)
id	C	1..*	II	3250-16914: If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914).
code		0..1	CD	Binding: ActEncounterCode (example)
text		0..1	ED
statusCode		0..1	CS	Binding: ActStatus (required)
effectiveTime		0..1	IVL_TS
sdtcDischargeDispositionCode		0..1	CE	XML Namespace: urn:hl7-org:sdtc XML: dischargeDispositionCode (urn:hl7-org:sdtc)
priorityCode		0..1	CE	Binding: ActPriority (example)
subject		0..1	Subject
specimen		0..*	Specimen
performer		0..*	Performer2
author		0..*	Author
informant		0..*	Informant
participant		0..*	Participant2
entryRelationship		0..*	EntryRelationship
reference		0..*	Reference
precondition		0..*	Precondition
sdtcPrecondition2		0..*	Precondition2	XML Namespace: urn:hl7-org:sdtc XML: precondition2 (urn:hl7-org:sdtc)
sdtcInFulfillmentOf1		0..*	InFulfillmentOf1	XML Namespace: urn:hl7-org:sdtc XML: inFulfillmentOf1 (urn:hl7-org:sdtc)
observation		0..1	Observation
observationMedia		0..1	ObservationMedia
organizer		0..1	Organizer
procedure		0..1	Procedure
regionOfInterest		0..1	RegionOfInterest
substanceAdministration		0..1	SubstanceAdministration
supply		0..1	Supply
Slices for reference		0..*	Reference	Slice: Unordered, Open by exists:externalDocument
reference:externalDocument		0..*	Reference	Represents an unstructured C-CDA document containing the original contents of the note in the original format.
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@typeCode		1..1	cs	Binding: x_ActRelationshipExternalReference (required)
seperatableInd		0..1	BL
externalAct		0..1	ExternalAct
externalObservation		0..1	ExternalObservation
externalProcedure		0..1	ExternalProcedure
externalDocument	C	1..1	ExternalDocument	should-code: SHOULD contain code
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
realmCode		0..*	CS
typeId		0..1	II
@nullFlavor		0..1	cs	Binding: CDANullFlavor (required)
@assigningAuthorityName		0..1	st
@displayable		0..1	bl
@root		1..1	oid, uuid, ruid	Fixed Value: 2.16.840.1.113883.1.3
@extension		1..1	st
templateId		0..*	II
@classCode		0..1	cs	Binding: ActClassDocument (required)
@moodCode		0..1	cs	Binding: CDAActMood (required) Fixed Value: EVN
id		1..1	II
code		0..1	CD	Binding: FHIRDocumentTypeCodes (example)
text		0..1	ED
setId		0..1	II
versionNumber		0..1	INT
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)
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Act.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.templateId:note-activity.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.classCode	required	Fixed Value: ACT http://terminology.hl7.org/ValueSet/v3-xActClassDocumentEntryAct|2.0.0
Act.moodCode	required	Fixed Value: EVN http://terminology.hl7.org/ValueSet/v3-xDocumentActMood|2.0.0
Act.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Act.code.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.code.translation	preferred	NoteTypes http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.68 from https://vsac.nlm.nih.gov
Act.text.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.text.compression	required	CDACompressionAlgorithm http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm
Act.text.integrityCheckAlgorithm	required	IntegrityCheckAlgorithm http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0
Act.text.mediaType	preferred	SupportedFileFormats http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.7.1 from https://vsac.nlm.nih.gov
Act.text.representation	required	BinaryDataEncoding http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding
Act.text.reference.use	required	TelecommunicationAddressUse http://terminology.hl7.org/ValueSet/v3-TelecommunicationAddressUse|2.0.0
Act.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Act.effectiveTime.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.effectiveTime.operator	required	CDASetOperator http://hl7.org/cda/stds/core/ValueSet/CDASetOperator
Act.priorityCode	example	ActPriority http://terminology.hl7.org/ValueSet/v3-ActPriority
Act.languageCode	required	AllLanguages http://hl7.org/fhir/ValueSet/all-languages from the FHIR Standard
Act.participant:legalAuthenticator.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.typeCode	required	Fixed Value: LA http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType
Act.participant:legalAuthenticator.contextControlCode	required	Fixed Value: OP http://hl7.org/cda/stds/core/ValueSet/CDAContextControl
Act.participant:legalAuthenticator.participantRole.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.participantRole.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.participantRole.classCode	required	CDARoleClassRoot http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot
Act.participant:legalAuthenticator.participantRole.code	example	CDARoleCode http://hl7.org/cda/stds/core/ValueSet/CDARoleCode
Act.participant:legalAuthenticator.participantRole.playingEntity.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.participantRole.playingEntity.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.participant:legalAuthenticator.participantRole.playingEntity.classCode	required	EntityClassRoot http://terminology.hl7.org/ValueSet/v3-EntityClassRoot
Act.participant:legalAuthenticator.participantRole.playingEntity.determinerCode	required	Fixed Value: INSTANCE http://terminology.hl7.org/ValueSet/v3-EntityDeterminer
Act.participant:legalAuthenticator.participantRole.playingEntity.code	example	CDAEntityCode http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode
Act.entryRelationship:encounter.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.entryRelationship:encounter.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.entryRelationship:encounter.typeCode	required	Fixed Value: COMP http://terminology.hl7.org/ValueSet/v3-xActRelationshipEntryRelationship
Act.entryRelationship:encounter.encounter.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.entryRelationship:encounter.encounter.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.entryRelationship:encounter.encounter.classCode	required	Fixed Value: ENC http://hl7.org/cda/stds/core/ValueSet/CDAActClass
Act.entryRelationship:encounter.encounter.moodCode	required	XDocumentEncounterMood http://terminology.hl7.org/ValueSet/v3-xDocumentEncounterMood|2.0.0
Act.entryRelationship:encounter.encounter.code	example	ActEncounterCode http://terminology.hl7.org/ValueSet/v3-ActEncounterCode
Act.entryRelationship:encounter.encounter.statusCode	required	ActStatus http://terminology.hl7.org/ValueSet/v3-ActStatus
Act.entryRelationship:encounter.encounter.priorityCode	example	ActPriority http://terminology.hl7.org/ValueSet/v3-ActPriority
Act.reference:externalDocument.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.reference:externalDocument.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.reference:externalDocument.typeCode	required	XActRelationshipExternalReference http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference
Act.reference:externalDocument.externalDocument.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.reference:externalDocument.externalDocument.typeId.nullFlavor	required	CDANullFlavor http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
Act.reference:externalDocument.externalDocument.classCode	required	ActClassDocument http://terminology.hl7.org/ValueSet/v3-ActClassDocument
Act.reference:externalDocument.externalDocument.moodCode	required	Fixed Value: EVN http://hl7.org/cda/stds/core/ValueSet/CDAActMood
Act.reference:externalDocument.externalDocument.code	example	FHIRDocumentTypeCodes http://hl7.org/fhir/ValueSet/doc-typecodes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
3250-16912	error	Act.text	If @mediaType is present, the text SHALL contain exactly one [1..1] @representation="B64" and mixed content corresponding to the contents of the note (CONF:3250-16912). : mediaType.exists() implies (representation = 'B64' and xmlText.exists())
3250-16914	error	Act.entryRelationship:encounter.encounter.id	If the id does not match an encounter/id from the Encounters Section or encompassingEncounter within the same document and the id does not contain @nullFlavor="NA", then this entry SHALL conform to the Encounter Activity (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.49:2015-08-01) (CONF:3250-16914). :
3250-16930	error	Act.participant:legalAuthenticator.participantRole	If no id matches an author or participant elsewhere in the document, then playingEntity SHALL be present (CONF:3250-16930). :
81-9371	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	The content of name **SHALL** be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). : conformsTo('http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPatientNamePTNUSFIELDED') or item.xmlText.exists()
81-9372	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	The string **SHALL NOT** contain name parts (CONF:81-9372). : item.xmlText.exists() implies (item.delimiter | item.family | item.given | item.prefix | item.suffix).empty()
ivl-ts-center	error	Act.participant:legalAuthenticator.time	Center cannot co-exist with low or high : center.empty() or (low.empty() and high.empty())
ivl-value-shall	error	Act.participant:legalAuthenticator.time	If a time interval contains @value, then it shall be precise to at least the day. : value.exists() implies value.toString().length() >= 10
ivl-value-should	warning	Act.participant:legalAuthenticator.time	If a time interval contains @value, then it SHOULD contain a time component. : value.exists() implies value.toString().length() > 10
pn-no-ls	error	Act.participant:legalAuthenticator.participantRole.playingEntity.name	No PN name part may have a qualifier of LS. : (item.delimiter | item.family | item.given | item.prefix | item.suffix).where(qualifier.where($this = 'LS').exists()).empty()
should-code	warning	Act.reference:externalDocument.externalDocument	SHOULD contain code : code.exists()
should-text-ref-value	warning	Act	SHOULD contain text/reference/@value : text.reference.value.exists()
should-translation	warning	Act.code	SHOULD contain translation : translation.exists()
should-value-att	warning	Act.effectiveTime	SHOULD contain @value : value.exists()
value-starts-octothorpe	error	Act.text.reference	If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative : value.exists() implies value.startsWith('#')

This structure is derived from Act

Summary

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

Structures

This structure refers to these other structures:

• Author Participation (http://hl7.org/cda/us/ccda/StructureDefinition/AuthorParticipation)
• US Realm Date and Time - Interval (http://hl7.org/cda/us/ccda/StructureDefinition/USRealmDateTimeInterval)
• US Realm Person Name (PN.US.FIELDED) (http://hl7.org/cda/us/ccda/StructureDefinition/USRealmPersonNamePNUSFIELDED)

Slices

This structure defines the following Slices:

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