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

## Example Bundle: Complete Document Bundle Example

Document Details

version: 4; Last updated: 2020-08-19 05:53:55+0000;

Information Source: #7jwafzgbwz3cPoym

Preliminary Document at 2016-06-15 09:10:14+0000 by Brenda Jennings Richard MD for Amy V. Shaw

Document Subject

Amy V. SHAW

Identifier | 1032702
Address | 49 Meadow St Mounds OK US
Date of birth | 20 February 2007

Document Content

Document Id | 12345
Document Created: | June 15, 2016, 16:14, PST

Care Provision | Care Plan for Amy Shaw
Performer | Ronald Boone, MD

Author | Ronald Boone, MD
Contact info | 1003 Healthcare Drive Amherst MA 01002, US Tel: +1(555)555-1003

Encounter Id | 9937012 2.16.840.1.113883.19
Encounter Type | Care Plan
Encounter Period | From June 15, 2016, 16:20 to Sept 18, 2016, 18:20
Encounter Location | Ambulatory Care at Acme Laboratories
Responsible party | Ronald Boone, MD
Contact info | 1003 Healthcare Drive Amherst MA 01002, US Tel: +1(555)555-1003

Assigned entity | Acme Laboratories
Emergency contact | Michael Shaw
Contact info | 49 Meadow St Amherst MA 01003, US Tel: (555)555-1212
Care giver | Mrs. Lillian White
Contact info | 49 Meadow St Amherst MA 01003, US Tel: (555)555-1215

Entered by | Sally Jones
Contact info | 1003 Healthcare Drive Amherst MA 01002, US Tel: +1(555)555-1003

Signed | Ronald Boone at June 15, 2016
Contact info | 1003 Healthcare Drive Amherst MA 01002, US Tel: +1(555)555-1003

Informant | Henry Vincent, CPh
Contact info | 1007 Pharmacy Drive Portland, OR 99123, US Tel: +1(555)555-1215

Information recipient: | Primary Physician, MD
Contact info | 1005 St. Clair Avenue Amherst MA 01002, US Tel: +1(555)555-1666

Legal authenticator | Ronald Boone, MD signed at June 15, 2016
Contact info | 1003 Healthcare Drive Amherst MA 01002, US Tel: +1(555)555-1003

Document maintained by | Acme Laboratories
Contact info | 1003 Healthcare Drive Amherst MA 01002, US Tel: +1(555)555-1003

## Health Concerns Section

Concern | Status | Date
Current every day smoker | Active | Concern from June 16, 2015
Respiratory insufficiency | Completed | Concern from June 13, 2015
Pneumonia | Completed | June 16, 2015

## Goals Section

Goal | Value | Date
Pulse oximetry | 92% | September 2, 2015

## Interventions Section

Planned Intervention | Status | Date
Elevate head of bed | active | June 18, 2016
Oxygen administration by nasal cannula | active | June 18, 2016
pulse oximetry monitoring | active | June 18, 2016

## Health Status Evaluations and Outcomes Section

Item | Outcome | Date
Pulse oximetry | 95% | June 20, 2016

## Additional Resources Included in Document

Entry 2 - fullUrl = urn:uuid:23d3a2c1-44ae-491b-94d3-764d2a9d8f8c

Resource PractitionerRole:

> practitioner: Brenda Jennings Richard MD

> organization: Acme Lab

Entry 3 - fullUrl = urn:uuid:d0dbd5a1-0bd7-4205-b936-09482c02c6d9

Resource Patient:

> Amy V. SHAW

> Identifier | 1032702
> Address | 49 Meadow St Mounds OK US
> Date of birth | 20 February 2007

Entry 4 - fullUrl = urn:uuid:58d390ba-6348-4b0d-b85f-7fbd94223718

Resource Organization:

> identifier: `http://hl7.org.fhir/sid/us-npi`/1144221847, `http://www.acme.org/organization`/2523423456

> active: true

> type: Healthcare Provider

> name: Acme Labs

> > contact

> > telecom: ph: (+1) 734-677-7777, hq@acme.org

> > address: 3300 Washtenaw Avenue, Suite 227 Amherst MA 01002 USA

Entry 5 - fullUrl = urn:uuid:51819bca-6cdd-4a9c-a76f-51b4f50e7fd2

Resource Practitioner:

> identifier: US National Provider Identifier/9999991011 (use: official, )

> name: Brenda Jennings Richard

> telecom: ph: 313-555-6868(Home), ph: 313-555-6443(Work)

> gender: Female

> birthDate: 1976-11-15

> address: 346 W Plum Avenu Dearborn MI 48123