Consolidated CDA (C-CDA)
4.0.0-ballot - STU4 United States of America flag

Consolidated CDA (C-CDA), published by Health Level Seven. This guide is not an authorized publication; it is the continuous build for version 4.0.0-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

: Discharge Summary Complete Header Example - JSON Representation

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// 
 Title:        Discharge Summary

 Based on:     C-CDA_R2_Discharge_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 Discharge 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.
 ********************************************************
 
{
  "resourceType" : "ClinicalDocument",
  "realmCode" : [
    //  ** CDA Header ** 
    {
      "code" : "US"
    }
  ],
  "typeId" : {
    "extension" : "POCD_HD000040",
    "root" : "2.16.840.1.113883.1.3"
  },
  "templateId" : [
    //  US General Header Template 
    {
      "extension" : "2024-05-01",
      "root" : "2.16.840.1.113883.10.20.22.1.1"
    },
    {
      "extension" : "2024-05-01",
      "root" : "2.16.840.1.113883.10.20.22.1.8"
    }
  ],
  "id" : //  *** Note: The next templateId, code and title will differ depending on what type of document is being sent. *** 
  {
    "extension" : "TT988",
    "root" : "2.16.840.1.113883.19.5.99999.1"
  },
  "sdtcCategory" : [
    {
      "code" : "18842-5",
      "codeSystem" : "2.16.840.1.113883.6.1",
      "displayName" : "Discharge summary"
    }
  ],
  "code" : {
    "code" : "18842-5",
    "codeSystem" : "2.16.840.1.113883.6.1",
    "codeSystemName" : "LOINC",
    "displayName" : "Discharge summary"
  },
  "title" : {
    "xmlText" : "Community Health and Hospitals: Discharge Summary"
  },
  "effectiveTime" : {
    "value" : "2014-09-17T19:04:00+05:00"
  },
  "confidentialityCode" : {
    "code" : "N",
    "codeSystem" : "2.16.840.1.113883.5.25"
  },
  "languageCode" : {
    "code" : "en-US"
  },
  "setId" : {
    "extension" : "sTT988",
    "root" : "2.16.840.1.113883.19.5.99999.19"
  },
  "versionNumber" : {
    "value" : 1
  },
  "recordTarget" : [
    {
      "patientRole" : {
        "id" : [
          {
            "extension" : "998991",
            "root" : "2.16.840.1.113883.19.5.99999.2"
          },
          {
            "extension" : "111-00-2330",
            "root" : "2.16.840.1.113883.4.1"
          }
        ],
        "addr" : [
          //  Fake ID using HL7 example OID. 
          //  Fake Social Security Number using the actual SSN OID. 
          //  US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 
          {
            "use" : [
              "HP"
            ],
            "item" : [
              {
                "streetAddressLine" : //  HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 
                {
                  "xmlText" : "1357 Amber Drive"
                }
              },
              {
                "city" : {
                  "xmlText" : "Beaverton"
                }
              },
              {
                "state" : {
                  "xmlText" : "OR"
                }
              },
              {
                "postalCode" : {
                  "xmlText" : "97867"
                }
              },
              {
                "country" : {
                  "xmlText" : "US"
                }
              }
            ]
          }
        ],
        "telecom" : [
          {
            "use" : [
              "HP"
            ],
            "value" : "tel:(816)276-6909"
          }
        ],
        "patient" : //  HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 
        {
          "name" : [
            {
              "use" : [
                "L"
              ],
              "item" : [
                {
                  "given" : [
                    //  L is "Legal" from HL7 EntityNameUse 2.16.840.1.113883.5.45 
                    {
                      "xmlText" : "Isabella"
                    }
                  ]
                },
                {
                  "family" : [
                    {
                      "xmlText" : "Jones"
                    }
                  ]
                }
              ]
            }
          ],
          "administrativeGenderCode" : {
            "code" : "F",
            "codeSystem" : "2.16.840.1.113883.5.1",
            "displayName" : "Female"
          },
          "birthTime" : {
            "value" : "2005-05-01"
          },
          "maritalStatusCode" : {
            "code" : "M",
            "codeSystem" : "2.16.840.1.113883.5.2",
            "codeSystemName" : "MaritalStatusCode",
            "displayName" : "Married"
          },
          "religiousAffiliationCode" : {
            "code" : "1013",
            "codeSystem" : "2.16.840.1.113883.5.1076",
            "codeSystemName" : "HL7 Religious Affiliation",
            "displayName" : "Christian (non-Catholic, non-specific)"
          },
          "raceCode" : {
            "code" : "2028-9",
            "codeSystem" : "2.16.840.1.113883.6.238",
            "codeSystemName" : "Race & Ethnicity - CDC",
            "displayName" : "Asian"
          },
          "ethnicGroupCode" : {
            "code" : "2186-5",
            "codeSystem" : "2.16.840.1.113883.6.238",
            "codeSystemName" : "Race & Ethnicity - CDC",
            "displayName" : "Not Hispanic or Latino"
          },
          "guardian" : [
            {
              "code" : {
                "code" : "GRPRN",
                "codeSystem" : "2.16.840.1.113883.5.111",
                "codeSystemName" : "HL7 Role code",
                "displayName" : "Grandparent"
              },
              "addr" : [
                //  US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 
                {
                  "use" : [
                    "HP"
                  ],
                  "item" : [
                    {
                      "streetAddressLine" : //  HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 
                      {
                        "xmlText" : "1357 Amber Drive"
                      }
                    },
                    {
                      "city" : {
                        "xmlText" : "Beaverton"
                      }
                    },
                    {
                      "state" : {
                        "xmlText" : "OR"
                      }
                    },
                    {
                      "postalCode" : {
                        "xmlText" : "97867"
                      }
                    },
                    {
                      "country" : {
                        "xmlText" : "US"
                      }
                    }
                  ]
                }
              ],
              "telecom" : [
                {
                  "use" : [
                    "HP"
                  ],
                  "value" : "tel:(816)276-6909"
                }
              ],
              "guardianPerson" : {
                "name" : [
                  {
                    "item" : [
                      {
                        "given" : [
                          {
                            "xmlText" : "Ralph"
                          }
                        ]
                      },
                      {
                        "family" : [
                          {
                            "xmlText" : "Jones"
                          }
                        ]
                      }
                    ]
                  }
                ]
              }
            }
          ],
          "birthplace" : {
            "place" : {
              "addr" : {
                "item" : [
                  {
                    "city" : {
                      "xmlText" : "Beaverton"
                    }
                  },
                  {
                    "state" : {
                      "xmlText" : "OR"
                    }
                  },
                  {
                    "postalCode" : {
                      "xmlText" : "97867"
                    }
                  },
                  {
                    "country" : {
                      "xmlText" : "US"
                    }
                  }
                ]
              }
            }
          },
          "languageCommunication" : [
            {
              "languageCode" : {
                "code" : "en"
              },
              "modeCode" : {
                "code" : "ESP",
                "codeSystem" : "2.16.840.1.113883.5.60",
                "codeSystemName" : "LanguageAbilityMode",
                "displayName" : "Expressed spoken"
              },
              "proficiencyLevelCode" : {
                "code" : "G",
                "codeSystem" : "2.16.840.1.113883.5.61",
                "codeSystemName" : "LanguageAbilityProficiency",
                "displayName" : "Good"
              },
              "preferenceInd" : {
                "value" : true
              }
            }
          ]
        },
        "providerOrganization" : {
          "id" : [
            {
              "root" : "2.16.840.1.113883.19.5.9999.1393"
            }
          ],
          "name" : [
            {
              "item" : [
                {
                  "xmlText" : "Community Health and Hospitals"
                }
              ]
            }
          ],
          "telecom" : [
            {
              "use" : [
                "WP"
              ],
              "value" : "tel:555-555-5000"
            }
          ],
          "addr" : [
            {
              "use" : [
                "WP"
              ],
              "item" : [
                {
                  "streetAddressLine" : {
                    "xmlText" : "1001 Village Avenue"
                  }
                },
                {
                  "city" : {
                    "xmlText" : "Portland"
                  }
                },
                {
                  "state" : {
                    "xmlText" : "OR"
                  }
                },
                {
                  "postalCode" : {
                    "xmlText" : "99123"
                  }
                },
                {
                  "country" : {
                    "xmlText" : "US"
                  }
                }
              ]
            }
          ]
        }
      }
    }
  ],
  "author" : [
    {
      "time" : {
        "value" : "2014-09-17T19:04:00+05:00"
      },
      "assignedAuthor" : {
        "id" : [
          {
            "extension" : "99999999",
            "root" : "2.16.840.1.113883.4.6"
          }
        ],
        "code" : {
          "code" : "200000000X",
          "codeSystem" : "2.16.840.1.113883.6.101",
          "displayName" : "Allopathic & Osteopathic Physicians"
        },
        "addr" : [
          {
            "use" : [
              "WP"
            ],
            "item" : [
              {
                "streetAddressLine" : {
                  "xmlText" : "1002 Healthcare Drive"
                }
              },
              {
                "city" : {
                  "xmlText" : "Portland"
                }
              },
              {
                "state" : {
                  "xmlText" : "OR"
                }
              },
              {
                "postalCode" : {
                  "xmlText" : "99123"
                }
              },
              {
                "country" : {
                  "xmlText" : "US"
                }
              }
            ]
          }
        ],
        "telecom" : [
          {
            "use" : [
              "WP"
            ],
            "value" : "tel:555-555-1002"
          }
        ],
        "assignedPerson" : {
          "name" : [
            {
              "item" : [
                {
                  "given" : [
                    {
                      "xmlText" : "Henry"
                    }
                  ]
                },
                {
                  "family" : [
                    {
                      "xmlText" : "Seven"
                    }
                  ]
                }
              ]
            }
          ]
        }
      }
    },
    {
      "time" : {
        "value" : "2014-09-17T19:04:00+05:00"
      },
      "assignedAuthor" : {
        "id" : [
          {
            "nullFlavor" : "NI"
          }
        ],
        "addr" : [
          {
            "use" : [
              "WP"
            ],
            "item" : [
              {
                "streetAddressLine" : {
                  "xmlText" : "1001 Village Avenue"
                }
              },
              {
                "city" : {
                  "xmlText" : "Portland"
                }
              },
              {
                "state" : {
                  "xmlText" : "OR"
                }
              },
              {
                "postalCode" : {
                  "xmlText" : "99123"
                }
              },
              {
                "country" : {
                  "xmlText" : "US"
                }
              }
            ]
          }
        ],
        "telecom" : [
          {
            "use" : [
              "WP"
            ],
            "value" : "tel:+1(555)555-1004"
          }
        ],
        "assignedAuthoringDevice" : {
          "manufacturerModelName" : {
            "xmlText" : "Generic EHR Clinical System 2.0.0.0.0.0"
          },
          "softwareName" : {
            "xmlText" : "Generic EHR C-CDA Factory 2.0.0.0.0.0 - C-CDA Transform 2.0.0.0.0"
          }
        },
        "representedOrganization" : {
          "id" : [
            {
              "root" : "2.16.840.1.113883.19.5.9999.1393"
            }
          ],
          "name" : [
            {
              "item" : [
                {
                  "xmlText" : "Community Health and Hospitals"
                }
              ]
            }
          ],
          "telecom" : [
            {
              "use" : [
                "WP"
              ],
              "value" : "tel:555-555-5000"
            }
          ],
          "addr" : [
            {
              "item" : [
                {
                  "streetAddressLine" : {
                    "xmlText" : "1001 Village Avenue"
                  }
                },
                {
                  "city" : {
                    "xmlText" : "Portland"
                  }
                },
                {
                  "state" : {
                    "xmlText" : "OR"
                  }
                },
                {
                  "postalCode" : {
                    "xmlText" : "99123"
                  }
                },
                {
                  "country" : {
                    "xmlText" : "US"
                  }
                }
              ]
            }
          ]
        }
      }
    }
  ],
  "dataEnterer" : {
    "assignedEntity" : {
      "id" : [
        {
          "extension" : "999999943252",
          "root" : "2.16.840.1.113883.4.6"
        }
      ],
      "addr" : [
        {
          "use" : [
            "WP"
          ],
          "item" : [
            {
              "streetAddressLine" : {
                "xmlText" : "1001 Village Avenue"
              }
            },
            {
              "city" : {
                "xmlText" : "Portland"
              }
            },
            {
              "state" : {
                "xmlText" : "OR"
              }
            },
            {
              "postalCode" : {
                "xmlText" : "99123"
              }
            },
            {
              "country" : {
                "xmlText" : "US"
              }
            }
          ]
        }
      ],
      "telecom" : [
        {
          "use" : [
            "WP"
          ],
          "value" : "tel:555-555-1002"
        }
      ],
      "assignedPerson" : {
        "name" : [
          {
            "item" : [
              {
                "given" : [
                  {
                    "xmlText" : "Henry"
                  }
                ]
              },
              {
                "family" : [
                  {
                    "xmlText" : "Seven"
                  }
                ]
              }
            ]
          }
        ]
      }
    }
  },
  "informant" : [
    {
      "assignedEntity" : {
        "id" : [
          {
            "extension" : "KP00017",
            "root" : "2.16.840.1.113883.19.5"
          }
        ],
        "addr" : [
          {
            "use" : [
              "WP"
            ],
            "item" : [
              {
                "streetAddressLine" : {
                  "xmlText" : "1001 Village Avenue"
                }
              },
              {
                "city" : {
                  "xmlText" : "Portland"
                }
              },
              {
                "state" : {
                  "xmlText" : "OR"
                }
              },
              {
                "postalCode" : {
                  "xmlText" : "99123"
                }
              },
              {
                "country" : {
                  "xmlText" : "US"
                }
              }
            ]
          }
        ],
        "telecom" : [
          {
            "use" : [
              "WP"
            ],
            "value" : "tel:555-555-1002"
          }
        ],
        "assignedPerson" : {
          "name" : [
            {
              "item" : [
                {
                  "given" : [
                    {
                      "xmlText" : "Henry"
                    }
                  ]
                },
                {
                  "family" : [
                    {
                      "xmlText" : "Seven"
                    }
                  ]
                }
              ]
            }
          ]
        }
      }
    },
    {
      "relatedEntity" : {
        "classCode" : "PRS",
        "code" : //  classCode PRS represents a person with personal relationship with
        the patient. 
        {
          "code" : "SPS",
          "codeSystem" : "2.16.840.1.113883.1.11.19563",
          "codeSystemName" : "Personal Relationship Role Type Value Set",
          "displayName" : "SPOUSE"
        },
        "relatedPerson" : {
          "name" : [
            {
              "item" : [
                {
                  "given" : [
                    {
                      "xmlText" : "Frank"
                    }
                  ]
                },
                {
                  "family" : [
                    {
                      "xmlText" : "Jones"
                    }
                  ]
                }
              ]
            }
          ]
        }
      }
    }
  ],
  "custodian" : {
    "assignedCustodian" : {
      "representedCustodianOrganization" : {
        "id" : [
          {
            "extension" : "99999999",
            "root" : "2.16.840.1.113883.4.6"
          }
        ],
        "name" : {
          "item" : [
            {
              "xmlText" : "Community Health and Hospitals"
            }
          ]
        },
        "telecom" : {
          "use" : [
            "WP"
          ],
          "value" : "tel:555-555-1002"
        },
        "addr" : {
          "use" : [
            "WP"
          ],
          "item" : [
            {
              "streetAddressLine" : {
                "xmlText" : "1001 Village Avenue"
              }
            },
            {
              "city" : {
                "xmlText" : "Portland"
              }
            },
            {
              "state" : {
                "xmlText" : "OR"
              }
            },
            {
              "postalCode" : {
                "xmlText" : "99123"
              }
            },
            {
              "country" : {
                "xmlText" : "US"
              }
            }
          ]
        }
      }
    }
  },
  "informationRecipient" : [
    {
      "intendedRecipient" : {
        "informationRecipient" : {
          "name" : [
            {
              "item" : [
                {
                  "given" : [
                    {
                      "xmlText" : "Henry"
                    }
                  ]
                },
                {
                  "family" : [
                    {
                      "xmlText" : "Seven"
                    }
                  ]
                }
              ]
            }
          ]
        },
        "receivedOrganization" : {
          "name" : [
            {
              "item" : [
                {
                  "xmlText" : "Community Health and Hospitals"
                }
              ]
            }
          ]
        }
      }
    }
  ],
  "legalAuthenticator" : {
    "time" : {
      "value" : "2014-09-17T19:04:00+05:00"
    },
    "signatureCode" : {
      "code" : "S"
    },
    "assignedEntity" : {
      "id" : [
        {
          "extension" : "999999999",
          "root" : "2.16.840.1.113883.4.6"
        }
      ],
      "addr" : [
        {
          "use" : [
            "WP"
          ],
          "item" : [
            {
              "streetAddressLine" : {
                "xmlText" : "1001 Village Avenue"
              }
            },
            {
              "city" : {
                "xmlText" : "Portland"
              }
            },
            {
              "state" : {
                "xmlText" : "OR"
              }
            },
            {
              "postalCode" : {
                "xmlText" : "99123"
              }
            },
            {
              "country" : {
                "xmlText" : "US"
              }
            }
          ]
        }
      ],
      "telecom" : [
        {
          "use" : [
            "WP"
          ],
          "value" : "tel:555-555-1002"
        }
      ],
      "assignedPerson" : {
        "name" : [
          {
            "item" : [
              {
                "given" : [
                  {
                    "xmlText" : "Henry"
                  }
                ]
              },
              {
                "family" : [
                  {
                    "xmlText" : "Seven"
                  }
                ]
              }
            ]
          }
        ]
      }
    }
  },
  "authenticator" : [
    {
      "time" : {
        "value" : "2014-09-17T19:04:00+05:00"
      },
      "signatureCode" : {
        "code" : "S"
      },
      "assignedEntity" : {
        "id" : [
          {
            "extension" : "999999999",
            "root" : "2.16.840.1.113883.4.6"
          }
        ],
        "addr" : [
          {
            "use" : [
              "WP"
            ],
            "item" : [
              {
                "streetAddressLine" : {
                  "xmlText" : "1001 Village Avenue"
                }
              },
              {
                "city" : {
                  "xmlText" : "Portland"
                }
              },
              {
                "state" : {
                  "xmlText" : "OR"
                }
              },
              {
                "postalCode" : {
                  "xmlText" : "99123"
                }
              },
              {
                "country" : {
                  "xmlText" : "US"
                }
              }
            ]
          }
        ],
        "telecom" : [
          {
            "use" : [
              "WP"
            ],
            "value" : "tel:555-555-1002"
          }
        ],
        "assignedPerson" : {
          "name" : [
            {
              "item" : [
                {
                  "given" : [
                    {
                      "xmlText" : "Henry"
                    }
                  ]
                },
                {
                  "family" : [
                    {
                      "xmlText" : "Seven"
                    }
                  ]
                }
              ]
            }
          ]
        }
      }
    }
  ],
  "participant" : [
    {
      "typeCode" : "IND",
      "time" : {
        "low" : {
          "value" : "1989-01-01"
        },
        "high" : {
          "value" : "2014-09-16"
        }
      },
      "associatedEntity" : {
        "classCode" : "NOK",
        "code" : {
          "code" : "MTH",
          "codeSystem" : "2.16.840.1.113883.5.111"
        },
        "addr" : [
          {
            "item" : [
              {
                "streetAddressLine" : {
                  "xmlText" : "17 Daws Rd."
                }
              },
              {
                "city" : {
                  "xmlText" : "Beaverton"
                }
              },
              {
                "state" : {
                  "xmlText" : "OR"
                }
              },
              {
                "postalCode" : {
                  "xmlText" : "97867"
                }
              },
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