C-CDA on FHIR
2.0.0-ballot - STU 2 Ballot

C-CDA on FHIR, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ccda-on-fhir/ and changes regularly. See the Directory of published versions

## C-CDA to FHIR Notes

This page provides a mapping from CDA to FHIR. For guidance on how to read the table below, see Reading the C-CDA ↔ FHIR Mapping Pages.

Clinical Notes may appear in their own section or as an entry in any open section. They are identified by an `<act>` with a `<code>` value of `34109-9` (Note).

### C-CDA to FHIR

C-CDA¹ Note Activity | DocumentReference | Transform Steps
--- | --- | ---
/id | .identifier | CDA id ↔ FHIR identifier
/code/translation | .type | CDA coding ↔ FHIR CodeableConcept NOTE: The root code in C-CDA is always `34109-9: Note`. A more specific code may be sent in translation which should be sent as the DocumentReference.type. If there is no translation, however, `34109-9` may be sent as the type.
| .category | Set to `clinical-note`.
/text/@mediaType & /text/text() | .content.attachment.contentType & .content.attachment.data | If @mediaType is present, then representation should = B64, and the inner-text contents are embedded base64-encoded data. In this case, the mediaType and base64-encoded data map 1:1 to attachment.contentType and .data.
/text/reference/@value | .content.attachment.contentType & .content.attachment.data | Convert the narrative element referenced by @value following Narrative Text guidance and use `application/xhtml+xml` as the contentType. If the narrative has minimal markup (i.e. only `<content>` and `<paragraph>` elements which can be converted to line breaks), it can be converted to `text/plain`. To send the raw CDA narrative without converting, use `application/cda+xml`, but this is less useful to receivers.
/effectiveTime | .context.period | CDA ↔ FHIR Time/Dates
/author | .author | C-CDA → FHIR Participation
/author/time | .date | CDA ↔ FHIR Time/Dates
/entryRelationship[@typeCode=COMP]/encounter or Parent `<encounter>` element or `<encompassingEncounter>` | .context.encounter | If the Note Activity includes an entryRelationship to an Encounter Activity (or an `<encounter>` element with an `<id>` referencing an Encounter Activity elsewhere in the document), that is the context.encounter. If no entryRelationship is present, but the Note Activity is itself an entryRelationship underneath an Encounter Activity, use that. If neither are true, but the document contains an `<encompassingEncounter>`, that is the encounter for entire document (see context conduction) and should be used. CDA → FHIR Encounters
/reference/externalDocument/id | .relatesTo.target.identifier | CDA id ↔ FHIR identifier

### Example

CDA Note Activity Example | FHIR DocumentReference Resource
--- | ---
<act classCode="ACT" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.22.4.202" extension="2016-11-01"/> <code code="34109-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Note"> <!-- Code must match or be equivalent to section code --> <translation code="11488-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Consultation note"/> </code> <text mediaType="application/rtf" representation="B64"> e1xydGYxXGFuc2kgSGVsbG8gd29ybGQhfQ== <reference value="#ConsultNote1"/> </text> <statusCode code="completed"/> <!-- Clinically-relevant time of the note --> <effectiveTime value="20160908"/> <!-- Author Participation --> <author> <templateId root="2.16.840.1.113883.10.20.22.4.119"/> <!-- Time note was actually written --> <time value="20160908083215-0500"/> <assignedAuthor> <!-- Full author information is elsewhere in the document . --> <id root="20cf14fb-b65c-4c8c-a54d-b0cca834c18c"/> <!-- Becomes reference: Practitioner/DrSpecialist --> <assignedPerson> <name> <prefix>Dr.</prefix> <family>Specialist</family> </name> </assignedPerson> </assignedAuthor> </author> <entryRelationship typeCode="COMP"> <!-- Creates an encounter with reference: Encounter/123 --> <encounter> ... </encounter> </entryRelationship> <reference typeCode="REFR"> <externalDocument> <id root="4dc41c26-43a4-48d9-b17e-067890006b29" /> </externalDocument> </reference> </act> | { "resourceType": "DocumentReference", "id": "642ed1f93eec840007aaec72", "language": "en-US", "status": "current", "type": { "text": "Note", "coding": [{ "code": "34109-9", "system": "http://loinc.org" }, { "code": "11488-4", "system": "http://loinc.org", "display": "Consultation Note" }] }, "category": [{ "text": "Clinical Note", "coding": [{ "code": "clinical-Note", "system": "http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category", "display": "Clinical Note" }] }], "subject": { "reference": "urn:uuid:a4986486-6599-4bb2-a7fb-e2deb8d50b5e" }, "date": "2016-09-08T08:32:15-05:00", "author": [{ "reference": "Practitioner/DrSpecialist" }], "content": [{ "attachment": { "data": "e1xydGYxXGFuc2kgSGVsbG8gd29ybGQhfQ==", "contentType": "application/rtf" } }], "context": { "period": { "start": "2016-09-08" }, "encounter": [{ "reference": "Encounter/123" }] }, "relatesTo": { "target": { "identifier": { "system": "urn:ietf:rfc:3986", "value": "urn:uuid:4dc41c26-43a4-48d9-b17e-067890006b29" } } } }