Clinical Document Architecture
2.0.0-sd - release

Clinical Document Architecture, published by Health Level 7. This guide is not an authorized publication; it is the continuous build for version 2.0.0-sd built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/CDA-core-sd/ and changes regularly. See the Directory of published versions

Logical Model: Reference (CDA Class)

Official URL: http://hl7.org/cda/stds/core/StructureDefinition/Reference Version: 2.0.0-sd
Active as of 2024-05-16 Computable Name: Reference

CDA entries can reference external objects such as external images and prior reports. These external objects are not part of the authenticated document content. They contain sufficient attributes to enable an explicit reference rather than duplicating the entire referenced object. The CDA entry that wraps the external reference can be used to encode the specific portions of the external reference that are addressed in the narrative block.

Each object allows for an identifier and a code, and contains the RIM Act.text attribute, which can be used to store the URL and MIME type of the object. External objects always have a fixed moodCode of “EVN”.

The reference class contains the attribute reference.seperatableInd, which indicates whether or not the source is intended to be interpreted independently of the target. The indicator cannot prevent an individual or application from separating the source and target, but indicates the author’s desire and willingness to attest to the content of the source if separated from the target. Typically, where seperatableInd is “false”, the exchanged package should include the target of the reference so that the recipient can render it.

Usage:

Formal Views of Template Content

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

This structure is derived from InfrastructureRoot

NameFlagsCard.TypeDescription & Constraintsdoco
.. Reference C 1..* InfrastructureRoot XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
reference-external: Must contain one (and only one) external reference
... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
... seperatableInd 0..1 BL
... (Choice of one) 1..1
.... externalAct 0..1 ExternalAct
.... externalObservation 0..1 ExternalObservation
.... externalProcedure 0..1 ExternalProcedure
.... externalDocument 0..1 ExternalDocument

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Reference.typeCoderequiredXActRelationshipExternalReference
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference

Constraints

IdGradePath(s)DetailsRequirements
reference-externalerrorReferenceMust contain one (and only one) external reference
: (externalAct | externalObservation | externalProcedure | externalDocument).count() = 1
NameFlagsCard.TypeDescription & Constraintsdoco
.. Reference C 1..* InfrastructureRoot XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
reference-external: Must contain one (and only one) external reference
... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
... seperatableInd 0..1 BL
... (Choice of one) 1..1
.... externalAct 0..1 ExternalAct
.... externalObservation 0..1 ExternalObservation
.... externalProcedure 0..1 ExternalProcedure
.... externalDocument 0..1 ExternalDocument

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Reference.typeCoderequiredXActRelationshipExternalReference
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference

Constraints

IdGradePath(s)DetailsRequirements
reference-externalerrorReferenceMust contain one (and only one) external reference
: (externalAct | externalObservation | externalProcedure | externalDocument).count() = 1
NameFlagsCard.TypeDescription & Constraintsdoco
.. Reference C 1..* InfrastructureRoot XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
reference-external: Must contain one (and only one) external reference
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId 0..1 II
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @assigningAuthorityName 0..1 st
.... @displayable 0..1 bl
.... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1 st
... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
... seperatableInd 0..1 BL
... (Choice of one) 1..1
.... externalAct 0..1 ExternalAct
.... externalObservation 0..1 ExternalObservation
.... externalProcedure 0..1 ExternalProcedure
.... externalDocument 0..1 ExternalDocument

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Reference.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
from this IG
Reference.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
from this IG
Reference.typeCoderequiredXActRelationshipExternalReference
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference

Constraints

IdGradePath(s)DetailsRequirements
reference-externalerrorReferenceMust contain one (and only one) external reference
: (externalAct | externalObservation | externalProcedure | externalDocument).count() = 1

This structure is derived from InfrastructureRoot

Differential View

This structure is derived from InfrastructureRoot

NameFlagsCard.TypeDescription & Constraintsdoco
.. Reference C 1..* InfrastructureRoot XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
reference-external: Must contain one (and only one) external reference
... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
... seperatableInd 0..1 BL
... (Choice of one) 1..1
.... externalAct 0..1 ExternalAct
.... externalObservation 0..1 ExternalObservation
.... externalProcedure 0..1 ExternalProcedure
.... externalDocument 0..1 ExternalDocument

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
Reference.typeCoderequiredXActRelationshipExternalReference
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference

Constraints

IdGradePath(s)DetailsRequirements
reference-externalerrorReferenceMust contain one (and only one) external reference
: (externalAct | externalObservation | externalProcedure | externalDocument).count() = 1

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Reference C 1..* InfrastructureRoot XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
reference-external: Must contain one (and only one) external reference
... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
... seperatableInd 0..1 BL
... (Choice of one) 1..1
.... externalAct 0..1 ExternalAct
.... externalObservation 0..1 ExternalObservation
.... externalProcedure 0..1 ExternalProcedure
.... externalDocument 0..1 ExternalDocument

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Reference.typeCoderequiredXActRelationshipExternalReference
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference

Constraints

IdGradePath(s)DetailsRequirements
reference-externalerrorReferenceMust contain one (and only one) external reference
: (externalAct | externalObservation | externalProcedure | externalDocument).count() = 1

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. Reference C 1..* InfrastructureRoot XML Namespace: urn:hl7-org:v3
Elements defined in Ancestors:@nullFlavor, realmCode, typeId, templateId
Base for all types and resources
Instance of this type are validated by templateId
Logical Container: ClinicalDocument (CDA Class)
reference-external: Must contain one (and only one) external reference
... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
... realmCode 0..* CS
... typeId 0..1 II
.... @nullFlavor 0..1 cs Binding: CDANullFlavor (required)
.... @assigningAuthorityName 0..1 st
.... @displayable 0..1 bl
.... @root 1..1 oid, uuid, ruid Fixed Value: 2.16.840.1.113883.1.3
.... @extension 1..1 st
... @typeCode 1..1 cs Binding: x_ActRelationshipExternalReference (required)
... seperatableInd 0..1 BL
... (Choice of one) 1..1
.... externalAct 0..1 ExternalAct
.... externalObservation 0..1 ExternalObservation
.... externalProcedure 0..1 ExternalProcedure
.... externalDocument 0..1 ExternalDocument

doco Documentation for this format

Terminology Bindings

PathConformanceValueSetURI
Reference.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
from this IG
Reference.typeId.nullFlavorrequiredCDANullFlavor
http://hl7.org/cda/stds/core/ValueSet/CDANullFlavor
from this IG
Reference.typeCoderequiredXActRelationshipExternalReference
http://terminology.hl7.org/ValueSet/v3-xActRelationshipExternalReference

Constraints

IdGradePath(s)DetailsRequirements
reference-externalerrorReferenceMust contain one (and only one) external reference
: (externalAct | externalObservation | externalProcedure | externalDocument).count() = 1

This structure is derived from InfrastructureRoot

 

Other representations of profile: CSV, Excel