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
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<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2024-05-01"/>
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<code displayName="Summarization of Episode Note" codeSystemName="LOINC"
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<!-- Title of the document -->
<title>Patient Chart Summary</title>
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codeSystem="2.16.840.1.113883.5.25" code="N"/>
<languageCode code="en-US"/>
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<!-- Version of the document -->
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<patientRole>
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<!-- Example Social Security Number using the actual SSN OID. -->
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
<addr use="HP">
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<streetAddressLine>2222 Home Street</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
</addr>
<telecom value="tel:+1(555)555-2003" use="HP"/>
<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
<patient>
<name use="L">
<given>Eve</given>
<!-- The "SP" is "Spouse" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
<family qualifier="SP">Betterhalf</family>
</name>
<administrativeGenderCode displayName="Female"
codeSystemName="AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"
code="F"/>
<!-- Date of birth need only be precise to the day -->
<birthTime value="19750501"/>
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<maritalStatusCode displayName="Married"
codeSystemName="MaritalStatusCode" codeSystem="2.16.840.1.113883.5.2" code="M"/>
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displayName="Christian (non-Catholic, non-specific)" codeSystemName="HL7 Religious Affiliation"
codeSystem="2.16.840.1.113883.5.1076" code="1013"/>
<!-- CDC Race and Ethnicity code set contains the five minimum race and ethnicity
categories defined by OMB Standards -->
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<sdtc:sdtcRaceCode xmlns:sdtc="urn:hl7-org:sdtc"
displayName="Native Hawaiian or Other Pacific Islander" codeSystemName="Race & Ethnicity - CDC"
codeSystem="2.16.840.1.113883.6.238" code="2076-8"/>
<ethnicGroupCode displayName="Not Hispanic or Latino"
codeSystemName="Race & Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" code="2186-5"/>
<guardian>
<code displayName="Power of Attorney" codeSystemName="RoleCode"
codeSystem="2.16.840.1.113883.5.111" code="POWATT"/>
<addr use="HP">
<streetAddressLine>2222 Home Street</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
</addr>
<telecom value="tel:+1(555)555-2008" use="MC"/>
<guardianPerson>
<name>
<given>Boris</given>
<given qualifier="CL">Bo</given>
<family>Betterhalf</family>
</name>
</guardianPerson>
</guardian>
<birthplace>
<place>
<addr>
<streetAddressLine>4444 Home Street</streetAddressLine>
<city>Beaverton</city>
<state>OR</state>
<postalCode>97867</postalCode>
<country>US</country>
</addr>
</place>
</birthplace>
<languageCommunication>
<languageCode code="en"/>
<!-- "en" is ISO 639-1 alpha-2 code for "English" -->
<modeCode displayName="Expressed spoken"
codeSystemName="LanguageAbilityMode" codeSystem="2.16.840.1.113883.5.60" code="ESP"/>
<proficiencyLevelCode displayName="Good"
codeSystemName="LanguageAbilityProficiency" codeSystem="2.16.840.1.113883.5.61" code="G"/>
<!-- Patient's preferred language -->
<preferenceInd value="true"/>
</languageCommunication>
</patient>
</patientRole>
</recordTarget>
<!-- The author represents the person who provides the content in the document -->
<author>
<time value="20130815103000-0800"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="5555555555"/>
<code displayName="Adult Medicine Physician"
codeSystemName="Healthcare Provider Taxonomy (HIPAA)" codeSystem="2.16.840.1.113883.6.101" code="207QA0505X"/>
<addr use="WP">
<streetAddressLine>1004 Healthcare Drive</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
<telecom value="tel:+1(555)555-1004" use="WP"/>
<assignedPerson>
<name>
<given>Patricia</given>
<given qualifier="CL">Patty</given>
<family>Primary</family>
<suffix qualifier="AC">M.D.</suffix>
</name>
</assignedPerson>
</assignedAuthor>
</author>
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<custodian>
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<id root="2.16.840.1.113883.4.6" extension="321CX"/>
<name>Good Health HIE</name>
<telecom value="tel:+1(555)555-1009" use="WP"/>
<addr use="WP">
<streetAddressLine>1009 Healthcare Drive</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
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<informationRecipient>
<intendedRecipient classCode="ASSIGNED">
<addr>
<streetAddressLine>1004 Healthcare Drive</streetAddressLine>
<city>Portland</city>
<state>OR</state>
<postalCode>99123</postalCode>
<country>US</country>
</addr>
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