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
//
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.
********************************************************
{
"resourceType" : "ClinicalDocument",
"realmCode" : [
// ** CDA Header **
{
"code" : "US"
}
],
"typeId" : {
"extension" : "POCD_HD000040",
"root" : "2.16.840.1.113883.1.3"
},
"templateId" : [
// Identifies document as conformant to US Realm Header (V2) Template
{
"extension" : "2024-05-01",
"root" : "2.16.840.1.113883.10.20.22.1.1"
},
{
"extension" : "2024-05-01",
"root" : "2.16.840.1.113883.10.20.22.1.13"
}
],
"id" : // Transfer Summary Document
{
"root" : "04fc2b90-10e0-11e2-892e-0800200c9a66"
},
"sdtcCategory" : [
{
"code" : "18761-7",
"codeSystem" : "2.16.840.1.113883.6.1",
"displayName" : "Transfer summary note"
}
],
"code" : {
"code" : "18761-7",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "Transfer summary note"
},
"title" : {
"xmlText" : "Transfer Summary"
},
"effectiveTime" : {
"value" : "2013-09-21T05:00:00-08:00"
},
"confidentialityCode" : {
"code" : "N",
"codeSystem" : "2.16.840.1.113883.5.25"
},
"languageCode" : {
"code" : "en"
},
"setId" : {
"extension" : "sTT988",
"root" : "2.16.840.1.113883.19.5.99999.19"
},
"versionNumber" : {
"value" : 1
},
"recordTarget" : [
{
"patientRole" : {
"id" : [
{
"extension" : "444222222",
"root" : "2.16.840.1.113883.4.1"
}
],
"addr" : [
// Example 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" : "2222 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "97867"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"HP"
],
"value" : "tel:+1(555)555-2003"
}
],
"patient" : // HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119
{
"name" : [
// The first name element represents what the patient is known as
{
"use" : [
"L"
],
"item" : [
{
"given" : [
{
"xmlText" : "Eve"
}
]
},
{
"family" : [
// The "SP" is "Spouse" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43
{
"xmlText" : "Betterhalf",
"qualifier" : [
"SP"
]
}
]
}
]
},
{
"use" : [
"SRCH"
],
"item" : [
{
"given" : [
{
"xmlText" : "Eve"
}
]
},
{
"family" : [
// The "BR" is "Birth" from HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43
{
"xmlText" : "Everywoman",
"qualifier" : [
"BR"
]
}
]
}
]
}
],
"administrativeGenderCode" : // The second name element represents another name associated with the patient
{
"code" : "F",
"codeSystem" : "2.16.840.1.113883.5.1",
"codeSystemName" : "AdministrativeGender",
"displayName" : "Female"
},
"birthTime" : // Date of birth need only be precise to the day
{
"value" : "1945-05-01"
},
"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" : // CDC Race and Ethnicity code set contains the five minimum race and ethnicity
categories defined by OMB Standards
{
"code" : "2106-3",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "White"
},
"sdtcRaceCode" : [
// The raceCode extension is only used if raceCode is valued
{
"code" : "2076-8",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "Native Hawaiian or Other Pacific Islander"
}
],
"ethnicGroupCode" : {
"code" : "2186-5",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "Not Hispanic or Latino"
},
"guardian" : [
{
"code" : {
"code" : "POWATT",
"codeSystem" : "2.16.840.1.113883.5.111",
"codeSystemName" : "RoleCode",
"displayName" : "Power of Attorney"
},
"addr" : [
{
"use" : [
"HP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "2222 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "97867"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"MC"
],
"value" : "tel:+1(555)555-2008"
}
],
"guardianPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Boris"
}
]
},
{
"given" : [
{
"xmlText" : "Bo",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Betterhalf"
}
]
}
]
}
]
}
}
],
"birthplace" : {
"place" : {
"addr" : {
"item" : [
{
"streetAddressLine" : {
"xmlText" : "4444 Home Street"
}
},
{
"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" : // Patient's preferred language
{
"value" : true
}
}
]
},
"providerOrganization" : {
"id" : [
{
"extension" : "219BX",
"root" : "2.16.840.1.113883.4.6"
}
],
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsTogether Physician Group"
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-5000"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Health Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
]
}
}
}
],
"author" : [
// The author represents the person who provides the content in the document
{
"typeCode" : "AUT",
"templateId" : [
{
"root" : "2.16.840.1.113883.10.20.22.4.119"
}
],
"time" : {
"value" : "2013-07-30"
},
"assignedAuthor" : {
"id" : [
{
"extension" : "5555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine Physician"
},
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Patricia"
}
]
},
{
"given" : [
{
"xmlText" : "Patty",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Primary"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
}
],
"dataEnterer" : // The dataEnterer transferred the content created by the author into the document
{
"assignedEntity" : {
"id" : [
{
"extension" : "333777777",
"root" : "2.16.840.1.113883.4.6"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1050"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Ellen"
}
]
},
{
"family" : [
{
"xmlText" : "Enter"
}
]
}
]
}
]
}
}
},
"informant" : [
// The informant represents any sources of information for document content
{
"assignedEntity" : {
"id" : [
{
"extension" : "888888888",
"root" : "2.16.840.1.113883.19.5"
}
],
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1003"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Harold"
}
]
},
{
"family" : [
{
"xmlText" : "Hippocrates"
}
]
},
{
"suffix" : [
{
"xmlText" : "D.O.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
},
{
"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" : "Rose"
}
]
},
{
"family" : [
{
"xmlText" : "Everyman"
}
]
}
]
}
]
}
}
}
],
"custodian" : // The custodian represents the organization charged with maintaining the original source document
{
"assignedCustodian" : {
"representedCustodianOrganization" : {
"id" : [
{
"extension" : "321CX",
"root" : "2.16.840.1.113883.4.6"
}
],
"name" : {
"item" : [
{
"xmlText" : "Good Health HIE"
}
]
},
"telecom" : {
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1009"
},
"addr" : {
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1009 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
}
}
},
"informationRecipient" : [
// The informationRecipient represents the intended recipient of the document
{
"intendedRecipient" : {
"informationRecipient" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Sara"
}
]
},
{
"family" : [
{
"xmlText" : "Specialize"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
},
"receivedOrganization" : {
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsApart Physician Group"
}
]
}
]
}
}
}
],
"legalAuthenticator" : // The legalAuthenticator represents the individual who is responsible for the document
{
"time" : {
"value" : "2013-09-15T22:36:15-08:00"
},
"signatureCode" : {
"code" : "S"
},
"assignedEntity" : {
"id" : [
{
"extension" : "5555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine Physician"
},
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Patricia"
}
]
},
{
"given" : [
{
"xmlText" : "Patty",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Primary"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
},
"authenticator" : [
// The authenticator represents the individual attesting to the accuracy of information in the document
{
"time" : {
"value" : "2012-09-15T10:30:00-08:00"
},
"signatureCode" : {
"code" : "S"
},
"assignedEntity" : {
"id" : [
{
"extension" : "5555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine"
},
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)555-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Patricia"
}
]
},
{
"given" : [
{
"xmlText" : "Patty",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Primary"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
}
],
"participant" : [
// Contact Person
{
"typeCode" : "CALLBCK",
"time" : {
"value" : "2005-03-29T22:44:11+05:00"
},
"associatedEntity" : {
"classCode" : "ASSIGNED",
"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" : "Ann Arbor"
}
},
{
"state" : {
"xmlText" : "MI"
}
},
{
"postalCode" : {
"xmlText" : "97857"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:555-555-1002"
}
],
"associatedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Henry"
}
]
},
{
"family" : [
{
"xmlText" : "Seven"
}
]
},
{
"suffix" : [
{
"xmlText" : "DO"
}
]
}
]
}
]
}
}
},
{
"typeCode" : "IND",
"functionCode" : {
"code" : "407543004",
"codeSystem" : "2.16.840.1.113883.6.96",
"codeSystemName" : "SNOMED-CT",
"displayName" : "Primary Carer"
},
"associatedEntity" : // Caregiver
{
"classCode" : "CAREGIVER",
"code" : {
"code" : "MTH",
"codeSystem" : "2.16.840.1.113883.5.111"
},
"addr" : [
{
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "17 Daws Rd."
}
},
{
"city" : {
"xmlText" : "Ann Arbor"
}
},
{
"state" : {
"xmlText" : "MI"
}
},
{
"postalCode" : {
"xmlText" : "97857"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:1+(555)555-1212"
}
],
"associatedPerson" : {
"name" : [
{
"item" : [
{
"prefix" : [
{
"xmlText" : "Mrs."
}
]
},
{
"given" : [
{
"xmlText" : "Martha"
}
]
},
{
"family" : [
{
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