Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 4.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-ccda/ and changes regularly. See the Directory of published versions
@prefix fhir: <http://hl7.org/fhir/> . @prefix owl: <http://www.w3.org/2002/07/owl#> . @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> . @prefix xsd: <http://www.w3.org/2001/XMLSchema#> . # - resource ------------------------------------------------------------------- # Title: Transfer Summary Based on: C-CDA_R2_Transfer_Summary.xml Updated for C-CDA R3.0 with a focus on header elements - required/suggested sections are populated with nullFlavor="NI" to demonstrate WHICH sections should be included, but they all contain "No information" as this is an example of the header ******************************************************** Disclaimer: This sample file contains representative data elements to represent a Transfer Summary. The file depicts a fictional character's health data. Any resemblance to a real person is coincidental. To illustrate as many data elements as possible, the clinical scenario may not be plausible. The data in this sample file is not intended to represent real patients, people or clinical events. This sample is designed to be used in conjunction with the C-CDA Clinical Notes Implementation Guide. ******************************************************** a fhir:ClinicalDocument ; fhir:nodeRole fhir:treeRoot ; fhir:realmCode ( [ fhir:code [ fhir:v "US" ] ] ) ; # ** CDA Header ** fhir:typeId [ fhir:extension [ fhir:v "POCD_HD000040" ] ; fhir:root [ fhir:v "2.16.840.1.113883.1.3" ] ] ; # fhir:templateId ( [ fhir:extension [ fhir:v "2024-05-01" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.1.1" ] ] [ fhir:extension [ fhir:v "2024-05-01" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.1.13" ] ] ) ; # Identifies document as conformant to US Realm Header (V2) Template fhir:id [ fhir:root [ fhir:v "04fc2b90-10e0-11e2-892e-0800200c9a66" ] ] ; # fhir:sdtcCategory ( [ fhir:code [ fhir:v "18761-7" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:displayName [ fhir:v "Transfer summary note" ] ] ) ; # fhir:code [ fhir:code [ fhir:v "18761-7" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "Transfer summary note" ] ] ; # fhir:title [ fhir:xmlText [ fhir:v "Transfer Summary" ] ] ; # fhir:effectiveTime [ fhir:value [ fhir:v "2013-09-21T05:00:00-08:00"^^xsd:dateTime ] ] ; # fhir:confidentialityCode [ fhir:code [ fhir:v "N" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.25" ] ] ; # fhir:languageCode [ fhir:code [ fhir:v "en" ] ] ; # fhir:setId [ fhir:extension [ fhir:v "sTT988" ] ; fhir:root [ fhir:v "2.16.840.1.113883.19.5.99999.19" ] ] ; # fhir:versionNumber [ fhir:value [ fhir:v "1"^^xsd:integer ] ] ; # fhir:recordTarget ( [ fhir:patientRole [ ( fhir:id [ fhir:extension [ fhir:v "444222222" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.1" ] ] ) ; ( fhir:addr [ ( fhir:use [ fhir:v "HP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "2222 Home Street" ] ] # HP is \"primary home\" from codeSystem 2.16.840.1.113883.5.1119 ] [ fhir:city [ fhir:xmlText [ fhir:v "Beaverton" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "97867" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; # Example Social Security Number using the actual SSN OID. , US is \"United States\" from ISO 3166-1 Country Codes: 1.0.3166.1 ( fhir:telecom [ ( fhir:use [ fhir:v "HP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-2003"^^xsd:anyURI ] ] ) ; fhir:patient [ ( fhir:name [ ( fhir:use [ fhir:v "L" ] ) ; ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Eve" ] ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Betterhalf" ] ; ( fhir:qualifier [ fhir:v "SP" ] ) ] ) # The \"SP\" is \"Spouse\" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 ] ) ] [ ( fhir:use [ fhir:v "SRCH" ] ) ; ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Eve" ] ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Everywoman" ] ; ( fhir:qualifier [ fhir:v "BR" ] ) ] ) # The \"BR\" is \"Birth\" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 ] ) ] ) ; # The first name element represents what the patient is known as fhir:administrativeGenderCode [ fhir:code [ fhir:v "F" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.1" ] ; fhir:codeSystemName [ fhir:v "AdministrativeGender" ] ; fhir:displayName [ fhir:v "Female" ] ] ; fhir:birthTime [ fhir:value [ fhir:v "1945-05-01"^^xsd:date ] ] ; # Date of birth need only be precise to the day fhir:maritalStatusCode [ fhir:code [ fhir:v "M" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.2" ] ; fhir:codeSystemName [ fhir:v "MaritalStatusCode" ] ; fhir:displayName [ fhir:v "Married" ] ] ; fhir:religiousAffiliationCode [ fhir:code [ fhir:v "1013" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.1076" ] ; fhir:codeSystemName [ fhir:v "HL7 Religious Affiliation" ] ; fhir:displayName [ fhir:v "Christian (non-Catholic, non-specific)" ] ] ; fhir:raceCode [ fhir:code [ fhir:v "2106-3" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ; fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ; fhir:displayName [ fhir:v "White" ] ] ; # CDC Race and Ethnicity code set contains the five minimum race and ethnicity \n categories defined by OMB Standards ( fhir:sdtcRaceCode [ fhir:code [ fhir:v "2076-8" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ; fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ; fhir:displayName [ fhir:v "Native Hawaiian or Other Pacific Islander" ] ] ) ; # The raceCode extension is only used if raceCode is valued fhir:ethnicGroupCode [ fhir:code [ fhir:v "2186-5" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.238" ] ; fhir:codeSystemName [ fhir:v "Race & Ethnicity - CDC" ] ; fhir:displayName [ fhir:v "Not Hispanic or Latino" ] ] ; ( fhir:guardian [ fhir:code [ fhir:code [ fhir:v "POWATT" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.111" ] ; fhir:codeSystemName [ fhir:v "RoleCode" ] ; fhir:displayName [ fhir:v "Power of Attorney" ] ] ; ( fhir:addr [ ( fhir:use [ fhir:v "HP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "2222 Home Street" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Beaverton" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "97867" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "MC" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-2008"^^xsd:anyURI ] ] ) ; fhir:guardianPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Boris" ] ] ) ] [ ( fhir:given [ fhir:xmlText [ fhir:v "Bo" ] ; ( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Betterhalf" ] ] ) ] ) ] ) ] ] ) ; fhir:birthplace [ fhir:place [ fhir:addr [ ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "4444 Home Street" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Beaverton" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "97867" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ] ] ; ( fhir:languageCommunication [ fhir:languageCode [ fhir:code [ fhir:v "en" ] ] ; fhir:modeCode [ fhir:code [ fhir:v "ESP" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.60" ] ; fhir:codeSystemName [ fhir:v "LanguageAbilityMode" ] ; fhir:displayName [ fhir:v "Expressed spoken" ] ] ; fhir:proficiencyLevelCode [ fhir:code [ fhir:v "G" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.61" ] ; fhir:codeSystemName [ fhir:v "LanguageAbilityProficiency" ] ; fhir:displayName [ fhir:v "Good" ] ] ; fhir:preferenceInd [ fhir:value [ fhir:v "true"^^xsd:boolean ] ] # Patient's preferred language ] ) ] ; # HP is \"primary home\" from HL7 AddressUse 2.16.840.1.113883.5.1119 fhir:providerOrganization [ ( fhir:id [ fhir:extension [ fhir:v "219BX" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; ( fhir:name [ ( fhir:item [ fhir:xmlText [ fhir:v "The DoctorsTogether Physician Group" ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-5000"^^xsd:anyURI ] ] ) ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1007 Health Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ] ] ] ) ; # fhir:author ( [ fhir:typeCode [ fhir:v "AUT" ] ; ( fhir:templateId [ fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.4.119" ] ] ) ; fhir:time [ fhir:value [ fhir:v "2013-07-30"^^xsd:date ] ] ; fhir:assignedAuthor [ ( fhir:id [ fhir:extension [ fhir:v "5555555555" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; fhir:code [ fhir:code [ fhir:v "207QA0505X" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ; fhir:codeSystemName [ fhir:v "Healthcare Provider Taxonomy (HIPAA)" ] ; fhir:displayName [ fhir:v "Adult Medicine Physician" ] ] ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1004 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1004"^^xsd:anyURI ] ] ) ; fhir:assignedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Patricia" ] ] ) ] [ ( fhir:given [ fhir:xmlText [ fhir:v "Patty" ] ; ( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Primary" ] ] ) ] [ ( fhir:suffix [ fhir:xmlText [ fhir:v "M.D." ] ; ( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ] ] ) ; # The author represents the person who provides the content in the document fhir:dataEnterer [ fhir:assignedEntity [ ( fhir:id [ fhir:extension [ fhir:v "333777777" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1007 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1050"^^xsd:anyURI ] ] ) ; fhir:assignedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Ellen" ] ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Enter" ] ] ) ] ) ] ) ] ] ] ; # The dataEnterer transferred the content created by the author into the document fhir:informant ( [ fhir:assignedEntity [ ( fhir:id [ fhir:extension [ fhir:v "888888888" ] ; fhir:root [ fhir:v "2.16.840.1.113883.19.5" ] ] ) ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1007 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1003"^^xsd:anyURI ] ] ) ; fhir:assignedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Harold" ] ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Hippocrates" ] ] ) ] [ ( fhir:suffix [ fhir:xmlText [ fhir:v "D.O." ] ; ( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ] ] [ fhir:relatedEntity [ fhir:classCode [ fhir:v "PRS" ] ; fhir:code [ fhir:code [ fhir:v "SPS" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.1.11.19563" ] ; fhir:codeSystemName [ fhir:v "Personal Relationship Role Type Value Set" ] ; fhir:displayName [ fhir:v "SPOUSE" ] ] ; # classCode PRS represents a person with personal relationship with the patient. fhir:relatedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Rose" ] ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Everyman" ] ] ) ] ) ] ) ] ] ] ) ; # The informant represents any sources of information for document content fhir:custodian [ fhir:assignedCustodian [ fhir:representedCustodianOrganization [ ( fhir:id [ fhir:extension [ fhir:v "321CX" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; fhir:name [ ( fhir:item [ fhir:xmlText [ fhir:v "Good Health HIE" ] ] ) ] ; fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1009"^^xsd:anyURI ] ] ; fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1009 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ] ] ] ; # The custodian represents the organization charged with maintaining the original source document fhir:informationRecipient ( [ fhir:intendedRecipient [ fhir:informationRecipient [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Sara" ] ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Specialize" ] ] ) ] [ ( fhir:suffix [ fhir:xmlText [ fhir:v "M.D." ] ; ( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ; fhir:receivedOrganization [ ( fhir:name [ ( fhir:item [ fhir:xmlText [ fhir:v "The DoctorsApart Physician Group" ] ] ) ] ) ] ] ] ) ; # The informationRecipient represents the intended recipient of the document fhir:legalAuthenticator [ fhir:time [ fhir:value [ fhir:v "2013-09-15T22:36:15-08:00"^^xsd:dateTime ] ] ; fhir:signatureCode [ fhir:code [ fhir:v "S" ] ] ; fhir:assignedEntity [ ( fhir:id [ fhir:extension [ fhir:v "5555555555" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; fhir:code [ fhir:code [ fhir:v "207QA0505X" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ; fhir:codeSystemName [ fhir:v "Healthcare Provider Taxonomy (HIPAA)" ] ; fhir:displayName [ fhir:v "Adult Medicine Physician" ] ] ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1004 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1004"^^xsd:anyURI ] ] ) ; fhir:assignedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Patricia" ] ] ) ] [ ( fhir:given [ fhir:xmlText [ fhir:v "Patty" ] ; ( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Primary" ] ] ) ] [ ( fhir:suffix [ fhir:xmlText [ fhir:v "M.D." ] ; ( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ] ] ; # The legalAuthenticator represents the individual who is responsible for the document fhir:authenticator ( [ fhir:time [ fhir:value [ fhir:v "2012-09-15T10:30:00-08:00"^^xsd:dateTime ] ] ; fhir:signatureCode [ fhir:code [ fhir:v "S" ] ] ; fhir:assignedEntity [ ( fhir:id [ fhir:extension [ fhir:v "5555555555" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; fhir:code [ fhir:code [ fhir:v "207QA0505X" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ; fhir:codeSystemName [ fhir:v "Healthcare Provider Taxonomy (HIPAA)" ] ; fhir:displayName [ fhir:v "Adult Medicine" ] ] ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1004 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1004"^^xsd:anyURI ] ] ) ; fhir:assignedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Patricia" ] ] ) ] [ ( fhir:given [ fhir:xmlText [ fhir:v "Patty" ] ; ( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Primary" ] ] ) ] [ ( fhir:suffix [ fhir:xmlText [ fhir:v "M.D." ] ; ( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ] ] ) ; # The authenticator represents the individual attesting to the accuracy of information in the document fhir:participant ( [ fhir:typeCode [ fhir:v "CALLBCK" ] ; fhir:time [ fhir:value [ fhir:v "2005-03-29T22:44:11+05:00"^^xsd:dateTime ] ] ; fhir:associatedEntity [ fhir:classCode [ fhir:v "ASSIGNED" ] ; ( fhir:id [ fhir:extension [ fhir:v "99999999" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; fhir:code [ fhir:code [ fhir:v "200000000X" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ; fhir:displayName [ fhir:v "Allopathic & Osteopathic Physicians" ] ] ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1002 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Ann Arbor" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "MI" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "97857" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:555-555-1002"^^xsd:anyURI ] ] ) ; fhir:associatedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Henry" ] ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Seven" ] ] ) ] [ ( fhir:suffix [ fhir:xmlText [ fhir:v "DO" ] ] ) ] ) ] ) ] ] ] [ fhir:typeCode [ fhir:v "IND" ] ; fhir:functionCode [ fhir:code [ fhir:v "407543004" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.96" ] ; fhir:codeSystemName [ fhir:v "SNOMED-CT" ] ; fhir:displayName [ fhir:v "Primary Carer" ] ] ; fhir:associatedEntity [ fhir:classCode [ fhir:v "CAREGIVER" ] ; fhir:code [ fhir:code [ fhir:v "MTH" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.111" ] ] ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "17 Daws Rd." ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Ann Arbor" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "MI" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "97857" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:1+(555)555-1212"^^xsd:anyURI ] ] ) ; fhir:associatedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:prefix [ fhir:xmlText [ fhir:v "Mrs." ] ] ) ] [ ( fhir:given [ fhir:xmlText [ fhir:v "Martha" ] ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Jones" ] ] ) ] ) ] ) ] ] # Caregiver ] ) ; # Contact Person fhir:documentationOf ( [ fhir:typeCode [ fhir:v "DOC" ] ; fhir:serviceEvent [ fhir:classCode [ fhir:v "PCPR" ] ; fhir:effectiveTime [ fhir:low [ fhir:value [ fhir:v "2013-06-01T10:30:00-08:00"^^xsd:dateTime ] ] ; fhir:high [ fhir:value [ fhir:v "2013-08-15T22:00:00-08:00"^^xsd:dateTime ] ] ] ; ( fhir:performer [ fhir:typeCode [ fhir:v "PRF" ] ; fhir:functionCode [ fhir:code [ fhir:v "PCP" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.5.88" ] ; fhir:codeSystemName [ fhir:v "ParticipationFunction" ] ; fhir:displayName [ fhir:v "primary care physician" ] ; fhir:originalText [ fhir:xmlText [ fhir:v "Primary Care Provider" ] ] ] ; fhir:assignedEntity [ ( fhir:id [ fhir:extension [ fhir:v "5555555555" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; fhir:code [ fhir:code [ fhir:v "207QA0505X" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ; fhir:codeSystemName [ fhir:v "Healthcare Provider Taxonomy (HIPAA)" ] ; fhir:displayName [ fhir:v "Adult Medicine Physician" ] ] ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1004 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1004"^^xsd:anyURI ] ] ) ; fhir:assignedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Patricia" ] ] ) ] [ ( fhir:given [ fhir:xmlText [ fhir:v "Patty" ] ; ( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Primary" ] ] ) ] [ ( fhir:suffix [ fhir:xmlText [ fhir:v "M.D." ] ; ( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ; fhir:representedOrganization [ ( fhir:id [ fhir:extension [ fhir:v "219BX" ] ; fhir:root [ fhir:v "1.1.1.1.1.1.1.1.2" ] ] ) ; ( fhir:name [ ( fhir:item [ fhir:xmlText [ fhir:v "Good Health Hospital" ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-5000"^^xsd:anyURI ] ] ) ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1004 Health Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Portland" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "OR" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ] ] ] [ fhir:typeCode [ fhir:v "PRF" ] ; fhir:assignedEntity [ ( fhir:id [ fhir:extension [ fhir:v "5555555555" ] ; fhir:root [ fhir:v "2.16.840.1.113883.4.6" ] ] ) ; fhir:code [ fhir:code [ fhir:v "207RN0300X" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.101" ] ; fhir:codeSystemName [ fhir:v "Healthcare Provider Taxonomy (HIPAA)" ] ; fhir:displayName [ fhir:v "Nephrology Physician" ] ] ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1004 Healthcare Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v "Ann Arbor" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "MA" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1038"^^xsd:anyURI ] ] ) ; fhir:assignedPerson [ ( fhir:name [ ( fhir:item [ ( fhir:given [ fhir:xmlText [ fhir:v "Rory" ] ] ) ] [ ( fhir:given [ fhir:xmlText [ fhir:v "Renal" ] ; ( fhir:qualifier [ fhir:v "CL" ] ) ] ) ] [ ( fhir:family [ fhir:xmlText [ fhir:v "Primary" ] ] ) ] [ ( fhir:suffix [ fhir:xmlText [ fhir:v "M.D." ] ; ( fhir:qualifier [ fhir:v "AC" ] ) ] ) ] ) ] ) ] ; fhir:representedOrganization [ ( fhir:id [ fhir:extension [ fhir:v "219BX" ] ; fhir:root [ fhir:v "1.1.1.1.1.1.1.1.2" ] ] ) ; ( fhir:name [ ( fhir:item [ fhir:xmlText [ fhir:v "Good Health Hospital" ] ] ) ] ) ; ( fhir:telecom [ ( fhir:use [ fhir:v "WP" ] ) ; fhir:value [ fhir:v "tel:+1(555)555-1039"^^xsd:anyURI ] ] ) ; ( fhir:addr [ ( fhir:use [ fhir:v "WP" ] ) ; ( fhir:item [ fhir:streetAddressLine [ fhir:xmlText [ fhir:v "1036 Health Drive" ] ] ] [ fhir:city [ fhir:xmlText [ fhir:v ">Ann Arbor" ] ] ] [ fhir:state [ fhir:xmlText [ fhir:v "MA" ] ] ] [ fhir:postalCode [ fhir:xmlText [ fhir:v "99123" ] ] ] [ fhir:country [ fhir:xmlText [ fhir:v "US" ] ] ] ) ] ) ] ] ] ) ] ] ) ; # fhir:component [ fhir:structuredBody [ ( fhir:component [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2015-08-01" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.22.1" ] ] ) ; # *** Encounters section (entries required) (V3) *** fhir:code [ fhir:code [ fhir:v "46240-8" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "History of encounters" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "ENCOUNTERS" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2015-08-01" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.17" ] ] ) ; # ** Social History Section (V3) ** fhir:code [ fhir:code [ fhir:v "29762-2" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "Social History" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "SOCIAL HISTORY" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2015-08-01" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.6.1" ] ] ) ; # *** Allergies and Intolerances Section (entries required) (V3) *** fhir:code [ fhir:code [ fhir:v "48765-2" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "ALLERGIES AND ADVERSE REACTIONS" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2015-08-01" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.5.1" ] ] ) ; # *** Problem Section (entries required) (V3) *** fhir:code [ fhir:code [ fhir:v "11450-4" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "PROBLEM LIST" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "PROBLEMS" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2014-06-09" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.1.1" ] ] ) ; # *** Medications Section (entries required) (V2) *** fhir:code [ fhir:code [ fhir:v "10160-0" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "HISTORY OF MEDICATION USE" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "MEDICATIONS" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2015-08-01" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.3.1" ] ] ) ; # Results Section (entries required) (V3) fhir:code [ fhir:code [ fhir:v "30954-2" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "RESULTS" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "RESULTS" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2015-08-01" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.4.1" ] ] ) ; # ** Vital Signs Section (entries required) (V3) ** fhir:code [ fhir:code [ fhir:v "8716-3" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "VITAL SIGNS" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "VITAL SIGNS" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2014-06-09" ] ; fhir:root [ fhir:v "2.16.840.1.113883.10.20.22.2.9" ] ] ) ; fhir:code [ fhir:code [ fhir:v "51847-2" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "Evaluation + Plan note" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "ASSESSMENT AND PLAN" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] [ fhir:section [ fhir:nullFlavor [ fhir:v "NI" ] ; ( fhir:templateId [ fhir:extension [ fhir:v "2014-06-09" ] ; fhir:root [ fhir:v "1.3.6.1.4.1.19376.1.5.3.1.3.1" ] ] ) ; fhir:code [ fhir:code [ fhir:v "42349-1" ] ; fhir:codeSystem [ fhir:v "2.16.840.1.113883.6.1" ] ; fhir:codeSystemName [ fhir:v "LOINC" ] ; fhir:displayName [ fhir:v "Reason for Referral" ] ] ; fhir:title [ fhir:xmlText [ fhir:v "REASON FOR REFERRAL" ] ] ; fhir:text "<div xmlns=\"http://www.w3.org/1999/xhtml\">No information</div>" ] ] ) # ******************** ENCOUNTERS ************************ ] # All sections are set to nullFlavor \/ text = No information, \n as this is a header example, not a complete body example ] . #
IG © 2019+ Health Level Seven. Package hl7.cda.us.ccda#4.0.0-ballot based on FHIR 5.0.0. Generated 2024-11-21
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