Consolidated CDA (C-CDA)
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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

Logical Model: AdvanceDirectiveObservation - Detailed Descriptions

Draft as of 2024-11-21

Definitions for the AdvanceDirectiveObservation logical model.

Guidance on how to interpret the contents of this table can be found here

0. Observation
Logical ContainerClinicalDocument (CDA Class)
ValidationInstance of this type are validated by templateId
XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
should-author: SHOULD contain author (author.exists())
should-informant: SHOULD contain informant (informant.exists())
2. Observation.templateId
Control1..?
SlicingThis element introduces a set of slices on Observation.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ root
  • value @ extension
  • 4. Observation.templateId:advance-directive-obs
    Slice Nameadvance-directive-obs
    Control1..1
    6. Observation.templateId:advance-directive-obs.root
    Control1..?
    Pattern Value2.16.840.1.113883.10.20.22.4.48
    8. Observation.templateId:advance-directive-obs.extension
    Control1..?
    Pattern Value2025-05-01
    10. Observation.classCode
    Comments

    SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC).

    Fixed ValueOBS
    12. Observation.moodCode
    Comments

    SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC).

    Fixed ValueEVN
    14. Observation.id
    Comments

    SHALL contain at least one [1..*] id.

    Control1..?
    16. Observation.code
    ShortAdvance Directive
    Invariantsshould-translation: SHOULD contain translation (translation.exists())
    18. Observation.code.code
    Control1..?
    Pattern Value75320-2
    20. Observation.code.codeSystem
    ShortLOINC
    Control1..?
    Pattern Value2.16.840.1.113883.6.1
    22. Observation.code.translation
    Short𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
    Comments

    This code SHOULD contain zero or more [0..*] translation, which SHOULD be selected from ValueSet Advance Directives Categories urn:oid:2.16.840.1.113883.11.20.9.69.4.

    BindingThe codes SHOULD be taken from Advance Directives Categories .
    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
    24. Observation.text
    ShortSHOULD reference the portion of section narrative text corresponding to this entry
    Control1..?
    26. Observation.text.reference
    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
    28. Observation.statusCode
    Comments

    SHALL contain exactly one [1..1] statusCode (CONF:1198-8652).

    Control1..?
    30. Observation.statusCode.code
    Comments

    This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:1198-19082).

    Control1..?
    Fixed Valuecompleted
    32. Observation.effectiveTime
    Comments

    SHALL contain exactly one [1..1] effectiveTime.

    Control1..?
    34. Observation.effectiveTime.low
    Comments

    This effectiveTime SHALL contain exactly one [1..1] low.

    Control1..?
    36. Observation.effectiveTime.high
    Comments

    This effectiveTime SHALL contain exactly one [1..1] high.

    Control1..?
    Invariants1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449). (value.exists() or nullFlavor = 'NA')
    38. Observation.value
    Comments

    MAY contain zero or more [0..*] value.

    Control0..1
    40. Observation.author
    Comments

    SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119).

    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
    42. Observation.informant
    ShortSHOULD contain informant
    44. Observation.participant
    SlicingThis element introduces a set of slices on Observation.participant. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ typeCode
    • 46. Observation.participant:verifier
      Slice Nameverifier
      Short𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
      Comments

      SHOULD contain zero or more [0..*] participant (CONF:1198-8662) such that it

      Control0..*
      Invariantsshould-time: SHOULD contain time (time.exists())
      48. Observation.participant:verifier.templateId
      Control1..?
      SlicingThis element introduces a set of slices on Observation.participant.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ root
      • 50. Observation.participant:verifier.templateId:primary
        Slice Nameprimary
        Comments

        SHALL contain exactly one [1..1] templateId (CONF:1198-8664) such that it

        Control1..1
        52. Observation.participant:verifier.templateId:primary.root
        Comments

        SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.1.58" (CONF:1198-10486).

        Control1..?
        Pattern Value2.16.840.1.113883.10.20.1.58
        54. Observation.participant:verifier.templateId:primary.extension
        Comments

        SHALL not contain [0..0] extension

        Control0..0
        56. Observation.participant:verifier.typeCode
        Comments

        SHALL contain exactly one [1..1] @typeCode="VRF" Verifier (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8663).

        Fixed ValueVRF
        58. Observation.participant:verifier.time
        Comments

        SHOULD contain zero or one [0..1] time (CONF:1198-8665).

        Invariantsvalue-only: Interval fields SHALL NOT be present ((low | high | width | center).empty())
        60. Observation.participant:verifier.time.value
        Shortvalue should be used instead of low/high
        62. Observation.participant:verifier.participantRole
        Comments

        SHALL contain exactly one [1..1] participantRole (CONF:1198-8825).

        Invariantsshould-code: SHOULD contain code (code.exists())
        64. Observation.participant:verifier.participantRole.code
        Comments

        This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-28446).

        BindingThe codes SHOULD be taken from Healthcare Provider Taxonomy .
        (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
        66. Observation.participant:verifier.participantRole.addr
        Comments

        This participantRole MAY contain zero or more [0..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-28451).

        Typehttp://hl7.org/cda/stds/core/StructureDefinition/AD(US Realm Address)
        68. Observation.participant:verifier.participantRole.playingEntity
        Comments

        This participantRole SHALL contain exactly one [1..1] playingEntity (CONF:1198-28428).

        Control1..?
        70. Observation.participant:verifier.participantRole.playingEntity.name
        Comments

        The playingEntity SHALL contain exactly one [1..1] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-28454).

        Control1..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PN(US Realm Person Name (PN.US.FIELDED))
        72. Observation.participant:custodian
        Slice Namecustodian
        ShortThis custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
        Comments

        SHOULD contain zero or more [0..*] participant (CONF:1198-8667) such that it

        Control0..*
        74. Observation.participant:custodian.typeCode
        Comments

        SHALL contain exactly one [1..1] @typeCode="CST" Custodian (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8668).

        Fixed ValueCST
        76. Observation.participant:custodian.participantRole
        Comments

        SHALL contain exactly one [1..1] participantRole (CONF:1198-8669).

        Invariantsshould-code: SHOULD contain code (code.exists())
        should-addr: SHOULD contain addr (addr.exists())
        should-telecom: SHOULD contain telecom (telecom.exists())
        78. Observation.participant:custodian.participantRole.classCode
        Comments

        This participantRole SHALL contain exactly one [1..1] @classCode="AGNT" Agent (CodeSystem: HL7RoleClass urn:oid:2.16.840.1.113883.5.110 STATIC) (CONF:1198-8670).

        Control1..?
        Fixed ValueAGNT
        80. Observation.participant:custodian.participantRole.code
        Comments

        This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Agent or Proxy Choices urn:oid:2.16.840.1.113762.1.4.1046.35 DYNAMIC (CONF:1198-28440).

        BindingThe codes SHOULD be taken from Healthcare Agent or Proxy Choices .
        (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35)
        82. Observation.participant:custodian.participantRole.addr
        Comments

        This participantRole SHOULD contain zero or one [0..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-8671).

        Control0..1
        Typehttp://hl7.org/cda/stds/core/StructureDefinition/AD(US Realm Address)
        84. Observation.participant:custodian.participantRole.telecom
        Comments

        This participantRole SHOULD contain zero or more [0..*] telecom (CONF:1198-8672).

        86. Observation.participant:custodian.participantRole.playingEntity
        Comments

        This participantRole SHALL contain exactly one [1..1] playingEntity (CONF:1198-8824).

        Control1..?
        Invariantsshould-code: SHOULD contain code (code.exists())
        88. Observation.participant:custodian.participantRole.playingEntity.code
        Comments

        This playingEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal and Legal Relationship RoleType urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC.

        BindingThe codes SHOULD be taken from Personal And Legal Relationship Role Type .
        (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1)
        90. Observation.participant:custodian.participantRole.playingEntity.name
        ShortThe name of the healthcare agent.
        Comments

        This playingEntity SHALL contain exactly one [1..1] name (CONF:1198-8673).

        Control1..1
        92. Observation.reference
        Control1..?
        SlicingThis element introduces a set of slices on Observation.reference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ typeCode
        • 94. Observation.reference:reference1
          Slice Namereference1
          Comments

          SHOULD contain at least one [1..*] reference (CONF:1198-8692) such that it

          Control1..*
          96. Observation.reference:reference1.typeCode
          Comments

          SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8694).

          Fixed ValueREFR
          98. Observation.reference:reference1.externalDocument
          Short𝗨𝗦𝗖𝗗𝗜: External Document
          Comments

          SHALL contain exactly one [1..1] externalDocument (CONF:1198-8693).

          Control1..?
          100. Observation.reference:reference1.externalDocument.id
          Comments

          This externalDocument SHALL contain at least one [1..*] id (CONF:1198-8695).

          Control1..?
          102. Observation.reference:reference1.externalDocument.code
          Control1..?
          BindingThe codes SHOULD be taken from Advance Directives Categories .
          (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
          104. Observation.reference:reference1.externalDocument.text
          Comments

          This externalDocument MAY contain zero or one [0..1] text (CONF:1198-8696).

          106. Observation.reference:reference1.externalDocument.text.reference
          ShortThe URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
          Comments

          The text, if present, MAY contain zero or one [0..1] reference (CONF:1198-8697).

          Invariants1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699). ()
          108. Observation.reference:reference1.externalDocument.sdtcAuthor
          Short𝗨𝗦𝗖𝗗𝗜: Author
          XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameauthor.

          Guidance on how to interpret the contents of this table can be found here

          0. Observation
          Definition

          Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.


          Base definition for all types defined in FHIR type system.

          ShortBase for all types and resources
          Control10..1*
          Is Modifierfalse
          Logical ContainerClinicalDocument (CDA Class)
          ValidationInstance of this type are validated by templateId
          XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
          Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
          should-author: SHOULD contain author (author.exists())
          should-informant: SHOULD contain informant (informant.exists())
          2. Observation.templateId
          Definition

          When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

          Control1..*
          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
          SlicingThis element introduces a set of slices on Observation.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ root
          • value @ extension
          • 4. Observation.templateId:advance-directive-obs
            Slice Nameadvance-directive-obs
            Definition

            When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

            Control1..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
            6. Observation.templateId:advance-directive-obs.root
            Definition

            A unique identifier that guarantees the global uniqueness of the instance identifier. The root alone may be the entire instance identifier.

            Control1..1
            Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelRoot
            Pattern Value2.16.840.1.113883.10.20.22.4.48
            8. Observation.templateId:advance-directive-obs.extension
            Definition

            A character string as a unique identifier within the scope of the identifier root.

            Control1..1
            Typestring(st: Character String)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelExtension
            Pattern Value2025-05-01
            10. Observation.classCode
            Comments

            SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC).

            Control1..1
            BindingThe codes SHALL be taken from CDAActClassObservation
            (required to http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation)
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            Fixed ValueOBS
            12. Observation.moodCode
            Comments

            SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC).

            Control1..1
            BindingThe codes SHALL be taken from XActMoodDocumentObservation (2.0.0)
            (required to http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0)
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            Fixed ValueEVN
            14. Observation.id
            Definition

            The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

            ShortLogical id of this artifact
            Comments

            SHALL contain at least one [1..*] id.


            Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

            Control10..*1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/IIid
            Is Modifierfalse
            16. Observation.code
            Definition

            Describes what was observed. Sometimes this is called the observation "name".

            ShortAdvance DirectiveType of observation (code / type)
            Comments

            All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

            Control1..1
            This element is affected by the following invariants: obs-7
            BindingFor example codes, see ObservationTypehttp://hl7.org/fhir/ValueSet/observation-codes
            (example to http://terminology.hl7.org/ValueSet/v3-ObservationType)
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/CDCodeableConcept
            Is Modifierfalse
            XML FormatThe type of this property is determined using the xsi:typeattribute.
            Requirements

            Knowing what kind of observation is being made is essential to understanding the observation.

            Alternate NamesName
            Invariantsshould-translation: SHOULD contain translation (translation.exists())
            ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            18. Observation.code.code
            Definition

            The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.

            Control1..1
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelCode
            Pattern Value75320-2
            20. Observation.code.codeSystem
            Definition

            Specifies the code system that defines the code.

            ShortLOINC
            Control1..1
            Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelCode System
            Pattern Value2.16.840.1.113883.6.1
            22. Observation.code.translation
            Definition

            A set of other concept descriptors that translate this concept descriptor into other code systems.

            Short𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
            Comments

            This code SHOULD contain zero or more [0..*] translation, which SHOULD be selected from ValueSet Advance Directives Categories urn:oid:2.16.840.1.113883.11.20.9.69.4.

            Control0..*
            BindingThe codes SHOULD be taken from Advance Directives Categories .
            (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
            XML FormatThe type of this property is determined using the xsi:typeattribute.
            LabelTranslation
            24. Observation.text
            Definition

            A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

            ShortSHOULD reference the portion of section narrative text corresponding to this entryText summary of the resource, for human interpretation
            Comments

            Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

            Control10..1
            This element is affected by the following invariants: dom-6
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/EDNarrative
            Is Modifierfalse
            XML FormatThe type of this property is determined using the xsi:typeattribute.
            Alternate Namesnarrative, html, xhtml, display
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            26. Observation.text.reference
            Definition

            A telecommunication address (TEL), such as a URL for HTTP or FTP, which will resolve to precisely the same binary data that could as well have been provided as inline data.

            Control0..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
            LabelReference
            Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
            28. Observation.statusCode
            Comments

            SHALL contain exactly one [1..1] statusCode (CONF:1198-8652).

            Control1..1
            BindingThe codes SHALL be taken from ActStatus
            (required to http://terminology.hl7.org/ValueSet/v3-ActStatus)
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
            30. Observation.statusCode.code
            Definition

            The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.

            Comments

            This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:1198-19082).

            Control1..1
            Typecode(cs: Coded Simple Value)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelCode
            Fixed Valuecompleted
            32. Observation.statusCode.codeSystem
            Definition

            Specifies the code system that defines the code.

            Control0..0
            Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelCode System
            34. Observation.statusCode.codeSystemName
            Definition

            The common name of the coding system.

            Control0..0
            Typestring(st: Character String)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelCode System Name
            36. Observation.statusCode.codeSystemVersion
            Definition

            If applicable, a version descriptor defined specifically for the given code system.

            Control0..0
            Typestring(st: Character String)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelCode System Version
            38. Observation.statusCode.displayName
            Definition

            A name or title for the code, under which the sending system shows the code value to its users.

            Control0..0
            Typestring(st: Character String)
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            XML FormatIn the XML format, this property is represented as an attribute.
            LabelDisplay Name
            40. Observation.statusCode.originalText
            Definition

            The text or phrase used as the basis for the coding.

            Control0..0
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
            LabelOriginal Text
            42. Observation.statusCode.qualifier
            Definition

            Specifies additional codes that increase the specificity of the the primary code.

            Control0..0
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/CR
            LabelQualifier
            44. Observation.statusCode.translation
            Definition

            A set of other concept descriptors that translate this concept descriptor into other code systems.

            Control0..0
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
            XML FormatThe type of this property is determined using the xsi:typeattribute.
            LabelTranslation
            46. Observation.effectiveTime
            Comments

            SHALL contain exactly one [1..1] effectiveTime.

            Control1..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
            48. Observation.effectiveTime.low
            Definition

            This is the low limit of the interval.

            Comments

            This effectiveTime SHALL contain exactly one [1..1] low.

            Control1..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
            LabelLow Boundary
            50. Observation.effectiveTime.high
            Definition

            This is the high limit of the interval.

            Comments

            This effectiveTime SHALL contain exactly one [1..1] high.

            Control1..1
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
            LabelHigh Boundary
            Invariants1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449). (value.exists() or nullFlavor = 'NA')
            52. Observation.value
            Comments

            MAY contain zero or more [0..*] value.

            Control0..1
            TypeChoice of: http://hl7.org/cda/stds/core/StructureDefinition/ANY, http://hl7.org/cda/stds/core/StructureDefinition/BL, http://hl7.org/cda/stds/core/StructureDefinition/ED, http://hl7.org/cda/stds/core/StructureDefinition/ST, http://hl7.org/cda/stds/core/StructureDefinition/CD, http://hl7.org/cda/stds/core/StructureDefinition/CV, http://hl7.org/cda/stds/core/StructureDefinition/CE, http://hl7.org/cda/stds/core/StructureDefinition/CO, http://hl7.org/cda/stds/core/StructureDefinition/SC, http://hl7.org/cda/stds/core/StructureDefinition/II, http://hl7.org/cda/stds/core/StructureDefinition/TEL, http://hl7.org/cda/stds/core/StructureDefinition/AD, http://hl7.org/cda/stds/core/StructureDefinition/EN, http://hl7.org/cda/stds/core/StructureDefinition/INT, http://hl7.org/cda/stds/core/StructureDefinition/REAL, http://hl7.org/cda/stds/core/StructureDefinition/PQ, http://hl7.org/cda/stds/core/StructureDefinition/MO, http://hl7.org/cda/stds/core/StructureDefinition/TS, http://hl7.org/cda/stds/core/StructureDefinition/IVL-PQ, http://hl7.org/cda/stds/core/StructureDefinition/IVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/PIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/EIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/SXPR-TS, http://hl7.org/cda/stds/core/StructureDefinition/RTO-PQ-PQ
            XML FormatThe type of this property is determined using the xsi:typeattribute.
            54. Observation.author
            Definition

            Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.

            ShortBase for all types and resources
            Comments

            SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119).

            Control0..*
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
            Is Modifierfalse
            56. Observation.informant
            ShortSHOULD contain informant
            Control0..*
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/Informant
            58. Observation.participant
            Control0..*
            Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
            SlicingThis element introduces a set of slices on Observation.participant. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ typeCode
            • 60. Observation.participant:verifier
              Slice Nameverifier
              Short𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
              Comments

              SHOULD contain zero or more [0..*] participant (CONF:1198-8662) such that it

              Control0..*
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
              Invariantsshould-time: SHOULD contain time (time.exists())
              62. Observation.participant:verifier.templateId
              Definition

              When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

              Control1..*
              Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
              SlicingThis element introduces a set of slices on Observation.participant.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ root
              • 64. Observation.participant:verifier.templateId:primary
                Slice Nameprimary
                Definition

                When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                Comments

                SHALL contain exactly one [1..1] templateId (CONF:1198-8664) such that it

                Control1..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                66. Observation.participant:verifier.templateId:primary.root
                Definition

                A unique identifier that guarantees the global uniqueness of the instance identifier. The root alone may be the entire instance identifier.

                Comments

                SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.1.58" (CONF:1198-10486).

                Control1..1
                Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                LabelRoot
                Pattern Value2.16.840.1.113883.10.20.1.58
                68. Observation.participant:verifier.templateId:primary.extension
                Definition

                A character string as a unique identifier within the scope of the identifier root.

                Comments

                SHALL not contain [0..0] extension

                Control0..0
                Typestring(st: Character String)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                LabelExtension
                70. Observation.participant:verifier.typeCode
                Comments

                SHALL contain exactly one [1..1] @typeCode="VRF" Verifier (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8663).

                Control1..1
                BindingThe codes SHALL be taken from CDAParticipationType
                (required to http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType)
                Typecode(cs: Coded Simple Value)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed ValueVRF
                72. Observation.participant:verifier.time
                Comments

                SHOULD contain zero or one [0..1] time (CONF:1198-8665).

                Control0..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
                Invariantsvalue-only: Interval fields SHALL NOT be present ((low | high | width | center).empty())
                74. Observation.participant:verifier.time.value
                Definition

                A quantity specifying a point on the axis of natural time. A point in time is most often represented as a calendar expression.

                Shortvalue should be used instead of low/high
                Control0..1
                TypedateTime(ts: Point in Time)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Date FormatYYYYMMDDHHMMSS.UUUU[+|-ZZzz]
                XML FormatIn the XML format, this property is represented as an attribute.
                76. Observation.participant:verifier.participantRole
                Comments

                SHALL contain exactly one [1..1] participantRole (CONF:1198-8825).

                Control1..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/ParticipantRole
                Invariantsshould-code: SHOULD contain code (code.exists())
                78. Observation.participant:verifier.participantRole.code
                Comments

                This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-28446).

                Control0..1
                BindingThe codes SHOULD be taken from Healthcare Provider Taxonomy .
                (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                80. Observation.participant:verifier.participantRole.addr
                Definition

                Mailing and home or office addresses. A sequence of address parts, such as street or post office Box, city, postal code, country, etc.

                ShortBase for all types and resources
                Comments

                This participantRole MAY contain zero or more [0..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-28451).

                Control0..*
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/AD(US Realm Address)
                Is Modifierfalse
                Invariantsshall-city: SHALL contain exactly one [1..1] city (CONF:81-7292). (nullFlavor.exists() or item.city.count() = 1)
                shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291). (nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4))
                should-use: SHOULD contain @use (nullFlavor.exists() or use.exists())
                should-country: SHOULD contain country (nullFlavor.exists() or item.country.exists())
                81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296) (item.xmlText.empty())
                81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024). (nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')))
                81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). (nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')))
                shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country ((item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1))
                82. Observation.participant:verifier.participantRole.playingEntity
                Comments

                This participantRole SHALL contain exactly one [1..1] playingEntity (CONF:1198-28428).

                Control1..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/PlayingEntity
                84. Observation.participant:verifier.participantRole.playingEntity.name
                Definition

                A name for a person. A sequence of name parts, such as given name or family name, prefix, suffix, etc. Examples for person name values are "Jim Bob Walton, Jr.", "Adam Everyman", etc. A person name may be as simple as a character string or may consist of several person name parts, such as, "Jim", "Bob", "Walton", and "Jr.". PN differs from EN because the qualifier type cannot include LS (Legal Status).

                ShortBase for all types and resources
                Comments

                The playingEntity SHALL contain exactly one [1..1] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-28454).

                Control1..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/PN(US Realm Person Name (PN.US.FIELDED))
                Is Modifierfalse
                Invariantspn-no-ls: 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())
                81-9371: 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: 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())
                86. Observation.participant:custodian
                Slice Namecustodian
                ShortThis custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
                Comments

                SHOULD contain zero or more [0..*] participant (CONF:1198-8667) such that it

                Control0..*
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
                88. Observation.participant:custodian.typeCode
                Comments

                SHALL contain exactly one [1..1] @typeCode="CST" Custodian (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8668).

                Control1..1
                BindingThe codes SHALL be taken from CDAParticipationType
                (required to http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType)
                Typecode(cs: Coded Simple Value)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Fixed ValueCST
                90. Observation.participant:custodian.participantRole
                Comments

                SHALL contain exactly one [1..1] participantRole (CONF:1198-8669).

                Control1..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/ParticipantRole
                Invariantsshould-code: SHOULD contain code (code.exists())
                should-addr: SHOULD contain addr (addr.exists())
                should-telecom: SHOULD contain telecom (telecom.exists())
                92. Observation.participant:custodian.participantRole.classCode
                Comments

                This participantRole SHALL contain exactly one [1..1] @classCode="AGNT" Agent (CodeSystem: HL7RoleClass urn:oid:2.16.840.1.113883.5.110 STATIC) (CONF:1198-8670).

                Control1..1
                BindingThe codes SHALL be taken from CDARoleClassRoot
                (required to http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot)
                Typecode(cs: Coded Simple Value)
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                XML FormatIn the XML format, this property is represented as an attribute.
                Default ValueROL
                Fixed ValueAGNT
                94. Observation.participant:custodian.participantRole.code
                Comments

                This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Agent or Proxy Choices urn:oid:2.16.840.1.113762.1.4.1046.35 DYNAMIC (CONF:1198-28440).

                Control0..1
                BindingThe codes SHOULD be taken from Healthcare Agent or Proxy Choices .
                (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35)
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                96. Observation.participant:custodian.participantRole.addr
                Definition

                Mailing and home or office addresses. A sequence of address parts, such as street or post office Box, city, postal code, country, etc.

                ShortBase for all types and resources
                Comments

                This participantRole SHOULD contain zero or one [0..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-8671).

                Control0..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/AD(US Realm Address)
                Is Modifierfalse
                Invariantsshall-city: SHALL contain exactly one [1..1] city (CONF:81-7292). (nullFlavor.exists() or item.city.count() = 1)
                shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291). (nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4))
                should-use: SHOULD contain @use (nullFlavor.exists() or use.exists())
                should-country: SHOULD contain country (nullFlavor.exists() or item.country.exists())
                81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296) (item.xmlText.empty())
                81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024). (nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')))
                81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). (nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')))
                shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country ((item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1))
                98. Observation.participant:custodian.participantRole.telecom
                Comments

                This participantRole SHOULD contain zero or more [0..*] telecom (CONF:1198-8672).

                Control0..*
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
                100. Observation.participant:custodian.participantRole.playingEntity
                Comments

                This participantRole SHALL contain exactly one [1..1] playingEntity (CONF:1198-8824).

                Control1..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/PlayingEntity
                Invariantsshould-code: SHOULD contain code (code.exists())
                102. Observation.participant:custodian.participantRole.playingEntity.code
                Comments

                This playingEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal and Legal Relationship RoleType urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC.

                Control0..1
                BindingThe codes SHOULD be taken from Personal And Legal Relationship Role Type .
                (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1)
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                104. Observation.participant:custodian.participantRole.playingEntity.name
                ShortThe name of the healthcare agent.
                Comments

                This playingEntity SHALL contain exactly one [1..1] name (CONF:1198-8673).

                Control1..1
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/PN
                106. Observation.reference
                Control1..*
                Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                SlicingThis element introduces a set of slices on Observation.reference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ typeCode
                • 108. Observation.reference:reference1
                  Slice Namereference1
                  Comments

                  SHOULD contain at least one [1..*] reference (CONF:1198-8692) such that it

                  Control1..*
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                  110. Observation.reference:reference1.typeCode
                  Comments

                  SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8694).

                  Control1..1
                  BindingThe codes SHALL be taken from x_ActRelationshipExternalReference
                  (required to http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference)
                  Typecode(cs: Coded Simple Value)
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Fixed ValueREFR
                  112. Observation.reference:reference1.externalDocument
                  Short𝗨𝗦𝗖𝗗𝗜: External Document
                  Comments

                  SHALL contain exactly one [1..1] externalDocument (CONF:1198-8693).

                  Control1..1
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalDocument
                  114. Observation.reference:reference1.externalDocument.id
                  Comments

                  This externalDocument SHALL contain at least one [1..*] id (CONF:1198-8695).

                  Control1..*
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                  116. Observation.reference:reference1.externalDocument.code
                  Control1..1
                  BindingThe codes SHOULD be taken from Advance Directives Categories .
                  (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                  118. Observation.reference:reference1.externalDocument.text
                  Comments

                  This externalDocument MAY contain zero or one [0..1] text (CONF:1198-8696).

                  Control0..1
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                  120. Observation.reference:reference1.externalDocument.text.reference
                  Definition

                  A telecommunication address (TEL), such as a URL for HTTP or FTP, which will resolve to precisely the same binary data that could as well have been provided as inline data.

                  ShortThe URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
                  Comments

                  The text, if present, MAY contain zero or one [0..1] reference (CONF:1198-8697).

                  Control0..1
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
                  LabelReference
                  Invariants1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699). ()
                  122. Observation.reference:reference1.externalDocument.sdtcAuthor
                  Short𝗨𝗦𝗖𝗗𝗜: Author
                  Control0..*
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author
                  XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameauthor.

                  Guidance on how to interpret the contents of this table can be found here

                  0. Observation
                  Definition

                  Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.

                  ShortBase for all types and resources
                  Control1..1
                  Is Modifierfalse
                  Logical ContainerClinicalDocument (CDA Class)
                  ValidationInstance of this type are validated by templateId
                  XML FormatIn the XML format, this property has the namespace urn:hl7-org:v3.
                  Invariantsshould-text-ref-value: SHOULD contain text/reference/@value (text.reference.value.exists())
                  should-author: SHOULD contain author (author.exists())
                  should-informant: SHOULD contain informant (informant.exists())
                  2. Observation.nullFlavor
                  Definition

                  If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                  Control0..1
                  BindingThe codes SHALL be taken from CDANullFlavor
                  (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                  Typecode(cs: Coded Simple Value)
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  LabelExceptional Value Detail
                  4. Observation.realmCode
                  Definition

                  When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                  Control0..*
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                  6. Observation.typeId
                  Definition

                  When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                  Control0..1
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                  8. Observation.typeId.nullFlavor
                  Definition

                  If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                  Control0..1
                  BindingThe codes SHALL be taken from CDANullFlavor
                  (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                  Typecode(cs: Coded Simple Value)
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  LabelExceptional Value Detail
                  10. Observation.typeId.assigningAuthorityName
                  Definition

                  A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                  Control0..1
                  Typestring(st: Character String)
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  LabelAssigning Authority Name
                  12. Observation.typeId.displayable
                  Definition

                  Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                  Control0..1
                  Typeboolean(bl: Boolean)
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  LabelDisplayable
                  14. Observation.typeId.root
                  Definition

                  Identifies the type as an HL7 Registered model

                  Control1..1
                  Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  LabelRoot
                  Fixed Value2.16.840.1.113883.1.3
                  16. Observation.typeId.extension
                  Definition

                  A character string as a unique identifier within the scope of the identifier root.

                  Control1..1
                  Typestring(st: Character String)
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  XML FormatIn the XML format, this property is represented as an attribute.
                  LabelExtension
                  18. Observation.templateId
                  Definition

                  When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                  Control1..*
                  Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                  SlicingThis element introduces a set of slices on Observation.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ root
                  • value @ extension
                  • 20. Observation.templateId:advance-directive-obs
                    Slice Nameadvance-directive-obs
                    Definition

                    When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                    22. Observation.templateId:advance-directive-obs.nullFlavor
                    Definition

                    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                    Control0..1
                    BindingThe codes SHALL be taken from CDANullFlavor
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelExceptional Value Detail
                    24. Observation.templateId:advance-directive-obs.assigningAuthorityName
                    Definition

                    A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                    Control0..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelAssigning Authority Name
                    26. Observation.templateId:advance-directive-obs.displayable
                    Definition

                    Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                    Control0..1
                    Typeboolean(bl: Boolean)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelDisplayable
                    28. Observation.templateId:advance-directive-obs.root
                    Definition

                    A unique identifier that guarantees the global uniqueness of the instance identifier. The root alone may be the entire instance identifier.

                    Control1..1
                    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelRoot
                    Pattern Value2.16.840.1.113883.10.20.22.4.48
                    30. Observation.templateId:advance-directive-obs.extension
                    Definition

                    A character string as a unique identifier within the scope of the identifier root.

                    Control1..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelExtension
                    Pattern Value2025-05-01
                    32. Observation.classCode
                    Comments

                    SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC).

                    Control1..1
                    BindingThe codes SHALL be taken from CDAActClassObservation
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDAActClassObservation)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Fixed ValueOBS
                    34. Observation.moodCode
                    Comments

                    SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC).

                    Control1..1
                    BindingThe codes SHALL be taken from XActMoodDocumentObservation (2.0.0)
                    (required to http://terminology.hl7.org/ValueSet/v3-xActMoodDocumentObservation|2.0.0)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Fixed ValueEVN
                    36. Observation.negationInd
                    Control0..1
                    Typeboolean(bl: Boolean)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    38. Observation.id
                    Comments

                    SHALL contain at least one [1..*] id.

                    Control1..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                    40. Observation.sdtcCategory
                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                    XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namecategory.
                    42. Observation.code
                    ShortAdvance Directive
                    Control1..1
                    BindingFor example codes, see ObservationType
                    (example to http://terminology.hl7.org/ValueSet/v3-ObservationType)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                    XML FormatThe type of this property is determined using the xsi:typeattribute.
                    Invariantsshould-translation: SHOULD contain translation (translation.exists())
                    44. Observation.code.nullFlavor
                    Definition

                    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                    Control0..1
                    BindingThe codes SHALL be taken from CDANullFlavor
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelExceptional Value Detail
                    46. Observation.code.code
                    Definition

                    The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.

                    Control1..1
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode
                    Pattern Value75320-2
                    48. Observation.code.codeSystem
                    Definition

                    Specifies the code system that defines the code.

                    ShortLOINC
                    Control1..1
                    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode System
                    Pattern Value2.16.840.1.113883.6.1
                    50. Observation.code.codeSystemName
                    Definition

                    The common name of the coding system.

                    Control0..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode System Name
                    52. Observation.code.codeSystemVersion
                    Definition

                    If applicable, a version descriptor defined specifically for the given code system.

                    Control0..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode System Version
                    54. Observation.code.displayName
                    Definition

                    A name or title for the code, under which the sending system shows the code value to its users.

                    Control0..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelDisplay Name
                    56. Observation.code.sdtcValueSet
                    Definition

                    The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.

                    Control0..1
                    Typestring(oid: ISO Object Identifier)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSet.
                    58. Observation.code.sdtcValueSetVersion
                    Definition

                    The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept.

                    Control0..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSetVersion.
                    60. Observation.code.originalText
                    Definition

                    The text or phrase used as the basis for the coding.

                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                    LabelOriginal Text
                    62. Observation.code.qualifier
                    Definition

                    Specifies additional codes that increase the specificity of the the primary code.

                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CR
                    LabelQualifier
                    64. Observation.code.translation
                    Definition

                    A set of other concept descriptors that translate this concept descriptor into other code systems.

                    Short𝗨𝗦𝗖𝗗𝗜: Advance Directive Type
                    Comments

                    This code SHOULD contain zero or more [0..*] translation, which SHOULD be selected from ValueSet Advance Directives Categories urn:oid:2.16.840.1.113883.11.20.9.69.4.

                    Control0..*
                    BindingThe codes SHOULD be taken from Advance Directives Categories .
                    (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                    XML FormatThe type of this property is determined using the xsi:typeattribute.
                    LabelTranslation
                    66. Observation.derivationExpr
                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ST
                    68. Observation.text
                    ShortSHOULD reference the portion of section narrative text corresponding to this entry
                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                    XML FormatThe type of this property is determined using the xsi:typeattribute.
                    70. Observation.text.nullFlavor
                    Definition

                    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                    Control0..1
                    BindingThe codes SHALL be taken from CDANullFlavor
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelExceptional Value Detail
                    72. Observation.text.compression
                    Definition

                    Indicates whether the raw byte data is compressed, and what compression algorithm was used.

                    Control0..1
                    BindingThe codes SHALL be taken from CDACompressionAlgorithm
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCompression
                    74. Observation.text.integrityCheck
                    Definition

                    The integrity check is a short binary value representing a cryptographically strong checksum that is calculated over the binary data. The purpose of this property, when communicated with a reference is for anyone to validate later whether the reference still resolved to the same data that the reference resolved to when the encapsulated data value with reference was created.

                    Control0..1
                    Typebase64Binary(bin: Binary Data)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelIntegrity Check
                    76. Observation.text.integrityCheckAlgorithm
                    Definition

                    Specifies the algorithm used to compute the integrityCheck value. The cryptographically strong checksum algorithm Secure Hash Algorithm-1 (SHA-1) is currently the industry standard. It has superseded the MD5 algorithm only a couple of years ago, when certain flaws in the security of MD5 were discovered. Currently the SHA-1 hash algorithm is the default choice for the integrity check algorithm. Note that SHA-256 is also entering widespread usage.

                    Control0..1
                    BindingThe codes SHALL be taken from IntegrityCheckAlgorithm (2.0.0)
                    (required to http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelIntegrity Check Algorithm
                    78. Observation.text.language
                    Definition

                    For character based information the language property specifies the human language of the text.

                    Control0..1
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelLanguage
                    80. Observation.text.mediaType
                    Definition

                    Identifies the type of the encapsulated data and identifies a method to interpret or render the data.

                    Control0..1
                    BindingFor example codes, see MediaType
                    (example to http://terminology.hl7.org/ValueSet/v3-MediaType)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelMedia Type
                    82. Observation.text.representation
                    Control0..1
                    BindingThe codes SHALL be taken from CDABinaryDataEncoding
                    (required to http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    84. Observation.text.xmlText
                    Definition

                    Data that is primarily intended for human interpretation or for further machine processing is outside the scope of HL7. This includes unformatted or formatted written language, multimedia data, or structured information as defined by a different standard (e.g., XML-signatures.)

                    ShortAllows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
                    Comments

                    This element is represented in XML as textual content. The actual name "xmlText" will not appear in a CDA instance.

                    Control0..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as unadorned text.
                    86. Observation.text.reference
                    Definition

                    A telecommunication address (TEL), such as a URL for HTTP or FTP, which will resolve to precisely the same binary data that could as well have been provided as inline data.

                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
                    LabelReference
                    Invariantsvalue-starts-octothorpe: If reference/@value is present, it SHALL begin with a '#' and SHALL point to its corresponding narrative (value.exists() implies value.startsWith('#'))
                    88. Observation.text.thumbnail
                    Definition

                    An abbreviated rendition of the full data. A thumbnail requires significantly fewer resources than the full data, while still maintaining some distinctive similarity with the full data. A thumbnail is typically used with by-reference encapsulated data. It allows a user to select data more efficiently before actually downloading through the reference.

                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                    LabelThumbnail
                    90. Observation.statusCode
                    Comments

                    SHALL contain exactly one [1..1] statusCode (CONF:1198-8652).

                    Control1..1
                    BindingThe codes SHALL be taken from ActStatus
                    (required to http://terminology.hl7.org/ValueSet/v3-ActStatus)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                    92. Observation.statusCode.nullFlavor
                    Definition

                    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                    Control0..1
                    BindingThe codes SHALL be taken from CDANullFlavor
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelExceptional Value Detail
                    94. Observation.statusCode.code
                    Definition

                    The plain code symbol defined by the code system. For example, "784.0" is the code symbol of the ICD-9 code "784.0" for headache.

                    Comments

                    This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:1198-19082).

                    Control1..1
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode
                    Fixed Valuecompleted
                    96. Observation.statusCode.codeSystem
                    Definition

                    Specifies the code system that defines the code.

                    Control0..0
                    Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode System
                    98. Observation.statusCode.codeSystemName
                    Definition

                    The common name of the coding system.

                    Control0..0
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode System Name
                    100. Observation.statusCode.codeSystemVersion
                    Definition

                    If applicable, a version descriptor defined specifically for the given code system.

                    Control0..0
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelCode System Version
                    102. Observation.statusCode.displayName
                    Definition

                    A name or title for the code, under which the sending system shows the code value to its users.

                    Control0..0
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelDisplay Name
                    104. Observation.statusCode.sdtcValueSet
                    Definition

                    The valueSet extension adds an attribute for elements with a CD dataType which indicates the particular value set constraining the coded concept.

                    Control0..1
                    Typestring(oid: ISO Object Identifier)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSet.
                    106. Observation.statusCode.sdtcValueSetVersion
                    Definition

                    The valueSetVersion extension adds an attribute for elements with a CD dataType which indicates the version of the particular value set constraining the coded concept.

                    Control0..1
                    Typestring(st: Character String)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.In the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namevalueSetVersion.
                    108. Observation.statusCode.originalText
                    Definition

                    The text or phrase used as the basis for the coding.

                    Control0..0
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                    LabelOriginal Text
                    110. Observation.statusCode.qualifier
                    Definition

                    Specifies additional codes that increase the specificity of the the primary code.

                    Control0..0
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CR
                    LabelQualifier
                    112. Observation.statusCode.translation
                    Definition

                    A set of other concept descriptors that translate this concept descriptor into other code systems.

                    Control0..0
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                    XML FormatThe type of this property is determined using the xsi:typeattribute.
                    LabelTranslation
                    114. Observation.effectiveTime
                    Comments

                    SHALL contain exactly one [1..1] effectiveTime.

                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
                    116. Observation.effectiveTime.nullFlavor
                    Definition

                    If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                    Control0..1
                    BindingThe codes SHALL be taken from CDANullFlavor
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    LabelExceptional Value Detail
                    118. Observation.effectiveTime.value
                    Definition

                    A quantity specifying a point on the axis of natural time. A point in time is most often represented as a calendar expression.

                    Control0..1
                    TypedateTime(ts: Point in Time)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Date FormatYYYYMMDDHHMMSS.UUUU[+|-ZZzz]
                    XML FormatIn the XML format, this property is represented as an attribute.
                    120. Observation.effectiveTime.operator
                    Definition

                    A code specifying whether the set component is included (union) or excluded (set-difference) from the set, or other set operations with the current set component and the set as constructed from the representation stream up to the current point.

                    Control0..1
                    BindingThe codes SHALL be taken from CDASetOperator
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDASetOperator)
                    Typecode(cs: Coded Simple Value)
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Default ValueI
                    122. Observation.effectiveTime.low
                    Definition

                    This is the low limit of the interval.

                    Comments

                    This effectiveTime SHALL contain exactly one [1..1] low.

                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
                    LabelLow Boundary
                    124. Observation.effectiveTime.center
                    Definition

                    The arithmetic mean of the interval (low plus high divided by 2). The purpose of distinguishing the center as a semantic property is for conversions of intervals from and to point values.

                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/TS
                    LabelCentral Value
                    126. Observation.effectiveTime.width
                    Definition

                    The difference between high and low boundary. The purpose of distinguishing a width property is to handle all cases of incomplete information symmetrically. In any interval representation only two of the three properties high, low, and width need to be stated and the third can be derived.

                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/PQ
                    LabelWidth
                    128. Observation.effectiveTime.high
                    Definition

                    This is the high limit of the interval.

                    Comments

                    This effectiveTime SHALL contain exactly one [1..1] high.

                    Control1..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
                    LabelHigh Boundary
                    Invariants1198-32449: If the Advance Directive does not have a specified ending time, the <high> element **SHALL** have the nullFlavor attribute set to *NA* (CONF:1198-32449). (value.exists() or nullFlavor = 'NA')
                    130. Observation.priorityCode
                    Control0..1
                    BindingFor example codes, see ActPriority
                    (example to http://terminology.hl7.org/ValueSet/v3-ActPriority)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                    132. Observation.repeatNumber
                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-INT
                    134. Observation.languageCode
                    Control0..1
                    BindingThe codes SHALL be taken from AllLanguages
                    (required to http://hl7.org/fhir/ValueSet/all-languages)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                    136. Observation.value
                    Comments

                    MAY contain zero or more [0..*] value.

                    Control0..1
                    TypeChoice of: http://hl7.org/cda/stds/core/StructureDefinition/ANY, http://hl7.org/cda/stds/core/StructureDefinition/BL, http://hl7.org/cda/stds/core/StructureDefinition/ED, http://hl7.org/cda/stds/core/StructureDefinition/ST, http://hl7.org/cda/stds/core/StructureDefinition/CD, http://hl7.org/cda/stds/core/StructureDefinition/CV, http://hl7.org/cda/stds/core/StructureDefinition/CE, http://hl7.org/cda/stds/core/StructureDefinition/CO, http://hl7.org/cda/stds/core/StructureDefinition/SC, http://hl7.org/cda/stds/core/StructureDefinition/II, http://hl7.org/cda/stds/core/StructureDefinition/TEL, http://hl7.org/cda/stds/core/StructureDefinition/AD, http://hl7.org/cda/stds/core/StructureDefinition/EN, http://hl7.org/cda/stds/core/StructureDefinition/INT, http://hl7.org/cda/stds/core/StructureDefinition/REAL, http://hl7.org/cda/stds/core/StructureDefinition/PQ, http://hl7.org/cda/stds/core/StructureDefinition/MO, http://hl7.org/cda/stds/core/StructureDefinition/TS, http://hl7.org/cda/stds/core/StructureDefinition/IVL-PQ, http://hl7.org/cda/stds/core/StructureDefinition/IVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/PIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/EIVL-TS, http://hl7.org/cda/stds/core/StructureDefinition/SXPR-TS, http://hl7.org/cda/stds/core/StructureDefinition/RTO-PQ-PQ
                    XML FormatThe type of this property is determined using the xsi:typeattribute.
                    138. Observation.interpretationCode
                    Control0..*
                    BindingThe codes SHALL be taken from CDAObservationInterpretation
                    (required to http://hl7.org/cda/stds/core/ValueSet/CDAObservationInterpretation)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                    140. Observation.methodCode
                    Control0..*
                    BindingFor example codes, see ObservationMethod
                    (example to http://terminology.hl7.org/ValueSet/v3-ObservationMethod)
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                    142. Observation.targetSiteCode
                    Definition

                    Drawn from concept domain ActSite

                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                    144. Observation.subject
                    Control0..1
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Subject
                    146. Observation.specimen
                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Specimen
                    148. Observation.performer
                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Performer2
                    150. Observation.author
                    Definition

                    Defines the basic properties of every data value. This is an abstract type, meaning that no value can be just a data value without belonging to any concrete type. Every concrete type is a specialization of this general abstract DataValue type.

                    ShortBase for all types and resources
                    Comments

                    SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119).

                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author(Author Participation)
                    Is Modifierfalse
                    152. Observation.informant
                    ShortSHOULD contain informant
                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Informant
                    154. Observation.participant
                    Control0..*
                    Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
                    SlicingThis element introduces a set of slices on Observation.participant. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ typeCode
                    • 156. Observation.participant:verifier
                      Slice Nameverifier
                      Short𝗨𝗦𝗖𝗗𝗜: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.
                      Comments

                      SHOULD contain zero or more [0..*] participant (CONF:1198-8662) such that it

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
                      Invariantsshould-time: SHOULD contain time (time.exists())
                      158. Observation.participant:verifier.nullFlavor
                      Definition

                      If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                      Control0..1
                      BindingThe codes SHALL be taken from CDANullFlavor
                      (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                      Typecode(cs: Coded Simple Value)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      LabelExceptional Value Detail
                      160. Observation.participant:verifier.realmCode
                      Definition

                      When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                      Control0..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                      162. Observation.participant:verifier.typeId
                      Definition

                      When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                      Control0..1
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      164. Observation.participant:verifier.typeId.nullFlavor
                      Definition

                      If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                      Control0..1
                      BindingThe codes SHALL be taken from CDANullFlavor
                      (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                      Typecode(cs: Coded Simple Value)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      LabelExceptional Value Detail
                      166. Observation.participant:verifier.typeId.assigningAuthorityName
                      Definition

                      A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                      Control0..1
                      Typestring(st: Character String)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      LabelAssigning Authority Name
                      168. Observation.participant:verifier.typeId.displayable
                      Definition

                      Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                      Control0..1
                      Typeboolean(bl: Boolean)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      LabelDisplayable
                      170. Observation.participant:verifier.typeId.root
                      Definition

                      Identifies the type as an HL7 Registered model

                      Control1..1
                      Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      LabelRoot
                      Fixed Value2.16.840.1.113883.1.3
                      172. Observation.participant:verifier.typeId.extension
                      Definition

                      A character string as a unique identifier within the scope of the identifier root.

                      Control1..1
                      Typestring(st: Character String)
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      XML FormatIn the XML format, this property is represented as an attribute.
                      LabelExtension
                      174. Observation.participant:verifier.templateId
                      Definition

                      When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                      Control1..*
                      Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                      SlicingThis element introduces a set of slices on Observation.participant.templateId. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ root
                      • 176. Observation.participant:verifier.templateId:primary
                        Slice Nameprimary
                        Definition

                        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                        Comments

                        SHALL contain exactly one [1..1] templateId (CONF:1198-8664) such that it

                        Control1..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        178. Observation.participant:verifier.templateId:primary.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        180. Observation.participant:verifier.templateId:primary.assigningAuthorityName
                        Definition

                        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                        Control0..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelAssigning Authority Name
                        182. Observation.participant:verifier.templateId:primary.displayable
                        Definition

                        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                        Control0..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelDisplayable
                        184. Observation.participant:verifier.templateId:primary.root
                        Definition

                        A unique identifier that guarantees the global uniqueness of the instance identifier. The root alone may be the entire instance identifier.

                        Comments

                        SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.1.58" (CONF:1198-10486).

                        Control1..1
                        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelRoot
                        Pattern Value2.16.840.1.113883.10.20.1.58
                        186. Observation.participant:verifier.templateId:primary.extension
                        Definition

                        A character string as a unique identifier within the scope of the identifier root.

                        Comments

                        SHALL not contain [0..0] extension

                        Control0..0
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExtension
                        188. Observation.participant:verifier.typeCode
                        Comments

                        SHALL contain exactly one [1..1] @typeCode="VRF" Verifier (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8663).

                        Control1..1
                        BindingThe codes SHALL be taken from CDAParticipationType
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed ValueVRF
                        190. Observation.participant:verifier.contextControlCode
                        Control0..1
                        BindingThe codes SHALL be taken from CDAContextControl
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDAContextControl)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed ValueOP
                        192. Observation.participant:verifier.sdtcFunctionCode
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namefunctionCode.
                        194. Observation.participant:verifier.time
                        Comments

                        SHOULD contain zero or one [0..1] time (CONF:1198-8665).

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
                        Invariantsvalue-only: Interval fields SHALL NOT be present ((low | high | width | center).empty())
                        196. Observation.participant:verifier.time.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        198. Observation.participant:verifier.time.value
                        Definition

                        A quantity specifying a point on the axis of natural time. A point in time is most often represented as a calendar expression.

                        Shortvalue should be used instead of low/high
                        Control0..1
                        TypedateTime(ts: Point in Time)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Date FormatYYYYMMDDHHMMSS.UUUU[+|-ZZzz]
                        XML FormatIn the XML format, this property is represented as an attribute.
                        200. Observation.participant:verifier.time.operator
                        Definition

                        A code specifying whether the set component is included (union) or excluded (set-difference) from the set, or other set operations with the current set component and the set as constructed from the representation stream up to the current point.

                        Control0..1
                        BindingThe codes SHALL be taken from CDASetOperator
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDASetOperator)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Default ValueI
                        202. Observation.participant:verifier.time.low
                        Definition

                        This is the low limit of the interval.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
                        LabelLow Boundary
                        204. Observation.participant:verifier.time.center
                        Definition

                        The arithmetic mean of the interval (low plus high divided by 2). The purpose of distinguishing the center as a semantic property is for conversions of intervals from and to point values.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/TS
                        LabelCentral Value
                        206. Observation.participant:verifier.time.width
                        Definition

                        The difference between high and low boundary. The purpose of distinguishing a width property is to handle all cases of incomplete information symmetrically. In any interval representation only two of the three properties high, low, and width need to be stated and the third can be derived.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PQ
                        LabelWidth
                        208. Observation.participant:verifier.time.high
                        Definition

                        This is the high limit of the interval.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVXB-TS
                        LabelHigh Boundary
                        210. Observation.participant:verifier.awarenessCode
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        212. Observation.participant:verifier.participantRole
                        Comments

                        SHALL contain exactly one [1..1] participantRole (CONF:1198-8825).

                        Control1..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ParticipantRole
                        Invariantsshould-code: SHOULD contain code (code.exists())
                        214. Observation.participant:verifier.participantRole.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        216. Observation.participant:verifier.participantRole.realmCode
                        Definition

                        When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                        218. Observation.participant:verifier.participantRole.typeId
                        Definition

                        When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        220. Observation.participant:verifier.participantRole.typeId.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        222. Observation.participant:verifier.participantRole.typeId.assigningAuthorityName
                        Definition

                        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                        Control0..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelAssigning Authority Name
                        224. Observation.participant:verifier.participantRole.typeId.displayable
                        Definition

                        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                        Control0..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelDisplayable
                        226. Observation.participant:verifier.participantRole.typeId.root
                        Definition

                        Identifies the type as an HL7 Registered model

                        Control1..1
                        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelRoot
                        Fixed Value2.16.840.1.113883.1.3
                        228. Observation.participant:verifier.participantRole.typeId.extension
                        Definition

                        A character string as a unique identifier within the scope of the identifier root.

                        Control1..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExtension
                        230. Observation.participant:verifier.participantRole.templateId
                        Definition

                        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        232. Observation.participant:verifier.participantRole.classCode
                        Control0..1
                        BindingThe codes SHALL be taken from CDARoleClassRoot
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Default ValueROL
                        234. Observation.participant:verifier.participantRole.id
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        236. Observation.participant:verifier.participantRole.sdtcIdentifiedBy
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IdentifiedBy
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameidentifiedBy.
                        238. Observation.participant:verifier.participantRole.code
                        Comments

                        This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-28446).

                        Control0..1
                        BindingThe codes SHOULD be taken from Healthcare Provider Taxonomy .
                        (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066)
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        240. Observation.participant:verifier.participantRole.addr
                        Definition

                        Mailing and home or office addresses. A sequence of address parts, such as street or post office Box, city, postal code, country, etc.

                        ShortBase for all types and resources
                        Comments

                        This participantRole MAY contain zero or more [0..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-28451).

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/AD(US Realm Address)
                        Is Modifierfalse
                        Invariantsshall-city: SHALL contain exactly one [1..1] city (CONF:81-7292). (nullFlavor.exists() or item.city.count() = 1)
                        shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291). (nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4))
                        should-use: SHOULD contain @use (nullFlavor.exists() or use.exists())
                        should-country: SHOULD contain country (nullFlavor.exists() or item.country.exists())
                        81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296) (item.xmlText.empty())
                        81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024). (nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')))
                        81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). (nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')))
                        shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country ((item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1))
                        242. Observation.participant:verifier.participantRole.telecom
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
                        244. Observation.participant:verifier.participantRole.playingDevice
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Device
                        246. Observation.participant:verifier.participantRole.playingEntity
                        Comments

                        This participantRole SHALL contain exactly one [1..1] playingEntity (CONF:1198-28428).

                        Control1..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PlayingEntity
                        248. Observation.participant:verifier.participantRole.playingEntity.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        250. Observation.participant:verifier.participantRole.playingEntity.realmCode
                        Definition

                        When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                        252. Observation.participant:verifier.participantRole.playingEntity.typeId
                        Definition

                        When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        254. Observation.participant:verifier.participantRole.playingEntity.typeId.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        256. Observation.participant:verifier.participantRole.playingEntity.typeId.assigningAuthorityName
                        Definition

                        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                        Control0..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelAssigning Authority Name
                        258. Observation.participant:verifier.participantRole.playingEntity.typeId.displayable
                        Definition

                        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                        Control0..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelDisplayable
                        260. Observation.participant:verifier.participantRole.playingEntity.typeId.root
                        Definition

                        Identifies the type as an HL7 Registered model

                        Control1..1
                        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelRoot
                        Fixed Value2.16.840.1.113883.1.3
                        262. Observation.participant:verifier.participantRole.playingEntity.typeId.extension
                        Definition

                        A character string as a unique identifier within the scope of the identifier root.

                        Control1..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExtension
                        264. Observation.participant:verifier.participantRole.playingEntity.templateId
                        Definition

                        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        266. Observation.participant:verifier.participantRole.playingEntity.classCode
                        Control0..1
                        BindingThe codes SHALL be taken from EntityClassRoot
                        (required to http://terminology.hl7.org/ValueSet/v3-EntityClassRoot)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Default ValueENT
                        268. Observation.participant:verifier.participantRole.playingEntity.determinerCode
                        Control0..1
                        BindingThe codes SHALL be taken from EntityDeterminer
                        (required to http://terminology.hl7.org/ValueSet/v3-EntityDeterminer)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed ValueINSTANCE
                        270. Observation.participant:verifier.participantRole.playingEntity.code
                        Control0..1
                        BindingFor example codes, see CDAEntityCode
                        (example to http://hl7.org/cda/stds/core/ValueSet/CDAEntityCode)
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        272. Observation.participant:verifier.participantRole.playingEntity.quantity
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PQ
                        274. Observation.participant:verifier.participantRole.playingEntity.name
                        Definition

                        A name for a person. A sequence of name parts, such as given name or family name, prefix, suffix, etc. Examples for person name values are "Jim Bob Walton, Jr.", "Adam Everyman", etc. A person name may be as simple as a character string or may consist of several person name parts, such as, "Jim", "Bob", "Walton", and "Jr.". PN differs from EN because the qualifier type cannot include LS (Legal Status).

                        ShortBase for all types and resources
                        Comments

                        The playingEntity SHALL contain exactly one [1..1] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-28454).

                        Control1..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PN(US Realm Person Name (PN.US.FIELDED))
                        Is Modifierfalse
                        Invariantspn-no-ls: 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())
                        81-9371: 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: 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())
                        276. Observation.participant:verifier.participantRole.playingEntity.sdtcBirthTime
                        Definition

                        The purpose of this extension is to allow the recording of the subscriber or member of a health plan in cases where the health plan eligibility system has different information on file than the provider does for the patient.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/TS
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namebirthTime.
                        278. Observation.participant:verifier.participantRole.playingEntity.desc
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                        280. Observation.participant:verifier.participantRole.scopingEntity
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Entity
                        282. Observation.participant:custodian
                        Slice Namecustodian
                        ShortThis custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter.
                        Comments

                        SHOULD contain zero or more [0..*] participant (CONF:1198-8667) such that it

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Participant2
                        284. Observation.participant:custodian.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        286. Observation.participant:custodian.realmCode
                        Definition

                        When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                        288. Observation.participant:custodian.typeId
                        Definition

                        When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        290. Observation.participant:custodian.typeId.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        292. Observation.participant:custodian.typeId.assigningAuthorityName
                        Definition

                        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                        Control0..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelAssigning Authority Name
                        294. Observation.participant:custodian.typeId.displayable
                        Definition

                        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                        Control0..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelDisplayable
                        296. Observation.participant:custodian.typeId.root
                        Definition

                        Identifies the type as an HL7 Registered model

                        Control1..1
                        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelRoot
                        Fixed Value2.16.840.1.113883.1.3
                        298. Observation.participant:custodian.typeId.extension
                        Definition

                        A character string as a unique identifier within the scope of the identifier root.

                        Control1..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExtension
                        300. Observation.participant:custodian.templateId
                        Definition

                        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        302. Observation.participant:custodian.typeCode
                        Comments

                        SHALL contain exactly one [1..1] @typeCode="CST" Custodian (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8668).

                        Control1..1
                        BindingThe codes SHALL be taken from CDAParticipationType
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDAParticipationType)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed ValueCST
                        304. Observation.participant:custodian.contextControlCode
                        Control0..1
                        BindingThe codes SHALL be taken from CDAContextControl
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDAContextControl)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed ValueOP
                        306. Observation.participant:custodian.sdtcFunctionCode
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namefunctionCode.
                        308. Observation.participant:custodian.time
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IVL-TS
                        310. Observation.participant:custodian.awarenessCode
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        312. Observation.participant:custodian.participantRole
                        Comments

                        SHALL contain exactly one [1..1] participantRole (CONF:1198-8669).

                        Control1..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ParticipantRole
                        Invariantsshould-code: SHOULD contain code (code.exists())
                        should-addr: SHOULD contain addr (addr.exists())
                        should-telecom: SHOULD contain telecom (telecom.exists())
                        314. Observation.participant:custodian.participantRole.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        316. Observation.participant:custodian.participantRole.realmCode
                        Definition

                        When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                        318. Observation.participant:custodian.participantRole.typeId
                        Definition

                        When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        320. Observation.participant:custodian.participantRole.typeId.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        322. Observation.participant:custodian.participantRole.typeId.assigningAuthorityName
                        Definition

                        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                        Control0..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelAssigning Authority Name
                        324. Observation.participant:custodian.participantRole.typeId.displayable
                        Definition

                        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                        Control0..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelDisplayable
                        326. Observation.participant:custodian.participantRole.typeId.root
                        Definition

                        Identifies the type as an HL7 Registered model

                        Control1..1
                        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelRoot
                        Fixed Value2.16.840.1.113883.1.3
                        328. Observation.participant:custodian.participantRole.typeId.extension
                        Definition

                        A character string as a unique identifier within the scope of the identifier root.

                        Control1..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExtension
                        330. Observation.participant:custodian.participantRole.templateId
                        Definition

                        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        332. Observation.participant:custodian.participantRole.classCode
                        Comments

                        This participantRole SHALL contain exactly one [1..1] @classCode="AGNT" Agent (CodeSystem: HL7RoleClass urn:oid:2.16.840.1.113883.5.110 STATIC) (CONF:1198-8670).

                        Control1..1
                        BindingThe codes SHALL be taken from CDARoleClassRoot
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDARoleClassRoot)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Default ValueROL
                        Fixed ValueAGNT
                        334. Observation.participant:custodian.participantRole.id
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        336. Observation.participant:custodian.participantRole.sdtcIdentifiedBy
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/IdentifiedBy
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameidentifiedBy.
                        338. Observation.participant:custodian.participantRole.code
                        Comments

                        This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Agent or Proxy Choices urn:oid:2.16.840.1.113762.1.4.1046.35 DYNAMIC (CONF:1198-28440).

                        Control0..1
                        BindingThe codes SHOULD be taken from Healthcare Agent or Proxy Choices .
                        (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35)
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        340. Observation.participant:custodian.participantRole.addr
                        Definition

                        Mailing and home or office addresses. A sequence of address parts, such as street or post office Box, city, postal code, country, etc.

                        ShortBase for all types and resources
                        Comments

                        This participantRole SHOULD contain zero or one [0..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-8671).

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/AD(US Realm Address)
                        Is Modifierfalse
                        Invariantsshall-city: SHALL contain exactly one [1..1] city (CONF:81-7292). (nullFlavor.exists() or item.city.count() = 1)
                        shall-streetAddressLine: SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291). (nullFlavor.exists() or (item.streetAddressLine.count() >= 1 and item.streetAddressLine.count() <= 4))
                        should-use: SHOULD contain @use (nullFlavor.exists() or use.exists())
                        should-country: SHOULD contain country (nullFlavor.exists() or item.country.exists())
                        81-7296: **SHALL NOT** have mixed content except for white space (CONF:81-7296) (item.xmlText.empty())
                        81-10024: If the country is US, the state element is required and SHALL be selected from ValueSet StateValueSet but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024). (nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.state.exists(nullFlavor.exists() or xmlText.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-usps-state')))
                        81-10025: If the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). (nullFlavor.exists() or (item.country.exists() and item.country.xmlText != 'US' and item.country.xmlText != 'USA') or item.postalCode.exists(nullFlavor.exists() or xmlText.matches('[0-9]{5}(-[0-9]{4})?')))
                        shall-max-ad-parts: SHALL have at most one of each: state, city, postalCode, and country ((item.state.empty() or item.state.count() = 1) and (item.city.empty() or item.city.count() = 1) and (item.postalCode.empty() or item.postalCode.count() = 1) and (item.country.empty() or item.country.count() = 1))
                        342. Observation.participant:custodian.participantRole.telecom
                        Comments

                        This participantRole SHOULD contain zero or more [0..*] telecom (CONF:1198-8672).

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
                        344. Observation.participant:custodian.participantRole.playingDevice
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Device
                        346. Observation.participant:custodian.participantRole.playingEntity
                        Comments

                        This participantRole SHALL contain exactly one [1..1] playingEntity (CONF:1198-8824).

                        Control1..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PlayingEntity
                        Invariantsshould-code: SHOULD contain code (code.exists())
                        348. Observation.participant:custodian.participantRole.playingEntity.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        350. Observation.participant:custodian.participantRole.playingEntity.realmCode
                        Definition

                        When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                        352. Observation.participant:custodian.participantRole.playingEntity.typeId
                        Definition

                        When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        354. Observation.participant:custodian.participantRole.playingEntity.typeId.nullFlavor
                        Definition

                        If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                        Control0..1
                        BindingThe codes SHALL be taken from CDANullFlavor
                        (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExceptional Value Detail
                        356. Observation.participant:custodian.participantRole.playingEntity.typeId.assigningAuthorityName
                        Definition

                        A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                        Control0..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelAssigning Authority Name
                        358. Observation.participant:custodian.participantRole.playingEntity.typeId.displayable
                        Definition

                        Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                        Control0..1
                        Typeboolean(bl: Boolean)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelDisplayable
                        360. Observation.participant:custodian.participantRole.playingEntity.typeId.root
                        Definition

                        Identifies the type as an HL7 Registered model

                        Control1..1
                        Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelRoot
                        Fixed Value2.16.840.1.113883.1.3
                        362. Observation.participant:custodian.participantRole.playingEntity.typeId.extension
                        Definition

                        A character string as a unique identifier within the scope of the identifier root.

                        Control1..1
                        Typestring(st: Character String)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        LabelExtension
                        364. Observation.participant:custodian.participantRole.playingEntity.templateId
                        Definition

                        When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                        366. Observation.participant:custodian.participantRole.playingEntity.classCode
                        Control0..1
                        BindingThe codes SHALL be taken from EntityClassRoot
                        (required to http://terminology.hl7.org/ValueSet/v3-EntityClassRoot)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Default ValueENT
                        368. Observation.participant:custodian.participantRole.playingEntity.determinerCode
                        Control0..1
                        BindingThe codes SHALL be taken from EntityDeterminer
                        (required to http://terminology.hl7.org/ValueSet/v3-EntityDeterminer)
                        Typecode(cs: Coded Simple Value)
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Fixed ValueINSTANCE
                        370. Observation.participant:custodian.participantRole.playingEntity.code
                        Comments

                        This playingEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal and Legal Relationship RoleType urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC.

                        Control0..1
                        BindingThe codes SHOULD be taken from Personal And Legal Relationship Role Type .
                        (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1)
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/CE
                        372. Observation.participant:custodian.participantRole.playingEntity.quantity
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PQ
                        374. Observation.participant:custodian.participantRole.playingEntity.name
                        ShortThe name of the healthcare agent.
                        Comments

                        This playingEntity SHALL contain exactly one [1..1] name (CONF:1198-8673).

                        Control1..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/PN
                        376. Observation.participant:custodian.participantRole.playingEntity.sdtcBirthTime
                        Definition

                        The purpose of this extension is to allow the recording of the subscriber or member of a health plan in cases where the health plan eligibility system has different information on file than the provider does for the patient.

                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/TS
                        XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual namebirthTime.
                        378. Observation.participant:custodian.participantRole.playingEntity.desc
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                        380. Observation.participant:custodian.participantRole.scopingEntity
                        Control0..1
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Entity
                        382. Observation.entryRelationship
                        Control0..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/EntryRelationship
                        384. Observation.reference
                        Control1..*
                        Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                        SlicingThis element introduces a set of slices on Observation.reference. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ typeCode
                        • 386. Observation.reference:reference1
                          Slice Namereference1
                          Comments

                          SHOULD contain at least one [1..*] reference (CONF:1198-8692) such that it

                          Control1..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/Reference
                          388. Observation.reference:reference1.nullFlavor
                          Definition

                          If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                          Control0..1
                          BindingThe codes SHALL be taken from CDANullFlavor
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExceptional Value Detail
                          390. Observation.reference:reference1.realmCode
                          Definition

                          When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                          392. Observation.reference:reference1.typeId
                          Definition

                          When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          394. Observation.reference:reference1.typeId.nullFlavor
                          Definition

                          If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                          Control0..1
                          BindingThe codes SHALL be taken from CDANullFlavor
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExceptional Value Detail
                          396. Observation.reference:reference1.typeId.assigningAuthorityName
                          Definition

                          A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                          Control0..1
                          Typestring(st: Character String)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelAssigning Authority Name
                          398. Observation.reference:reference1.typeId.displayable
                          Definition

                          Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                          Control0..1
                          Typeboolean(bl: Boolean)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelDisplayable
                          400. Observation.reference:reference1.typeId.root
                          Definition

                          Identifies the type as an HL7 Registered model

                          Control1..1
                          Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelRoot
                          Fixed Value2.16.840.1.113883.1.3
                          402. Observation.reference:reference1.typeId.extension
                          Definition

                          A character string as a unique identifier within the scope of the identifier root.

                          Control1..1
                          Typestring(st: Character String)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExtension
                          404. Observation.reference:reference1.templateId
                          Definition

                          When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          406. Observation.reference:reference1.typeCode
                          Comments

                          SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8694).

                          Control1..1
                          BindingThe codes SHALL be taken from x_ActRelationshipExternalReference
                          (required to http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Fixed ValueREFR
                          408. Observation.reference:reference1.seperatableInd
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/BL
                          410. Observation.reference:reference1.externalAct
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalAct
                          412. Observation.reference:reference1.externalObservation
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalObservation
                          414. Observation.reference:reference1.externalProcedure
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalProcedure
                          416. Observation.reference:reference1.externalDocument
                          Short𝗨𝗦𝗖𝗗𝗜: External Document
                          Comments

                          SHALL contain exactly one [1..1] externalDocument (CONF:1198-8693).

                          Control1..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ExternalDocument
                          418. Observation.reference:reference1.externalDocument.nullFlavor
                          Definition

                          If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                          Control0..1
                          BindingThe codes SHALL be taken from CDANullFlavor
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExceptional Value Detail
                          420. Observation.reference:reference1.externalDocument.realmCode
                          Definition

                          When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                          422. Observation.reference:reference1.externalDocument.typeId
                          Definition

                          When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          424. Observation.reference:reference1.externalDocument.typeId.nullFlavor
                          Definition

                          If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                          Control0..1
                          BindingThe codes SHALL be taken from CDANullFlavor
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExceptional Value Detail
                          426. Observation.reference:reference1.externalDocument.typeId.assigningAuthorityName
                          Definition

                          A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                          Control0..1
                          Typestring(st: Character String)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelAssigning Authority Name
                          428. Observation.reference:reference1.externalDocument.typeId.displayable
                          Definition

                          Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                          Control0..1
                          Typeboolean(bl: Boolean)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelDisplayable
                          430. Observation.reference:reference1.externalDocument.typeId.root
                          Definition

                          Identifies the type as an HL7 Registered model

                          Control1..1
                          Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelRoot
                          Fixed Value2.16.840.1.113883.1.3
                          432. Observation.reference:reference1.externalDocument.typeId.extension
                          Definition

                          A character string as a unique identifier within the scope of the identifier root.

                          Control1..1
                          Typestring(st: Character String)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExtension
                          434. Observation.reference:reference1.externalDocument.templateId
                          Definition

                          When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          436. Observation.reference:reference1.externalDocument.classCode
                          Control0..1
                          BindingThe codes SHALL be taken from ActClassDocument
                          (required to http://terminology.hl7.org/ValueSet/v3-ActClassDocument)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Default ValueDOC
                          438. Observation.reference:reference1.externalDocument.moodCode
                          Control0..1
                          BindingThe codes SHALL be taken from CDAActMood
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDAActMood)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Fixed ValueEVN
                          440. Observation.reference:reference1.externalDocument.id
                          Comments

                          This externalDocument SHALL contain at least one [1..*] id (CONF:1198-8695).

                          Control1..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          442. Observation.reference:reference1.externalDocument.code
                          Control1..1
                          BindingThe codes SHOULD be taken from Advance Directives Categories .
                          (preferred to http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4)
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/CD
                          444. Observation.reference:reference1.externalDocument.text
                          Comments

                          This externalDocument MAY contain zero or one [0..1] text (CONF:1198-8696).

                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                          446. Observation.reference:reference1.externalDocument.text.nullFlavor
                          Definition

                          If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                          Control0..1
                          BindingThe codes SHALL be taken from CDANullFlavor
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExceptional Value Detail
                          448. Observation.reference:reference1.externalDocument.text.compression
                          Definition

                          Indicates whether the raw byte data is compressed, and what compression algorithm was used.

                          Control0..1
                          BindingThe codes SHALL be taken from CDACompressionAlgorithm
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDACompressionAlgorithm)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelCompression
                          450. Observation.reference:reference1.externalDocument.text.integrityCheck
                          Definition

                          The integrity check is a short binary value representing a cryptographically strong checksum that is calculated over the binary data. The purpose of this property, when communicated with a reference is for anyone to validate later whether the reference still resolved to the same data that the reference resolved to when the encapsulated data value with reference was created.

                          Control0..1
                          Typebase64Binary(bin: Binary Data)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelIntegrity Check
                          452. Observation.reference:reference1.externalDocument.text.integrityCheckAlgorithm
                          Definition

                          Specifies the algorithm used to compute the integrityCheck value. The cryptographically strong checksum algorithm Secure Hash Algorithm-1 (SHA-1) is currently the industry standard. It has superseded the MD5 algorithm only a couple of years ago, when certain flaws in the security of MD5 were discovered. Currently the SHA-1 hash algorithm is the default choice for the integrity check algorithm. Note that SHA-256 is also entering widespread usage.

                          Control0..1
                          BindingThe codes SHALL be taken from IntegrityCheckAlgorithm (2.0.0)
                          (required to http://terminology.hl7.org/ValueSet/v3-IntegrityCheckAlgorithm|2.0.0)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelIntegrity Check Algorithm
                          454. Observation.reference:reference1.externalDocument.text.language
                          Definition

                          For character based information the language property specifies the human language of the text.

                          Control0..1
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelLanguage
                          456. Observation.reference:reference1.externalDocument.text.mediaType
                          Definition

                          Identifies the type of the encapsulated data and identifies a method to interpret or render the data.

                          Control0..1
                          BindingFor example codes, see MediaType
                          (example to http://terminology.hl7.org/ValueSet/v3-MediaType)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelMedia Type
                          458. Observation.reference:reference1.externalDocument.text.representation
                          Control0..1
                          BindingThe codes SHALL be taken from CDABinaryDataEncoding
                          (required to http://hl7.org/cda/stds/core/ValueSet/BinaryDataEncoding)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          460. Observation.reference:reference1.externalDocument.text.xmlText
                          Definition

                          Data that is primarily intended for human interpretation or for further machine processing is outside the scope of HL7. This includes unformatted or formatted written language, multimedia data, or structured information as defined by a different standard (e.g., XML-signatures.)

                          ShortAllows for mixed text content. If @representation='B64', this SHALL be a base64binary string.
                          Comments

                          This element is represented in XML as textual content. The actual name "xmlText" will not appear in a CDA instance.

                          Control0..1
                          Typestring(st: Character String)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as unadorned text.
                          462. Observation.reference:reference1.externalDocument.text.reference
                          Definition

                          A telecommunication address (TEL), such as a URL for HTTP or FTP, which will resolve to precisely the same binary data that could as well have been provided as inline data.

                          ShortThe URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698).
                          Comments

                          The text, if present, MAY contain zero or one [0..1] reference (CONF:1198-8697).

                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/TEL
                          LabelReference
                          Invariants1198-8699: If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699). ()
                          464. Observation.reference:reference1.externalDocument.text.thumbnail
                          Definition

                          An abbreviated rendition of the full data. A thumbnail requires significantly fewer resources than the full data, while still maintaining some distinctive similarity with the full data. A thumbnail is typically used with by-reference encapsulated data. It allows a user to select data more efficiently before actually downloading through the reference.

                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ED
                          LabelThumbnail
                          466. Observation.reference:reference1.externalDocument.setId
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          468. Observation.reference:reference1.externalDocument.versionNumber
                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/INT
                          470. Observation.reference:reference1.externalDocument.sdtcAuthor
                          Short𝗨𝗦𝗖𝗗𝗜: Author
                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/Author
                          XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameauthor.
                          472. Observation.precondition
                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition
                          474. Observation.sdtcPrecondition2
                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/Precondition2
                          XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameprecondition2.
                          476. Observation.referenceRange
                          Definition

                          Relates an Observation to the ObservationRange class, where the expected range of values for a particular observation can be specified.

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/InfrastructureRoot
                          478. Observation.referenceRange.nullFlavor
                          Definition

                          If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                          Control0..1
                          BindingThe codes SHALL be taken from CDANullFlavor
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExceptional Value Detail
                          480. Observation.referenceRange.realmCode
                          Definition

                          When valued in an instance, this attribute signals the imposition of realm-specific constraints. The value of this attribute identifies the realm in question

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/CS
                          482. Observation.referenceRange.typeId
                          Definition

                          When valued in an instance, this attribute signals the imposition of constraints defined in an HL7-specified message type. This might be a common type (also known as CMET in the messaging communication environment), or content included within a wrapper. The value of this attribute provides a unique identifier for the type in question.

                          Control0..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          484. Observation.referenceRange.typeId.nullFlavor
                          Definition

                          If a value is an exceptional value (NULL-value), this specifies in what way and why proper information is missing.

                          Control0..1
                          BindingThe codes SHALL be taken from CDANullFlavor
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExceptional Value Detail
                          486. Observation.referenceRange.typeId.assigningAuthorityName
                          Definition

                          A human readable name or mnemonic for the assigning authority. The Assigning Authority Name has no computational value. The purpose of a Assigning Authority Name is to assist an unaided human interpreter of an II value to interpret the authority. Note: no automated processing must depend on the assigning authority name to be present in any form.

                          Control0..1
                          Typestring(st: Character String)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelAssigning Authority Name
                          488. Observation.referenceRange.typeId.displayable
                          Definition

                          Specifies if the identifier is intended for human display and data entry (displayable = true) as opposed to pure machine interoperation (displayable = false).

                          Control0..1
                          Typeboolean(bl: Boolean)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelDisplayable
                          490. Observation.referenceRange.typeId.root
                          Definition

                          Identifies the type as an HL7 Registered model

                          Control1..1
                          Typestring(oid: ISO Object Identifier, uuid: DCE Universal Unique Identifier, ruid: HL7 Reserved Identifier Scheme)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelRoot
                          Fixed Value2.16.840.1.113883.1.3
                          492. Observation.referenceRange.typeId.extension
                          Definition

                          A character string as a unique identifier within the scope of the identifier root.

                          Control1..1
                          Typestring(st: Character String)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          LabelExtension
                          494. Observation.referenceRange.templateId
                          Definition

                          When valued in an instance, this attribute signals the imposition of a set of template-defined constraints. The value of this attribute provides a unique identifier for the templates in question

                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/II
                          496. Observation.referenceRange.typeCode
                          Control0..1
                          BindingThe codes SHALL be taken from CDAActRelationshipType
                          (required to http://hl7.org/cda/stds/core/ValueSet/CDAActRelationshipType)
                          Typecode(cs: Coded Simple Value)
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          XML FormatIn the XML format, this property is represented as an attribute.
                          Fixed ValueREFV
                          498. Observation.referenceRange.observationRange
                          Control1..1
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/ObservationRange
                          500. Observation.sdtcInFulfillmentOf1
                          Control0..*
                          Typehttp://hl7.org/cda/stds/core/StructureDefinition/InFulfillmentOf1
                          XML FormatIn the XML format, this property has the namespace urn:hl7-org:sdtc.In the XML format, this property has the actual nameinFulfillmentOf1.