Clinical Document Architecture
2.0.1 - active

Clinical Document Architecture, published by Health Level 7. This is not an authorized publication; it is the continuous build for version 2.0.1). This version is based on the current content of https://github.com/HL7/CDA-core-2.0/ and changes regularly. See the Directory of published versions

Logical Model: ClinicalDocument (CDA Class)

Official URL: http://hl7.org/cda/stds/core/StructureDefinition/ClinicalDocument Version: 2.0.1
Active as of 2023-10-03 Computable Name: CDAR2.ClinicalDocument

This is a generated StructureDefinition that describes CDA - that is, CDA as it actually is for R2. The intent of this StructureDefinition is to enable CDA to be a FHIR resource. That enables the FHIR infrastructure - API, conformance, query - to be used directly against CDA

Usage:

  • This Logical Model Profile is not used by any profiles in this Implementation Guide

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalDocument 1..1BaseXML Namespace: urn:hl7-org:v3
Base for all types and resources
... @classCode 0..1csBinding: ActClass (extensible)
Fixed Value: DOCCLIN
... @moodCode 0..1csBinding: ActMood (required)
Fixed Value: EVN
... realmCode 0..*CS
... typeId 1..1II
.... @root 1..1stFixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1st
... templateId 0..*II
... id 1..1II
... code 1..1CEBinding: FHIRDocumentTypeCodes (extensible)
... title 0..1ST
... effectiveTime 1..1TS
... confidentialityCode 1..1CE
... languageCode 0..1CSBinding: HumanLanguage (required)
... setId 0..1II
... versionNumber 0..1INT
... copyTime 0..1TS
... recordTarget 1..*RecordTarget
... author 1..*Author
... dataEnterer 0..1DataEnterer
... informant 0..*Informant
... custodian 1..1Custodian
... informationRecipient 0..*InformationRecipient
... legalAuthenticator 0..1LegalAuthenticator
... authenticator 0..*Authenticator
... participant 0..*Participant1
... inFulfillmentOf 0..*InFulfillmentOf
... documentationOf 0..*DocumentationOf
... relatedDocument 0..*RelatedDocument
... authorization 0..*Authorization
... componentOf 0..1ComponentOf
... component 1..1Component

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet / Code
ClinicalDocument.classCodeextensibleFixed Value: DOCCLIN
ClinicalDocument.moodCoderequiredFixed Value: EVN
ClinicalDocument.codeextensibleFHIRDocumentTypeCodes
ClinicalDocument.languageCoderequiredHumanLanguage (a valid code from http://terminology.hl7.org/CodeSystem/ietf3066)
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalDocument 1..1BaseXML Namespace: urn:hl7-org:v3
Base for all types and resources
... @classCode 0..1csBinding: ActClass (extensible)
Fixed Value: DOCCLIN
... @moodCode 0..1csBinding: ActMood (required)
Fixed Value: EVN
... realmCode 0..*CS
... typeId 1..1II
.... @root 1..1stFixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1st
... templateId 0..*II
... id 1..1II
... code 1..1CEBinding: FHIRDocumentTypeCodes (extensible)
... title 0..1ST
... effectiveTime 1..1TS
... confidentialityCode 1..1CE
... languageCode 0..1CSBinding: HumanLanguage (required)
... setId 0..1II
... versionNumber 0..1INT
... copyTime 0..1TS
... recordTarget 1..*RecordTarget
... author 1..*Author
... dataEnterer 0..1DataEnterer
... informant 0..*Informant
... custodian 1..1Custodian
... informationRecipient 0..*InformationRecipient
... legalAuthenticator 0..1LegalAuthenticator
... authenticator 0..*Authenticator
... participant 0..*Participant1
... inFulfillmentOf 0..*InFulfillmentOf
... documentationOf 0..*DocumentationOf
... relatedDocument 0..*RelatedDocument
... authorization 0..*Authorization
... componentOf 0..1ComponentOf
... component 1..1Component

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
ClinicalDocument.classCodeextensibleFixed Value: DOCCLIN
ClinicalDocument.moodCoderequiredFixed Value: EVN
ClinicalDocument.codeextensibleFHIRDocumentTypeCodes
ClinicalDocument.languageCoderequiredHumanLanguage (a valid code from http://terminology.hl7.org/CodeSystem/ietf3066)

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())
NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalDocument 1..1BaseXML Namespace: urn:hl7-org:v3
Base for all types and resources
... @classCode 0..1csBinding: ActClass (extensible)
Fixed Value: DOCCLIN
... @moodCode 0..1csBinding: ActMood (required)
Fixed Value: EVN
... realmCode 0..*CS
... typeId 1..1II
.... @root 1..1stFixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1st
... templateId 0..*II
... id 1..1II
... code 1..1CEBinding: FHIRDocumentTypeCodes (extensible)
... title 0..1ST
... effectiveTime 1..1TS
... confidentialityCode 1..1CE
... languageCode 0..1CSBinding: HumanLanguage (required)
... setId 0..1II
... versionNumber 0..1INT
... copyTime 0..1TS
... recordTarget 1..*RecordTarget
... author 1..*Author
... dataEnterer 0..1DataEnterer
... informant 0..*Informant
... custodian 1..1Custodian
... informationRecipient 0..*InformationRecipient
... legalAuthenticator 0..1LegalAuthenticator
... authenticator 0..*Authenticator
... participant 0..*Participant1
... inFulfillmentOf 0..*InFulfillmentOf
... documentationOf 0..*DocumentationOf
... relatedDocument 0..*RelatedDocument
... authorization 0..*Authorization
... componentOf 0..1ComponentOf
... component 1..1Component

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
ClinicalDocument.classCodeextensibleFixed Value: DOCCLIN
ClinicalDocument.moodCoderequiredFixed Value: EVN
ClinicalDocument.codeextensibleFHIRDocumentTypeCodes
ClinicalDocument.languageCoderequiredHumanLanguage (a valid code from http://terminology.hl7.org/CodeSystem/ietf3066)

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())

This structure is derived from Base

Summary

Mandatory: 0 element (11 nested mandatory elements)
Fixed Value: 3 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Differential View

This structure is derived from Base

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalDocument 1..1BaseXML Namespace: urn:hl7-org:v3
Base for all types and resources
... @classCode 0..1csBinding: ActClass (extensible)
Fixed Value: DOCCLIN
... @moodCode 0..1csBinding: ActMood (required)
Fixed Value: EVN
... realmCode 0..*CS
... typeId 1..1II
.... @root 1..1stFixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1st
... templateId 0..*II
... id 1..1II
... code 1..1CEBinding: FHIRDocumentTypeCodes (extensible)
... title 0..1ST
... effectiveTime 1..1TS
... confidentialityCode 1..1CE
... languageCode 0..1CSBinding: HumanLanguage (required)
... setId 0..1II
... versionNumber 0..1INT
... copyTime 0..1TS
... recordTarget 1..*RecordTarget
... author 1..*Author
... dataEnterer 0..1DataEnterer
... informant 0..*Informant
... custodian 1..1Custodian
... informationRecipient 0..*InformationRecipient
... legalAuthenticator 0..1LegalAuthenticator
... authenticator 0..*Authenticator
... participant 0..*Participant1
... inFulfillmentOf 0..*InFulfillmentOf
... documentationOf 0..*DocumentationOf
... relatedDocument 0..*RelatedDocument
... authorization 0..*Authorization
... componentOf 0..1ComponentOf
... component 1..1Component

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet / Code
ClinicalDocument.classCodeextensibleFixed Value: DOCCLIN
ClinicalDocument.moodCoderequiredFixed Value: EVN
ClinicalDocument.codeextensibleFHIRDocumentTypeCodes
ClinicalDocument.languageCoderequiredHumanLanguage (a valid code from http://terminology.hl7.org/CodeSystem/ietf3066)

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalDocument 1..1BaseXML Namespace: urn:hl7-org:v3
Base for all types and resources
... @classCode 0..1csBinding: ActClass (extensible)
Fixed Value: DOCCLIN
... @moodCode 0..1csBinding: ActMood (required)
Fixed Value: EVN
... realmCode 0..*CS
... typeId 1..1II
.... @root 1..1stFixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1st
... templateId 0..*II
... id 1..1II
... code 1..1CEBinding: FHIRDocumentTypeCodes (extensible)
... title 0..1ST
... effectiveTime 1..1TS
... confidentialityCode 1..1CE
... languageCode 0..1CSBinding: HumanLanguage (required)
... setId 0..1II
... versionNumber 0..1INT
... copyTime 0..1TS
... recordTarget 1..*RecordTarget
... author 1..*Author
... dataEnterer 0..1DataEnterer
... informant 0..*Informant
... custodian 1..1Custodian
... informationRecipient 0..*InformationRecipient
... legalAuthenticator 0..1LegalAuthenticator
... authenticator 0..*Authenticator
... participant 0..*Participant1
... inFulfillmentOf 0..*InFulfillmentOf
... documentationOf 0..*DocumentationOf
... relatedDocument 0..*RelatedDocument
... authorization 0..*Authorization
... componentOf 0..1ComponentOf
... component 1..1Component

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
ClinicalDocument.classCodeextensibleFixed Value: DOCCLIN
ClinicalDocument.moodCoderequiredFixed Value: EVN
ClinicalDocument.codeextensibleFHIRDocumentTypeCodes
ClinicalDocument.languageCoderequiredHumanLanguage (a valid code from http://terminology.hl7.org/CodeSystem/ietf3066)

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ClinicalDocument 1..1BaseXML Namespace: urn:hl7-org:v3
Base for all types and resources
... @classCode 0..1csBinding: ActClass (extensible)
Fixed Value: DOCCLIN
... @moodCode 0..1csBinding: ActMood (required)
Fixed Value: EVN
... realmCode 0..*CS
... typeId 1..1II
.... @root 1..1stFixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1st
... templateId 0..*II
... id 1..1II
... code 1..1CEBinding: FHIRDocumentTypeCodes (extensible)
... title 0..1ST
... effectiveTime 1..1TS
... confidentialityCode 1..1CE
... languageCode 0..1CSBinding: HumanLanguage (required)
... setId 0..1II
... versionNumber 0..1INT
... copyTime 0..1TS
... recordTarget 1..*RecordTarget
... author 1..*Author
... dataEnterer 0..1DataEnterer
... informant 0..*Informant
... custodian 1..1Custodian
... informationRecipient 0..*InformationRecipient
... legalAuthenticator 0..1LegalAuthenticator
... authenticator 0..*Authenticator
... participant 0..*Participant1
... inFulfillmentOf 0..*InFulfillmentOf
... documentationOf 0..*DocumentationOf
... relatedDocument 0..*RelatedDocument
... authorization 0..*Authorization
... componentOf 0..1ComponentOf
... component 1..1Component

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
ClinicalDocument.classCodeextensibleFixed Value: DOCCLIN
ClinicalDocument.moodCoderequiredFixed Value: EVN
ClinicalDocument.codeextensibleFHIRDocumentTypeCodes
ClinicalDocument.languageCoderequiredHumanLanguage (a valid code from http://terminology.hl7.org/CodeSystem/ietf3066)

Constraints

IdGradePath(s)DetailsRequirements
ele-1error**ALL** elementsAll FHIR elements must have a @value or children
: hasValue() or (children().count() > id.count())

This structure is derived from Base

Summary

Mandatory: 0 element (11 nested mandatory elements)
Fixed Value: 3 elements

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel