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Template CCD v1.0 Templates Root 2007‑04‑01

Id2.16.840.1.113883.10.20.1Effective Date2007‑04‑01
Statuspending Under pre-publication reviewVersion Label
NameCCDClinicalDocumentDisplay NameCCD v1.0 Templates Root
Description

2 CCR Header Representation

The CCR Header defines the document parameters, including its unique identifier, language, version, date/time, the patient whose data it contains, who or what has generated the CCR, to whom or what the CCR is directed, and the CCR’s purpose.

The following figure shows a subset of the CDA R2 Header model containing those classes being constrained or referred to in the conformance statements that follow.

2.1 CCR Unique Identifier

Represents a unique identifier for the current CCR instance. Corresponds to the ClinicalDocument / id in CDA R2. Required in both CCR and CDA. In addition, CDA R2 provides a ClinicalDocument / code, whose value is fixed by this specification

2.2 Language

No controlled vocabulary has been specified for Language in the CCR data set, whereas in CDA R2, the language is represented by a coded value using RFC-3066. Language is required in CCR, whereas it is optional in CDA R2.

CONF-5: CCD SHALL contain exactly one ClinicalDocument / languageCode.
CONF-6: ClinicalDocument / languageCode SHALL be in the form nn, or nn-CC. The nn portion SHALL be an ISO-639-1 language code in lower case. The CC portion, if present, SHALL be an ISO-3166 country code in upper case.

2.3 Version

Represents the version of the implementation guide used to create a given instance. In CDA, ClinicalDocument / templateId performs the same function, as described above in section 1.4 Asserting conformance to this Implementation Guide.

CONF-7: CCD SHALL contain one or more ClinicalDocument / templateId.
CONF-8: At least one ClinicalDocument / templateId SHALL value ClinicalDocument / templateId / @root with “2.16.840.1.113883.10.20.1”, and SHALL NOT contain ClinicalDocument / templateId / @extension.

2.4 CCR Creation Date/Time

Represents the exact clock time that the summarization was created, corresponding to the CDA R2 ClinicalDocument / effectiveTime. CCR further requires that the time be precise to the second, and must express a time zone offset.

CONF-9: ClinicalDocument / effectiveTimeSHALL be expressed with precision to include seconds.
CONF-10: ClinicalDocument / effectiveTimeSHALL include an explicit time zone offset.

2.5 Patient

Represents the patient to which the summarization refers. Corresponds to CDA R2 ClinicalDocument / recordTarget. CCR can only be about one patient with the extreme exception of conjoined twins.

CONF-11: CCD SHALL contain one to two ClinicalDocument / recordTarget.

2.6 From

Identifies who or what has generated the summarization, corresponding to CDA’s author paricipant. CDA R2 requires an author (which may be a person or a device), and stipulates that a completed document has been legally authenticated. CDA R2 also requires that a clinical document have a defined custodian. Where a CCD document is generated by a machine, legal authentication is represented as the organization responsible for generating the data.

CDA R2 author participant has a required participant time, which should be set to equal the ClinicalDocument / effectiveTime, and thus map back to CCR’s creation date/time.

CONF-12: CCD SHALL contain one or more ClinicalDocument / author / assignedAuthor / assignedPerson and/or ClinicalDocument / author / assignedAuthor / representedOrganization.

2.7 To

Represents to whom or what the summarization is targeted. Corresponds to the CDA R2 ClinicalDocument / informationRecipient participant. This is optional in both CCR and CDA.

CONF-14: CCD MAY contain one or more ClinicalDocument / informationRecipient.

2.8 Purpose

Represents the specific reason for which the summarization was generated, such as in response to a request.

The general use case does not require a purpose. Purpose should be utilized when the CCD has a specific purpose such as a transfer, referral, or patient request.

NOTE: Purpose is represented as a document body section in CCD. The template identifier for the Purpose section is 2.16.840.1.113883.10.20.1.13.

CONF-15: CCD MAY contain exactly one and SHALL NOT contain more than one Purpose section (templateId 2.16.840.1.113883.10.20.1.13). The Purpose section SHALL contain a narrative block, and SHOULD contain clinical statements. Clinical statements SHOULD include one or more purpose activities (templateId 2.16.840.1.113883.10.20.1.30).

2.8.1 Section conformance

CONF-16: The purpose section SHALL contain Section / code.
CONF-17: The value for “Section / code” SHALL be “48764-5” “Summary purpose” 2.16.840.1.113883.6.1 LOINC STATIC.
CONF-18: The purpose section SHALL contain Section / title.
CONF-19: Section / titleSHOULD be valued with a case-insensitive language-insensitive text string containing “purpose”.

2.8.2 Clinical statement conformance

The following figure shows a subset of the CDA Clinical Statement model containing those classes being constrained or referred to in the conformance statements that follow.

2.8.2.1 Purpose activity

The template identifier for a purpose activity is 2.16.840.1.113883.10.20.1.30.

CCD represents the ASTM CCR <Purpose> object as a relationship between two classes – the source represents the act of creating a summary document, the target is the reason for creating the document, and the relationship type is “RSON” (has reason). The target act may be an Observation, Procedure, or some other kind of act, and it may represent an order, an event, etc.

CONF-20: A purpose activity (templateId 2.16.840.1.113883.10.20.1.30) SHALL be represented with Act.
CONF-21: The value for “Act / @classCode” in a purpose activity SHALL be “ACT” 2.16.840.1.113883.5.6 ActClass STATIC.
CONF-22: The value for “Act / @moodCode” in a purpose activity SHALL be “EVN” 2.16.840.1.113883.5.1001 ActMood STATIC.
CONF-23: A purpose activity SHALL contain exactly one Act / statusCode.
CONF-24: The value for “Act / statusCode” in a purpose activity SHALL be “completed” 2.16.840.1.113883.5.14 ActStatus STATIC.
CONF-25: A purpose activity SHALL contain exactly one Act / code, with a value of “23745001” “Documentation procedure” 2.16.840.1.113883.6.96 SNOMED CT STATIC.
CONF-26: A purpose activity SHALL contain exactly one Act / entryRelationship / @typeCode, with a value of “RSON” “Has reason” 2.16.840.1.113883.5.1002 ActRelationshipType STATIC, to indicate the reason or purpose for creating the CCD.
CONF-27: The target of Act / entryRelationship / @typeCode in a purpose activity SHALL be an Act, Encounter, Observation, Procedure, SubstanceAdministration, or Supply.

2.9 ASTM CCR Header Mapping

The following table is the CCR Header subset of ASTM CCR Table A1.1 “CCR Data Fields Spreadsheet”.

Table 1. CCR Header mapping to CDA R2
CCR Data ObjectCCR XML ElementCCR Required or OptionalCDA R2 CorrespondenceMapping Comments
CCR Header Objects
/ccr:ContinuityOfCareRecord//ClniicalDocument/
CCR Unique Identifier
ccr:CCRDocumentObjectID		RequiredidSee section 5.4.5 Identifiers for more details.
Languageccr:LanguageRequiredlanguageCode
Versionccr:VersionRequiredtemplateId
CCR Creation Date/Timeccr:DateTimeRequiredeffectiveTime
Patientccr:PatientRequiredrecordTarget
Fromccr:FromRequiredauthor
Toccr:ToOptionalinformationRecipient
Purposeccr:PurposeOptionalAct / entryRelationship [@typeCode = “RSON”] /Represented as a document body section in CCD
ccr:DateTimeOptionalAct / effectiveTime
ccr:DescriptionRequiredAct | Encounter | Observation | Procedure | SubstanceAdministration | Supply]
ccr:OrderRequestOptional[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply]
ccr:IndicationsOptionalAct / entryRelationship [@typeCode = “RSON”] / [Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply]
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.

3 CCR Body Representation

The CCR Body contains the core patient-specific data, such as current and past medications, problems, and procedures. Data are aggregated into sections based on common clinical conventions.

In a typical scenario, the body is dynamically created by pulling in existing data from a variety of sources, and no new content is specifically created for the summary. In some cases the source data will be narrative; in other cases there may be coded data supporting some aspects of the narrative; and in some cases the source data will be fully coded. Where the body is dynamically created by pulling in existing data, the originating application creating the Continuity of Care Document can create (narrative, partially coded, or fully coded) entries corresponding to the source data, and then algorithmically construct each CDA Narrative Block (ClinicalDocument / component / structuredBody / component / section / text). In such a situation, the entry relationship "DRIV" (is derived from) (ClinicalDocument / component / structuredBody / component / section / entry / @typeCode=”DRIV”) can be used, to indicate that the CDA Narrative Block is fully derived from the (coded and/or non-coded) entries, and that the narrative contains no clinical content not derived from the entries.

CONF-28: The value for “ClinicalDocument / component / structuredBody / component / section / entry / @typeCode” MAY be “DRIV” “is derived from” 2.16.840.1.113883.5.1002 ActRelationshipType STATIC, to indicate that the CDA Narrative Block is fully derived from the structured entries.

CDA provides a mechanism to explicitly reference from an entry to the corresponding narrative, as illustrated in the following example (see CDA Release 2, section 4.3.5.1 <content> for details):

 <section> <code/> <title/> <text> <content ID="Blob1">...procedure/code original text...</content> <content ID="Blob2">...act/text uncoded text blob...</content> </text> <entry> <procedure> <code code="12345" codeSystem="2.16.840.1.113883.19.1"/> <originalText><reference value="#Blob1"/></originalText> </code> </procedure> </entry> <entry> <act> <text><reference value="#Blob2"/></text> </act> </entry> </section>

CCD recommends the use of these references to facilitate translation of CCD into ASTM’s XML CCR format.

CONF-29: A CCD entry SHOULD explicitly reference its corresponding narrative (using the approach defined in CDA Release 2, section 4.3.5.1 <content>).

....

3.1 Payers

....

3.2 Advance Directives

....

3.3 Support

....

3.4 Functional Status

....

3.5 Problems

....

3.6 Family History

....

3.7 Social History

....

3.8 Alerts

....

3.9 Medications

....

3.10 Medical Equipment

....

3.11 Immunizations

....

3.12 Vital Signs

....

3.13 Results

....

3.14 Procedures

....

3.15 Encounters

....

3.16 Plan of Care

....

3.17 Healthcare Providers

Represents the healthcare providers involved in the current or pertinent historical care of the patient. At a minimum, the patient’s key healthcare providers should be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors.

As noted above in section 2.1 CCR Unique Identifier, and illustrated in Figure 3 Subset of CDA R2 Header, the CDA R2 Header contains a ServiceEvent class which is to be used to indicate the time range being summarized. The main activity being described by the CCD is the provision of healthcare over a period of time. Relevant care providers during the summarization period are represented as ClinicalDocument / documentationOf / serviceEvent / performer, where performer / time is used to show the specific time period that the particular provider was involved in the patient’s care.

The CDA R2 Header contains additional participants, such as ClinicalDocument / author and ClinicalDocument / informationRecipient. Several CDA Header participations can be played by the same person. In such cases, the person should be identified as the player for each appropriate participation. For instance, if a person is both an author and a performer, the CDA Header should identify that person as both the author participant and as the serviceEvent / performer participant.

NOTE: CCR Healthcare Providers are not represented as a CCD Body section, but rather, are represented as performer participants in the CCD Header.

CONF-492: The value for “ClinicalDocument / documentationOf / serviceEvent / performer / @typeCodeSHALL be “PRF” “Participation physical performer” 2.16.840.1.113883.5.90 ParticipationType STATIC.
CONF-493: A value for “ClinicalDocument / documentationOf / serviceEvent / performer / assignedEntity / id” MAY be the HIPAA National Provider Identifier.
CONF-494: A value for “ClinicalDocument / documentationOf / serviceEvent / performer / assignedEntity / code” MAY be the National Uniform Claims Committee Provider Taxonomy Code.

3.18 ASTM CCR Body Mapping

The following table is the CCR Body subset of ASTM CCR Table A1.1 “CCR Data Fields Spreadsheet”.

Table 3. CCR Body mapping to CDA R2
CCR Data ObjectCCR XML ElementCCR Required or OptionalCDA R2 CorrespondenceMapping Comments
CCR Body Objects
Payersccr:PayerRequiredAct
ccr:CCRDataObjectIDRequiredAct / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalAct / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:TypeOptionalAct / code
ccr:PaymentProviderccr:ActorID is Required;
ccr:ActorRole is Optional		Act / performer [@typeCode=”PRF”]
ccr:Subscriberccr:ActorID is Required;
ccr:ActorRole is Optional		Act / participant [@typeCode=”COV”]; Act / participant [@typeCode=”HLD”]
ccr:AuthorizationsOptionalAct
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Advance Directivesccr:AdvanceDirectiveRequired if knownObservation
ccr:CCRDataObjectIDRequired if knownObservation / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalObservation / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalObservation / id; Role / id
ccr:TypeRequiredObservation / code
ccr:DescriptionRequiredObservation / value
ccr:StatusRequiredObservation / valueSee section 3.2.2.2 Representation of “status” values for more details.
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Supportccr:SupportProviderOptionalClinicalDocument / recordTarget / patientRole / patient / guardian ;
ClinicalDocument / participant
Functional Statusccr:FunctionOptionalObservation;
Act
ccr:CCRDataObjectIDRequiredObservation / id;
Act / id		See section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalObservation / effectiveTime;
Act / effectiveTime		See section 5.4.1 Dates and Times for more details.
ccr:TypeRequiredObservation / code
ccr:DescriptionOptionalAct
ccr:StatusRequiredObservation / valueSee section 3.4.2.1 Representation of “status” values for more details.
ccr:ProblemOptionalSee section 3.5 Problems.
ccr:TestOptionalSee section 3.13 Results.
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Problemsccr:ProblemOptionalActSee section 3.5.2.1 Representation of problems for more details.
ccr:CCRDataObjectIDRequiredAct / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalAct / effectiveTime;
Observation / effectiveTime		See section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalParticipantRole / id
ccr:TypeOptionalObservation / code
ccr:DescriptionOptionalObservation / value
ccr:StatusOptionalObservation / valueSee section 3.5.2.2 Representation of “status” values for more details.
ccr:EpisodesOptionalObservation / reference / @typeCode=”ELNK” / ExternalObservation;
Act / reference / @typeCode=”ELNK” / ExternalAct
ccr:HealthStatusOptionalObservation / valueSee section 3.5.2.2 Representation of “status” values for more details.
ccr:PatientKnowledgeOptionalObservation / participation / awarenessCode;
Act / participation / awarenessCode		See section 3.5.2.4 Patient awareness of a problem for more details.
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Family Historyccr:FamilyProblemHistoryOptionalObservationSee section 3.6.2.1 Family history representation for more details.
ccr:CCRDataObjectIDRequiredObservation / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalObservation / effectiveTime;
RelatedSubject / subject / birthTime;
RelatedSubject / subject / deceasedTime		See section 3.6.2.4 Representation of age for more details.
See section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalRelatedSubject / id
ccr:TypeOptionalObservation / code
ccr:DescriptionOptionalObservation / value
ccr:StatusOptionalObservation / valueSee section 3.5.2.2 Representation of “status” values for more details.
ccr:ProblemOptionalSee section 3.5 Problems.
ccr:FamilyMemberOptionalsubject / RelatedSubject See section 3.6.2.3 Family history participants for more details.
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Social Historyccr:SocialHistoryElementOptionalObservation
ccr:CCRDataObjectIDRequiredObservation / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalObservation / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalObservation / id;
Role / id
ccr:TypeOptionalObservation / code
ccr:DescriptionOptionalObservation / value
ccr:StatusOptionalObservation / valueSee section 3.5.2.2 Representation of “status” values for more details.
ccr:EpisodesOptionalObservationSee section 3.7.2.3 Episode observations for more details.
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Alertsccr:AlertOptionalAct
ccr:CCRDataObjectIDRequiredAct / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalAct / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalAct / id; Role / id
ccr:TypeOptionalObservation / code
ccr:DescriptionOptionalObservation / code;
Observation / value
ccr:StatusOptionalObservation / valueSee section 3.8.2.2 Representation of “status” values for more details.
ccr:AgentOptional. <Unknown> is required content.Observation / participant [@typeCode=”CSM”] / participantRole / playingEntity
ccr:ReactionOptionalObservation / entryRelationship [@typeCode=”MFST”] / Observation
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Medicationsccr:MedicationOptionalSubstanceAdministration
ccr:CCRDataObjectIDRequiredSubstanceAdministration / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalSubstanceAdministration / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalAct / id; Role / id
ccr:TypeOptionalObservation / code
ccr:DescriptionOptionalSection / text
ccr:StatusOptionalObservation / valueSee section 3.9.2.3 Representation of “status” values for more details.
ccr:ProductRequiredManufacturedProduct / material
ccr:ProductNameRequiredManufacturedProduct / material / code / originalText
ccr:BrandNameOptionalManufacturedProduct / material / name
ccr:StrengthOptionalManufacturedProduct / material / code
ccr:FormOptionalManufacturedProduct / material / code
ccr:ConcentrationOptionalManufacturedProduct / material / code
ccr:SizeOptionalManufacturedProduct / idSee section 3.9.2.4 Representation of a product for more details.
ccr:ManufacturerOptionalManufacturedProduct / manufacturerOrganization
ccr:IDsOptionalManufacturedProduct / id
ccr:QuantityOptionalSupply / quantity
ccr:DirectionsOptionalSection / text
ccr:DoseIndicatorOptionalSection / entry / @typeCodeThe “DRIV” relationship indicates that narrative is derived from the component entries.
ccr:DeliveryMethodOptionalSubstanceAdministration / routeCode
ccr:DoseOptionalSubstanceAdministration / doseQuantity
ccr:DoseCalculationOptionalSubstanceAdministration / doseQuantity; SubstanceAdministration / rateQuantity
ccr:VehicleOptionalSubstanceAdministration / entryRelationship [@typeCode = “COMP”] / SubstanceAdministrationFor example, a 313 mg vial of lyophilized hematin can be reconstituted with 132 mL of 25% human serum albumin (which is the vehicle), resulting in a hemin concentration of 2.4 mg/mL.:
  • SubstanceAdministration (hematin in albumin)
    • / component / SubstanceAdministration (hematin)
    • / component / SubstanceAdministration (albumin)
ccr:RouteOptionalSubstanceAdministration / routeCode
ccr:SiteOptionalSubstanceAdministration / approachSiteCode
ccr:AdministrationTimingOptionalSubstanceAdministration / effectiveTime
ccr:FrequencyOptionalSubstanceAdministration / effectiveTime
ccr:IntervalOptionalSubstanceAdministration / effectiveTime
ccr:DurationOptionalSubstanceAdministration / effectiveTime
ccr:DoseRestrictionOptionalSubstanceAdministration / maxDoseQuantity
ccr:IndicationOptionalSubstanceAdministration / precondition / criterion; ObservationSee section 3.9.2.2 Medication related information for more details.
ccr:StopIndicatorOptionalSubstanceAdministration / effectiveTime
ccr:DirectionSequencePositionOptionalSubstanceAdministrationEach direction in CCD is a distinct SubstanceAdministration.
ccr:MultipleDirectionModifierOptionalSection / textComplex directions in CCD are expressed as free text.
ccr:PatientInstructionsOptionalObservationSee section 3.9.2.2 Medication related information for more details.
ccr:FulfillmentInstructionsOptionalObservationSee section 3.9.2.2 Medication related information for more details.
ccr:RefillOptionalSupply / repeatNumber
ccr:SeriesNumberOptionalObservationSee section 3.9.2.2 Medication related information for more details.
ccr:ConsentOptionalClinicalDocument / authorization / consent
ccr:ReactionOptionalObservationSee section 3.9.2.2 Medication related information for more details.
ccr:FulfillmentHistoryOptionalSupply
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Medical Equipmentccr:EquipmentOptionalSupply
Immunizationsccr:ImmunizationOptionalSubstanceAdministration
Vital Signsccr:ResultOptionalOrganizer
Resultsccr:ResultOptionalOrganizer
ccr:CCRDataObjectIDRequiredOrganizer / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalOrganizer / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalOrganizer / id;
Role / id
ccr:TypeRequiredOrganizer / code
ccr:DescriptionOptionalOrganizer / code
ccr:ProcedureOptionalOrganizer / component / procedure
ccr:SubstanceOptionalOrganizer / specimen
ccr:TestOptionalObservation
ccr:DateTimeOptionalObservation / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalObservation / id;
Role / id
ccr:TypeRequiredObservation / code
ccr:DescriptionOptionalObservation / code
ccr:StatusOptionalObservation / statusCode
ccr:MethodOptionalObservation / methodCode
ccr:AgentOptionalObservation / participant
ccr:TestResultRequiredObservation / value
ccr:NormalResultOptionalObservation / referenceRange
ccr:FlagOptionalObservation / interpretationCode
ccr:ConfidenceValueOptionalObservation / valueHL7 Version 3 datatypes UVP (uncertain value, probabilistic), NPPD (non-parametric probability distribution), and PPD (parametric probability distribution) can be used to express confidence in an observation value.
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Proceduresccr:ProcedureOptionalProcedure
ccr:CCRDataObjectIDRequiredProcedure / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalProcedure / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalProcedure / id; role / id
ccr:TypeOptionalProcedure / code
ccr:DescriptionOptionalProcedure / code
ccr:StatusOptionalProcedure / statusCode
ccr:LocationOptionalProcedure / participant [@typeCode=”LOC”]
ccr:PractitionerOptionalProcedure / performer
ccr:FrequencyOptionalObservationCDA R2 Procedure / effectiveTime is IVL_TS data type, so can’t represent frequency. A nested frequency observation can be used.
ccr:DurationOptionalProcedure / effectiveTime
ccr:IndicationOptionalProcedure / entryRelationship [@typeCode=”RSON”]
ccr:ProductOptionalParticipant / participantRole [@typeCode=”DEV”]
ccr:SubstanceOptionalProcedure / entryRelationship / substanceAdministration
ccr:MethodOptionalProcedure / methodCode
ccr:PositionOptionalProcedure / methodCode
ccr:SiteOptionalProcedure / targetSiteCode
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Encountersccr:EncounterOptionalEncounter
ccr:CCRDataObjectIDRequiredEncounter / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptionalEncounter / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptionalEncounter / id
ccr:TypeOptionalEncounter / code
ccr:DescriptionRequiredEncounter / code
ccr:LocationOptionalEncounter / participant [@typeCode=”LOC”]
ccr:PractitionerOptionalEncounter / performer
ccr:FrequencyOptionalObservationCDA R2 Encounter / effectiveTime is IVL_TS data type, so can’t represent frequency. A nested frequency observation can be used.
ccr:DurationOptionalEncounter / effectiveTime
ccr:IndicationOptionalObservation
ccr:InstructionsOptionalEncounter / entryRelationship [@typeCode=”SUBJ”] / Act [@classCode=”ACT”]
ccr:ConsentOptionalClinicalDocument / authorization / consent
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Plan of Careccr:PlanOptionalAct; Encounter; Observation; Procedure; SubstanceAdministration; Supply
ccr:CCRDataObjectIDRequired[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply] / idSee section 5.4.5 Identifiers for more details.
ccr:DateTimeOptional[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply] / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptional[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply] / id; Role / id
ccr:TypeOptionalObservation / code
ccr:DescriptionOptional[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply] / code
ccr:StatusOptionalObservation / statusCode
ccr:OrderRequestOptional[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply] / code
ccr:DateTimeOptional[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply] / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:IDsOptional[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply] / id; Role / id
ccr:TypeOptionalObservation / code
ccr:DescriptionOptional[Act | Encounter | Observation | Procedure | SubstanceAdministration | Supply] / code
ccr:StatusOptionalObservation / statusCode
ccr:ProcedureOptionalAct; Observation; Procedure
ccr:ProductOptionalSupply
ccr:MedicationOptionalSubstanceAdministration
ccr:ImmunizationOptionalSubstanceAdministration
ccr:ServiceOptionalAct
ccr:EncounterOptionalEncounter
ccr:AuthorizationOptionalAct
ccr:GoalsOptionalObservation / @moodCode = GOL
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Healthcare Providersccr:ProvidersOptionalClinicalDocument / documentOf / serviceEvent / performer

4 CCR Footer Representation

The CCR Footer contains data defining all of the actors, as well as information about external references, all text comments, and signatures associated with any data within the CCR.

4.1 Actors

Used as a container to define all of the individuals, organizations, locations, and systems associated with data in the summary document. Within the CCR data set, an Actor is a <Person>, <Organization> or <Device>. These correspond to the HL7 RIM Entity classes: LivingSubject, Person, Organization or Device, and are mapped accordingly to these classes as exposed in a CDA document. Whereas ASTM CCR enumerates all Actors in the CCR Footer and references those Actors from within the CCR Body with the <ActorLink> element, CCD defines many participants within the document header and body.

Actor roles are constructed in the CCR by relating an Actor to an element in the CCR via the <ActorLink> element. This element indicates the entity (person, organization or device) by reference in the <ActorID> element, and the role in the <ActorRole> element. Within CDA R2, the role typically includes the entity by value, not by reference. However, appropriate construction of a CDA document, and application of the Care Record Summary extensions, will allow use of entities by reference as follows:

CONF-495: Each actor SHALL appear in the appropriate section of the CDA at least once with all information fully specified, and SHOULD include an entity identifier.
CONF-496: Other references to the same entity (a person or organization) in the same or different role NEED NOT fully specify the actor information, provided they include the same entity identifier.
CONF-497: There SHALL be a one-to-one relationship between entity identifiers in a CDA and ActorID as represented in the CCR data set.

Table 4. CCR <ActorLink> correspondence to CDA
CCR data elementCDA R2 correspondenceComments
ccr:ActorLink
ccr:ActorIDRole / Entity / idThere is a one to one relationship between ActorID and Entity / id, although the values need not be equivalent.
ccr:ActorRoleRole / code
ccr:TextRole / code / originalText
ccr:CodeRole / code / @code ;
Role / code / @codeSystem

4.2 References

Used to list the details concerning references to external data sources. Corresponds to the CDA R2 <reference> element. Whereas ASTM CCR enumerates all references in the CCR Footer, CCD defines the reference within the section where it occurs.

CONF-498: A clinical statement in a CCD section MAY contain one or more Observation / reference / externalDocument, to represent externally an externally referenced document.
CONF-499: An externally referenced document MAY contain exactly one Observation / reference / ExternalDocument / text / reference, to indicate the URL of the referenced document. A <linkHTML> element containing the same URL SHOULD be present in the associated CDA Narrative Block.
CONF-500: An externally referenced document MAY contain exactly one Observation / reference / ExternalDocument / text / @mediaType, to indicate the MIME type of the referenced document.
CONF-501: Where the value of Observation / reference / seperatableInd is “false”, the referenced document SHOULD be included in the CCD exchange package. The exchange mechanism SHOULD be based on Internet standard RFC 2557 “MIME Encapsulation of Aggregate Documents, such as HTML (MHTML)” (http://www.ietf.org/rfc/rfc2557.txt). (See CDA Release 2, section 3 “CDA Document Exchange in HL7 Messages” for examples and additional details).

4.3 Comments

The template identifier for a comment is 2.16.840.1.113883.10.20.1.40.

Used to contain comments associated with any of the data within the document. Whereas ASTM CCR enumerates all comments in the CCR Footer, CCD defines the comments within the section where they occur. CDA R2 represents comments as Acts.

CONF-502: A CCD section MAY contain one or more comments, either as a clinical statement or nested under another clinical statement.
CONF-503: A comment (templateId 2.16.840.1.113883.10.20.1.40) SHALL be represented with Act.
CONF-504: The value for “Act / @classCode” in a comment SHALL be “ACT” 2.16.840.1.113883.5.6 ActClass STATIC.
CONF-505: The value for “Act / @moodCode” in a comment SHALL be “EVN” 2.16.840.1.113883.5.1001 ActMood STATIC.
CONF-506: A comment SHALL contain exactly one Act / code.
CONF-507: The value for “Act / code” in a comment SHALL be 48767-8 “Annotation comment” 2.16.840.1.113883.6.1 LOINC STATIC.

4.4 Signatures

Used by ASTM CCR as a container for all signatures associated with any data in the summary document.

While electronic signatures are not captured in a CDA document, both authentication and legal authentication require that a document has been signed manually or electronically by the responsible individual. A legalAuthenticator has a required legalAuthenticator / time indicating the time of authentication, and a required legalAuthenticator / signatureCode, indicating that a signature has been obtained and is on file.

Application systems sending and receiving CDA documents are responsible for meeting all legal requirements for document authentication, confidentiality, and retention. For communications over public media, cryptographic techniques for source/recipient authentication and secure transport of encapsulated documents may be required, and should be addressed with commercially available tools outside the scope of the CDA specification.

4.5 ASTM CCR Footer Mapping

The following table is the CCR Footer subset of ASTM CCR Table A1.1 “CCR Data Fields Spreadsheet”.

Table 5. CCR Footer mapping to CDA R2
CCR Data ObjectCCR XML ElementCCR Required or OptionalCDA R2 CorrespondenceMapping Comments
CCR Footer Objects
Actorsccr:ActorRequiredA participating entity (e.g. Person, Organization, Device)
ccr:ActorObjectIDRequiredEntity / id
ccr:PersonOptionalPerson
ccr:NameOptionalSee section 5.4.2 Names.
ccr:BirthNameOptionalSee section 5.4.2 Names.
ccr:AdditionalNameOptionalSee section 5.4.2 Names.
ccr:CurrentNameOptionalSee section 5.4.2 Names.
ccr:DisplayNameOptionalSee section 5.4.2 Names.
ccr:DateOfBirthOptionalPatient / birthTime;
subject / relatedSubject / subject / birthTime		HL7: Date of Birth is only present for the patient or subject. It is not used elsewhere in the CDA.
ccr:GenderOptionalPatient / administrativeGenderCode;
subject / administrativeGenderCode		ASTM: Value set limited to Male, Female, Other and Unknown.
HL7: Gender is only present for the patient or subject. It is not used elsewhere in the CDA. HL7 AdministrativeGender vocabulary covers Male, Female and Undifferentiated.
ccr:OrganizationOptionalassignedAuthor / representedOrganization;
assignedEntity / representedOrganization;
intendedRecipient / recievedOrganization;
associatedEntity / scopingOrganization
ccr:InformationSystemOptionalassignedAuthoringDevice;
playingDevice
ccr:IDsOptionalEntity / id; Role / idHL7: Entities and Roles can have identifiers. Role identifiers are related to a specific role, but entities may participate in more than one role (and thus have more than one identifier). However, CDA Release 2.0 does not usually allow for Persons to have identifiers. CCD provides an extension that would allow recording of an arbitrary identifier for a person.
ccr:RelationOptionalsdtc:asPatientRelationshipSee section 7.4 Extensions to CDA R2.
ccr:SpecialtyOptionalPerformer / functionCode
ccr:AddressOptionalRole / addressHL7: Both roles and entities can have addresses. Storing these on the Entity is most closely aligned with the CCR notion of an Actor, however CDA Release 2.0 often limits storage of this information to Roles.
ccr:TelephoneOptionalRole / telecomHL7: Both roles and entities can have telephjone numbers. Storing these on the Entity is most closely aligned with the CCR notion of an Actor, however CDA Release 2.0 often limits storage of this information to Roles
ccr:EmailOptionalRole / telecomHL7: Both roles and entities can have e-mail addresses. Storing these on the Entity is most closely aligned with the CCR notion of an Actor, however CDA Release 2.0 often limits storage of this information to Roles
ccr:URLOptionalRole / telecomHL7: Both roles and entities can have web addresses. Storing these on the Entity is most closely aligned with the CCR notion of an Actor, however CDA Release 2.0 often limits storage of this information to Roles
ccr:StatusOptional-none-HL7: Not needed in CCD
ccr:SourceRequiredSee section 5.2 Source.
ccr:InternalCCRLinkOptionalSee section 5.3 InternalCCRLink.
ccr:ReferenceIDOptionalSee section 4.2 References.
ccr:CommentIDOptionalSee section 4.3 Comments.
Referencesccr:ReferenceOptional<reference>
ccr:ReferenceObjectIDRequiredNot applicableHL7: Because CCD states the reference within the section where it occurs, a referenceable object identifier is not required.
ccr:DateTimeOptional-none-HL7: CDA R2 doesn’t currently contain an effectiveTime attribute in the ExternalDocument class.
ccr:DescriptionOptionalExternalDocument / code
ccr:SourceOptionalSee section 5.2 Source.
ccr:LocationsOptionalExternalDocument / text / reference
Commentsccr:CommentOptionalAct
ccr:CommentObjectIDRequiredNot applicableHL7: Because CCD states the comment within the section where it occurs, a referenceable object identifier is not required.
ccr:DateTimeOptionalAct / effectiveTimeSee section 5.4.1 Dates and Times for more details.
ccr:DescriptionRequiredAct / code; Act / text
ccr:SourceOptionalSee section 5.2 Source.
ccr:ReferenceIDOptionalSee section 4.2 References.
Signaturesccr:CCRSignatureOptionalSee section 4.4 Signatures.
ccr:SignatureObjectIDRequiredSee section 4.4 Signatures.
ccr:ExactDateTimeOptionalSee section 4.4 Signatures.
ccr:TypeOptionalSee section 4.4 Signatures.
ccr:IDsOptionalSee section 4.4 Signatures.
ccr:SourceOptionalSee section 4.4 Signatures.
ccr:SignatureOptionalSee section 4.4 Signatures.

5 General Constraints

....

5.1 “Type” and “Status” values

....

5.2 Source

ASTM CCR requires that all data objects have a stated source (or state explicitly that the source is unknown) so that any data within the summary can be validated. The source of data may be a person, organization, reference to some other data object, etc.

CONF-520: A person source of information SHALL be represented with informant.
CONF-521: An organization source of information SHALL be represented with informant.
CONF-522: A reference source of information SHALL be represented with reference [@typeCode = “XCRPT”].
CONF-523: Any other source of information SHALL be represented with a source of information observation.
CONF-524: A source of information observation SHALL be the target of an entryRelationship whose value for “entryRelationship / @typeCode” SHALL be “REFR” “Refers to” 2.16.840.1.113883.5.1002 ActRelationshipType STATIC.
CONF-525: A source of information observation SHALL be represented with Observation.
CONF-526: The value for “Observation / @classCode” in a source of information observation SHALL be “OBS” 2.16.840.1.113883.5.6 ActClass STATIC.
CONF-527: The value for “Observation / @moodCode” in a source of information observation SHALL be “EVN” 2.16.840.1.113883.5.1001 ActMood STATIC.
CONF-528: A source of information observation SHALL contain exactly one Observation / statusCode.
CONF-529: The value for “Observation / statusCode” in a source of information observation SHALL be “completed” 2.16.840.1.113883.5.14 ActStatus STATIC.
CONF-530: A source of information observation SHALL contain exactly one Observation / code.
CONF-531: The value for “Observation / code” in a source of information observation SHALL be “48766-0” “Information source” 2.16.840.1.113883.6.1 LOINC STATIC.
CONF-532: A source of information observation SHALL contain exactly one Observation / value.
CONF-533: The absence of a known source of information SHALL be explicity asserted by valuing Observation / value in a source of information observation with the text string “Unknown”.

...

5.3 InternalCCRLink

....

5.4 Data Types

....

5.5 Terminology conformance

....

6 Acknowledgements

....

7 Appendix

....

7.1 Sample

....

7.2 Summary of CCD template identifiers

....

7.3 Summary of CCD value sets

....

7.4 Extensions to CDA R2

Where the ASTM CCR defines important components for which there is no suitable mapping in CDA R2, extensions to CDA R2 have been developed. These extensions are described above in the context of the section where they are used. This section serves to summarize the extensions and provide implementation guidance.

Extensions created for CCD include:

  • AssignedPerson / id
  • AssociatedPerson / id
  • GuardianPerson / id
  • InformationRecipient / id
  • MaintainingPerson / id
  • RelatedPerson / id
  • Subject / id
  • Subject / deceasedInd
  • Subject / deceasedTime
  • asPatientRelationship
  • asPatientRelationship / @classCode
  • asPatientRelationship / code

These extensions are illustrated in Figure 8 CDA R2 clinical statement model for family history and Figure 15 CDA R2 extensions.

Figure 15. CDA R2 extensions

To resolve issues that need to be addressed by extension, the developers of this guide chose to approach extensions as follows:

  • An extension is a collection of element or attribute declarations and rules for their application to the CDA Release 2.0.
  • All extensions are optional. An extension may be used, but need not be under this guide.
  • A single namespace for all extension elements or attributes that may be used by this guide will be defined.
  • The namespace for extensions created by the HL7 Structured Documents Technical Committee shall be urn:hl7-org:sdtc.
  • This namespace shall be used as the namespace for any extension elements or attributes that are defined by this implementation guide.
  • Each extension element shall use the same HL7 vocabularies and data types used by CDA Release 2.0.
  • Each extension element shall use the same conventions for order and naming as is used by the current HL7 tooling.
  • An extension element shall appear in the XML where the expected RIM element of the same name would have appeared had that element not been otherwise constrained from appearing in the CDA XML schema.
ContextPathname /
ClassificationCDA Document Level Template
Open/ClosedOpen (other than defined elements are allowed)
Used by / Uses
Used by 1 transaction and 0 templates, Uses 29 templates
Used by as NameVersion
2.16.840.1.113883.3.1937.777.4.4.1Transactionfinal Continuity of Care Document (CCD) (Release 1.1)2013‑01‑31
Uses as NameVersion
2.16.840.1.113883.3.1937.777.4.10.1Containmentpending CCD PersonDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.2Containmentpending CCD OrganizationDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.4Includepending CCDSupportingParticipantDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.6Containmentpending CCD DeviceDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.17Containmentpending CCD InformantDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.27Includepending CCD legalAuthenticatorDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.28Includepending CCD authenticatorDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.30Includepending CCD custodianDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.31Includepending CCD informationRecipientDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.32Includepending CCD participantDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.33Includepending CCD AuthorizationDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.34Includepending CCD componentOfDYNAMIC
2.16.840.1.113883.3.1937.777.4.10.35Includepending CCD relatedDocumentDYNAMIC
2.16.840.1.113883.10.20.1.1Containmentpending Advance directives sectionDYNAMIC
2.16.840.1.113883.10.20.1.2Containmentpending Alerts sectionDYNAMIC
2.16.840.1.113883.10.20.1.3Containmentpending Encounters sectionDYNAMIC
2.16.840.1.113883.10.20.1.4Containmentpending Family history sectionDYNAMIC
2.16.840.1.113883.10.20.1.5Containmentpending Functional status sectionDYNAMIC
2.16.840.1.113883.10.20.1.6Containmentpending Immunization sectionDYNAMIC
2.16.840.1.113883.10.20.1.7Containmentpending Medical equipment sectionDYNAMIC
2.16.840.1.113883.10.20.1.8Containmentpending Medication sectionDYNAMIC
2.16.840.1.113883.10.20.1.9Containmentpending Payers sectionDYNAMIC
2.16.840.1.113883.10.20.1.10Containmentpending Plan of care sectionDYNAMIC
2.16.840.1.113883.10.20.1.11Containmentpending Problem sectionDYNAMIC
2.16.840.1.113883.10.20.1.12Containmentpending Procedures sectionDYNAMIC
2.16.840.1.113883.10.20.1.13Containmentpending Purpose sectionDYNAMIC
2.16.840.1.113883.10.20.1.14Containmentpending Results sectionDYNAMIC
2.16.840.1.113883.10.20.1.15Containmentpending Social history sectionDYNAMIC
2.16.840.1.113883.10.20.1.16Containmentpending Vital signs sectionDYNAMIC
RelationshipAdaptation: template 2.16.840.1.113883.10.12.1 (2005‑09‑07)
ItemDTCardConfDescriptionLabel
hl7:ClinicalDocument
CCDCdotsment
@classCode
cs0 … 1FDOCCLIN
@moodCode
cs0 … 1 
 CONF
The value of @moodCode shall be drawn from value set 2.16.840.1.113883.1.11.20267 ActMoodEventOccurrence (DYNAMIC)
 Variable letNameentriesWithoutInternalReference 
 Valuedistinct-values(.//hl7:entry/*[not(.//*:reference/@value[starts-with(.,'#')])]/hl7:templateId/@root) 
 Variable letNameentriesWithBrokenInternalReference 
 Value.//hl7:entry//*[local-name()=('originalText','text','value')]/*:reference[starts-with(@value,'#')][not(substring(@value,2)=ancestor::hl7:section[1]/hl7:text//@ID)]/@value 
 Schematron assertrolered error 
 testnot($entriesWithoutInternalReference) 
 MessageCONF-29: Found one more CCD section entries without a reference. Entries: "<value-of select="$entriesWithoutInternalReference"/>" 
 Schematron assertrolered error 
 testnot(entriesWithBrokenInternalReference) 
 MessageCONF-29: Found one more CCD section entries with a reference that does not resolve into this sections narrative. References "<value-of select="$entriesWithBrokenInternalReference"/>" 
hl7:templateId
II1 … 1RCONF‑7 / CONF‑8
@root
uid1 … 1F2.16.840.1.113883.10.20.1
@extension
st0NPNP/not present
hl7:id
II1 … 1RCCR Unique IdentifierCCDCdotsment
hl7:code
CE1 … 1RCONF-1: The value for “ClinicalDocument / code” SHALL be “34133-9” “Summarization of episode note” 2.16.840.1.113883.6.1 LOINC STATIC.CONF‑1
@code
CONF0 … 1F34133-9
@codeSystem
0 … 1F2.16.840.1.113883.6.1
@displayName
0 … 1FSummarization of episode note
hl7:title
ST0 … 1CCDCdotsment
hl7:effectiveTime
TS1 … 1RCONF‑9 / CONF‑10
 Schematron assertrolered error 
 testnot(@value) or matches(@value,'^\d{14}[^+-]*[+-]\d+$') 
 MessageClinicalDocument / effectiveTime SHALL be expressed with precision to include seconds AND ClinicalDocument / effectiveTime SHALL include an explicit time zone offset. 
hl7:confidentialityCode
CE1 … 1RCCDCdotsment
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.16926 x_BasicConfidentialityKind (DYNAMIC)
hl7:languageCode
CS1 … 1CONF‑5 / CONF‑6
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.11526 HumanLanguage (DYNAMIC)
 Schematron assertrolered error 
 testnot(@value) or matches(@value,'[a-z]{2}(-[A-Z]{2})?') 
 MessageClinicalDocument / languageCode SHALL be in the form nn, or nn-CC. The nn portion SHALL be an ISO-639-1 language code in lower case. The CC portion, if present, SHALL be an ISO-3166 country code in upper case. 
hl7:setId
II0 … 1CCDCdotsment
hl7:versionNumber
INT0 … 1CCDCdotsment
hl7:recordTarget
1 … 2RCONF‑11
@typeCode
cs0 … 1FRCT
@contextControlCode
cs0 … 1FOP
hl7:patientRole
1 … 1CONF‑11
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.20155 RoleClassPatient (DYNAMIC)
hl7:id
II1 … *CONF‑11
hl7:addr
AD0 … *CONF‑11
hl7:telecom
TEL0 … *CONF‑11
hl7:patient
0 … 1CONF‑11
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.20049 EntityClassPerson (DYNAMIC)
@determinerCode
cs0 … 1FINSTANCE
hl7:id
II0 … 1CONF‑11
hl7:name
PN0 … *CONF‑11
hl7:administrativeGenderCode
CE0 … 1CONF‑11
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.1 AdministrativeGender (DYNAMIC)
hl7:birthTime
TS0 … 1CONF‑11
hl7:maritalStatusCode
CE0 … 1

CONF-250: Marital status SHOULD be represented as ClinicalDocument / recordTarget / patientRole / patient / maritalStatusCode. Additional information MAY be represented as social history observations.

CONF‑250
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.12212 MaritalStatus (DYNAMIC)
hl7:religiousAffiliationCode
CE0 … 1

CONF-251: Religious affiliation SHOULD be represented as ClinicalDocument / recordTarget / patientRole / patient / religiousAffiliationCode. Additional information MAY be represented as social history observations.

CONF‑251
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.19185 ReligiousAffiliation (DYNAMIC)
hl7:raceCode
CE0 … 1

CONF-252: A patient’s race SHOULD be represented as ClinicalDocument / recordTarget / patientRole / patient / raceCode. Additional information MAY be represented as social history observations.
CONF-253: The value for “ClinicalDocument / recordTarget / patientRole / patient / raceCode” MAY be selected from codeSystem 2.16.840.1.113883.5.104 (Race).

CONF‑252 / CONF‑253
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.14914 Race (DYNAMIC)
hl7:ethnicGroupCode
CE0 … 1

CONF-254: A patient’s ethnicity SHOULD be represented as ClinicalDocument / recordTarget / patientRole / patient / ethnicGroupCode. Additional information MAY be represented as social history observations.
CONF-255: The value for “ClinicalDocument / recordTarget / patientRole / patient / ethnicGroupCode” MAY be selected from codeSystem 2.16.840.1.113883.5.50 (Ethnicity).

CONF‑254 / CONF‑255
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.15836 Ethnicity (DYNAMIC)
hl7:guardian
0 … *

Represents the patient’s sources of support such as immediate family, relatives, and guardian at the time the summarization is generated. Support information also includes next of kin, caregivers, and support organizations. At a minimum, key support contacts relative to healthcare decisions, including next of kin, should be included.

CDA R2 represents a patient’s guardian with the CDA Header Guardian class. Other Supporters are represented as participant participations in the CDA Header.

NOTE: CCR Supporters are not represented as a CCD Body section, but rather, are represented as participants in the CCD Header.

CONF-108: CCD MAY contain one or more patient guardians.
CONF-109: A patient guardian SHALL be represented with ClinicalDocument / recordTarget / patientRole / patient / guardian.

CONF‑108 / CONF‑109
@classCode
cs1 … 1FGUARD
hl7:id
II0 … *CONF‑108 / CONF‑109
hl7:code
CE0 … 1CONF‑108 / CONF‑109
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CONF‑108 / CONF‑109
hl7:telecom
TEL0 … *CONF‑108 / CONF‑109
Choice1 … 1Elements to choose from:
hl7:guardianPerson
Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CONF‑108 / CONF‑109
hl7:guardianOrganization
Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CONF‑108 / CONF‑109
hl7:birthplace
0 … 1CONF‑11
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.20115 RoleClassBirthplace (DYNAMIC)
hl7:birthplace
1 … 1CONF‑11
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.10892 EntityClassPlace (DYNAMIC)
@determinerCode
cs0 … 1FINSTANCE
hl7:name
EN0 … 1CONF‑11
hl7:addr
AD0 … 1CONF‑11
hl7:languageCommunication
0 … *CONF‑11
hl7:languageCode
CS0 … 1CONF‑11
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.11526 HumanLanguage (DYNAMIC)
hl7:modeCode
CE0 … 1CONF‑11
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.12249 LanguageAbilityMode (DYNAMIC)
hl7:proficiencyLevelCode
CE0 … 1CONF‑11
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.12199 LanguageAbilityProficiency (DYNAMIC)
hl7:preferenceInd
BL0 … 1CONF‑11
hl7:providerOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CONF‑11
hl7:author
1 … *MCONF‑12
@typeCode
cs0 … 1FAUT
@contextControlCode
cs0 … 1FOP
hl7:functionCode
CE0 … 1CONF‑12
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10267 ParticipationFunction (DYNAMIC)
hl7:time
TS1 … 1RCONF‑12
hl7:assignedAuthor
1 … 1CONF‑12
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.11595 RoleClassAssignedEntity (DYNAMIC)
 Schematron assertrolered error 
 testhl7:assignedPerson or hl7:representedOrganization 
 MessageCCD SHALL contain one or more ClinicalDocument / author / assignedAuthor / assignedPerson and/or ClinicalDocument / author / assignedAuthor / representedOrganization. 
hl7:id
II1 … *Rnl-NL CONF-13: If author has an associated representedOrganization with no assignedPerson or assignedAuthoringDevice, then the value for “ClinicalDocument / author / assignedAuthor / id / @NullFlavor” SHALL be “NA” “Not applicable” 2.16.840.1.113883.5.1008 NullFlavor STATIC.CONF‑13
@nullFlavor
cs0 … 1FNA
 Schematron assertrolered error 
 testnot(parent::hl7:assignedAuthor[hl7:representedOrganization][not(hl7:assignedPerson or hl7:assignedAuthoringDevice)]) or @nullFlavor='NA' 
 MessageIf author has an associated representedOrganization with no assignedPerson or assignedAuthoringDevice, then the value for “ClinicalDocument / author / assignedAuthor / id / @NullFlavor” SHALL be “NA” “Not applicable” 2.16.840.1.113883.5.1008 NullFlavor STATIC. 
hl7:code
CE0 … 1CONF‑12
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CONF‑12
hl7:telecom
TEL0 … *CONF‑12
Choice0 … 1Elements to choose from:
hl7:assignedPerson
Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CONF‑12
hl7:assignedAuthoringDevice
Contains 2.16.840.1.113883.3.1937.777.4.10.6 CCD Device (DYNAMIC)CONF‑12
hl7:representedOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CONF‑12
hl7:informant
0 … *Contains 2.16.840.1.113883.3.1937.777.4.10.17 CCD Informant (DYNAMIC)CCDCdotsment
Included1 … 1 from 2.16.840.1.113883.3.1937.777.4.10.30 CCD custodian (DYNAMIC)
hl7:custodian
1 … 1CCDcdotsdian
@typeCode
cs0 … 1FCST
hl7:assignedCustodian
1 … 1CCDcdotsdian
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.11595 RoleClassAssignedEntity (DYNAMIC)
hl7:representedCustodianOrganization
1 … 1CCDcdotsdian
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.10889 EntityClassOrganization (DYNAMIC)
@determinerCode
cs0 … 1FINSTANCE
hl7:id
II1 … *MCCDcdotsdian
hl7:name
ON0 … 1CCDcdotsdian
hl7:telecom
TEL0 … 1CCDcdotsdian
hl7:addr
AD0 … 1CCDcdotsdian
Included0 … * from 2.16.840.1.113883.3.1937.777.4.10.31 CCD informationRecipient (DYNAMIC)
hl7:informationRecipient
0 … *CCDidotsient
@typeCode
cs1 … 1R
 CONF
The value of @typeCode shall be drawn from value set 2.16.840.1.113883.1.11.19366 x_InformationRecipient (DYNAMIC)
hl7:intendedRecipient
1 … 1CCDidotsient
@classCode
cs1 … 1R
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.16772 x_InformationRecipientRole (DYNAMIC)
hl7:id
II0 … *RCCDidotsient
hl7:addr
AD0 … *CCDidotsient
hl7:telecom
TEL0 … *CCDidotsient
hl7:informationRecipient
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CCDidotsient
hl7:receivedOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CCDidotsient
Included0 … 1 from 2.16.840.1.113883.3.1937.777.4.10.27 CCD legalAuthenticator (DYNAMIC)
hl7:legalAuthenticator
0 … 1CCDldotsator
@typeCode
cs0 … 1FLA
@contextControlCode
cs0 … 1FOP
hl7:time
TS1 … 1RCCDldotsator
hl7:signatureCode
CS1 … 1RCCDldotsator
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10282 ParticipationSignature (DYNAMIC)
hl7:assignedEntity
1 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.16 CCD AssignedEntity (DYNAMIC)CCDldotsator
Included0 … * from 2.16.840.1.113883.3.1937.777.4.10.28 CCD authenticator (DYNAMIC)
hl7:authenticator
0 … *CCDadotsator
@typeCode
cs0 … 1FAUTHEN
hl7:time
TS1 … 1RCCDadotsator
hl7:signatureCode
CS1 … 1RCCDadotsator
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10282 ParticipationSignature (DYNAMIC)
hl7:assignedEntity
1 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.16 CCD AssignedEntity (DYNAMIC)CCDadotsator
Included0 … * from 2.16.840.1.113883.3.1937.777.4.10.4 CCDSupportingParticipant (DYNAMIC)
hl7:participant
0 … *CCDSdotspant
@typeCode
cs1 … 1FINDCONF‑112 / CONF‑117 / CONF‑121
@contextControlCode
cs0 … 1FOP
hl7:functionCode
CE0 … 1CCDSdotspant
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10267 ParticipationFunction (DYNAMIC)
hl7:time
IVL_TS0 … 1CCDSdotspant
Choice1 … 1Elements to choose from:
  • hl7:associatedEntity[@classCode='NOK']
  • hl7:associatedEntity[@classCode='ECON']
  • hl7:associatedEntity[@classCode='CAREGIVER']
hl7:associatedEntity
CCDSdotspant
where [@classCode='NOK']
@classCode
cs1 … 1FNOKCONF‑113
hl7:id
II0 … *CCDSdotspant
hl7:code
CE0 … 1CCDSdotspant
 CONF
shall be drawn from concept domain "FamilyHistoryRelatedSubjectCode"
hl7:addr
AD0 … *CCDSdotspant
hl7:telecom
TEL0 … *CCDSdotspant
hl7:associatedPerson
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CCDSdotspant
hl7:scopingOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CCDSdotspant
hl7:associatedEntity
CCDSdotspant
where [@classCode='ECON']
@classCode
cs1 … 1FECONCONF‑118
hl7:id
II0 … *CCDSdotspant
hl7:code
CE0 … 1CCDSdotspant
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CCDSdotspant
hl7:telecom
TEL0 … *CCDSdotspant
hl7:associatedPerson
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CCDSdotspant
hl7:scopingOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CCDSdotspant
hl7:associatedEntity
CCDSdotspant
where [@classCode='CAREGIVER']
@classCode
cs1 … 1FCAREGIVERCONF‑122
hl7:id
II0 … *CCDSdotspant
hl7:code
CE0 … 1CCDSdotspant
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CCDSdotspant
hl7:telecom
TEL0 … *CCDSdotspant
hl7:associatedPerson
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CCDSdotspant
hl7:scopingOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CCDSdotspant
Included0 … * from 2.16.840.1.113883.3.1937.777.4.10.32 CCD participant (DYNAMIC)
hl7:participant
0 … *CCDpdotspant
@typeCode
cs1 … 1R
 CONF
The value of @typeCode shall be drawn from value set 2.16.840.1.113883.1.11.10901 ParticipationType (DYNAMIC)
@contextControlCode
cs0 … 1FOP
hl7:functionCode
CE0 … 1CCDpdotspant
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10267 ParticipationFunction (DYNAMIC)
hl7:time
IVL_TS0 … 1CCDpdotspant
hl7:associatedEntity
1 … 1CCDpdotspant
@classCode
cs1 … 1R
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.19313 RoleClassAssociative (DYNAMIC)
hl7:id
II0 … *CCDpdotspant
hl7:code
CE0 … 1CCDpdotspant
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CCDpdotspant
hl7:telecom
TEL0 … *CCDpdotspant
hl7:associatedPerson
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CCDpdotspant
hl7:scopingOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CCDpdotspant
hl7:documentationOf
1 … 1MThe main activity being described by a CCD is the provision of healthcare over a period of time. This is shown by setting the value of ClinicalDocument / documentationOf / serviceEvent / @classCode to “PCPR” (care provision) and indicating the duration over which care was provided in ClinicalDocument / documentationOf / serviceEvent / effectiveTime. Additional data from outside this duration may also be included if it is relevant to care provided during that time range (e.g. reviewed during the stated time range).

NOTE: Implementations originating a CCD should take care to discover what the episode of care being summarized is. For example, when a patient fills out a form providing relevant health history, the episode of care being documented might be from birth to the present.

CCDCdotsment
@typeCode
cs0 … 1FDOC
hl7:serviceEvent
1 … 1

CONF-2: A CCD SHALL contain exactly one ClinicalDocument / documentationOf / serviceEvent.
CONF-3: The value for “ClinicalDocument / documentationOf / serviceEvent / @classCode” SHALL be “PCPR” “Care provision” 2.16.840.1.113883.5.6 ActClass STATIC.

CONF‑2
@classCode
cs1 … 1FPCPRCONF‑3
@moodCode
cs0 … 1 
 CONF
The value of @moodCode shall be drawn from value set 2.16.840.1.113883.1.11.20267 ActMoodEventOccurrence (DYNAMIC)
hl7:id
II0 … *CONF‑2
hl7:code
CE0 … 1CONF‑2
 CONF
shall be drawn from concept domain "ActCode"
hl7:effectiveTime
IVL_TS1 … 1CONF-4: ClinicalDocument / documentationOf / serviceEvent SHALL contain exactly one serviceEvent / effectiveTime / low and exactly one serviveEvent / effectiveTime / high.CONF‑2
hl7:low
1 … CONF‑2
hl7:high
1 … CONF‑2
hl7:performer
0 … *CONF‑2
@typeCode
cs1 … 1FPRFCONF‑492
hl7:functionCode
CE0 … 1ccr:SpecialtyCONF‑2
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.10267 ParticipationFunction (DYNAMIC)
hl7:time
IVL_TS0 … 1CONF‑2
hl7:assignedEntity
1 … 1CONF‑2
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.11595 RoleClassAssignedEntity (DYNAMIC)
hl7:id
II1 … *RCONF‑493
hl7:code
CE0 … 1CONF‑494
 CONF
shall be drawn from concept domain "RoleCode"
hl7:addr
AD0 … *CONF‑2
hl7:telecom
TEL0 … *CONF‑2
hl7:assignedPerson
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.1 CCD Person (DYNAMIC)CONF‑2
hl7:representedOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CONF‑2
Included0 … * from 2.16.840.1.113883.3.1937.777.4.10.35 CCD relatedDocument (DYNAMIC)
hl7:relatedDocument
0 … *CCDrdotsment
@typeCode
cs1 … 1R
 CONF
The value of @typeCode shall be drawn from value set 2.16.840.1.113883.1.11.11610 x_ActRelationshipDocument (DYNAMIC)
hl7:parentDocument
1 … 1CCDrdotsment
@classCode
cs0 … 1FDOCCLIN
@moodCode
cs0 … 1 
 CONF
The value of @moodCode shall be drawn from value set 2.16.840.1.113883.1.11.20267 ActMoodEventOccurrence (DYNAMIC)
hl7:id
II1 … *RCCDrdotsment
hl7:code
CD0 … 1CCDrdotsment
@codeSystem
CONF0 … 1F2.16.840.1.113883.6.1
hl7:text
ED0 … 1CCDrdotsment
hl7:setId
II0 … 1CCDrdotsment
hl7:versionNumber
INT0 … 1CCDrdotsment
Included0 … * from 2.16.840.1.113883.3.1937.777.4.10.33 CCD Authorization (DYNAMIC)

CONF-314: A medication activity MAY have one or more associated consents, represented in the CCD Header as ClinicalDocument / authorization / consent.

CONF-442: A procedure activity MAY have one or more associated consents, represented in the CCD Header as ClinicalDocument / authorization / consent.

hl7:authorization
0 … *CCDadotstion
@typeCode
cs0 … 1FAUTH
hl7:consent
1 … 1CCDadotstion
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.20206 ActClassConsent (DYNAMIC)
@moodCode
cs0 … 1 
 CONF
The value of @moodCode shall be drawn from value set 2.16.840.1.113883.1.11.20267 ActMoodEventOccurrence (DYNAMIC)
hl7:id
II0 … *CCDadotstion
hl7:code
CE0 … 1CCDadotstion
 CONF
shall be drawn from concept domain "ActCode"
hl7:statusCode
CS1 … 1RCCDadotstion
@code
CONF0 … 1Fcompleted
hl7:component
1 … 1CCDCdotsment
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:structuredBody
1 … 1CCDCdotsment
@classCode
cs0 … 1FDOCBODY
@moodCode
cs0 … 1 
 CONF
The value of @moodCode shall be drawn from value set 2.16.840.1.113883.1.11.20267 ActMoodEventOccurrence (DYNAMIC)
hl7:confidentialityCode
CE0 … 1CCDCdotsment
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.16926 x_BasicConfidentialityKind (DYNAMIC)
hl7:languageCode
CS0 … 1CCDCdotsment
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.11526 HumanLanguage (DYNAMIC)
hl7:component
0 … 1Contains 2.16.840.1.113883.10.20.1.13 Purpose section (DYNAMIC)CONF‑15
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.9 Payers section (DYNAMIC)CONF‑30
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.1 Advance directives section (DYNAMIC)CONF‑77
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.5 Functional status section (DYNAMIC)CONF‑123
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.11 Problem section (DYNAMIC)CONF‑140
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.4 Family history section (DYNAMIC)CONF‑184
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.15 Social history section (DYNAMIC)CONF‑232
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.2 Alerts section (DYNAMIC)CONF‑256
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.8 Medication section (DYNAMIC)CONF‑298
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.7 Medical equipment section (DYNAMIC)CONF‑371
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.6 Immunization section (DYNAMIC)CONF‑376
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.16 Vital signs section (DYNAMIC)CONF‑381
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.14 Results section (DYNAMIC)CONF‑388
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.12 Procedures section (DYNAMIC)CONF‑422
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.3 Encounters section (DYNAMIC)CONF‑453
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
hl7:component
1 … 1Contains 2.16.840.1.113883.10.20.1.10 Plan of care section (DYNAMIC)CONF‑480
@typeCode
cs0 … 1FCOMP
@contextConductionInd
bl0 … 1Ftrue
Included0 … 1 from 2.16.840.1.113883.3.1937.777.4.10.34 CCD componentOf (DYNAMIC)
hl7:componentOf
0 … 1CCDcdotsntOf
@typeCode
cs0 … 1FCOMP
hl7:encompassingEncounter
1 … 1CCDcdotsntOf
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.20217 ActClassEncounter (DYNAMIC)
@moodCode
cs0 … 1 
 CONF
The value of @moodCode shall be drawn from value set 2.16.840.1.113883.1.11.20267 ActMoodEventOccurrence (DYNAMIC)
hl7:id
II0 … *CCDcdotsntOf
hl7:code
CE0 … 1CCDcdotsntOf
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.13955 ActEncounterCode (DYNAMIC)
hl7:effectiveTime
IVL_TS1 … 1RCCDcdotsntOf
hl7:dischargeDispositionCode
CE0 … 1CCDcdotsntOf
 CONF
shall be drawn from concept domain "EncounterDischargeDisposition"
hl7:responsibleParty
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.16 CCD AssignedEntity (DYNAMIC)CCDcdotsntOf
@typeCode
cs0 … 1FRESP
hl7:encounterParticipant
0 … *CCDcdotsntOf
@typeCode
cs1 … 1R
 CONF
The value of @typeCode shall be drawn from value set 2.16.840.1.113883.1.11.19600 x_EncounterParticipant (DYNAMIC)
hl7:time
IVL_TS0 … 1CCDcdotsntOf
hl7:assignedEntity
1 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.16 CCD AssignedEntity (DYNAMIC)CCDcdotsntOf
hl7:location
0 … 1CCDcdotsntOf
@typeCode
cs0 … 1FLOC
hl7:healthCareFacility
1 … 1CCDcdotsntOf
@classCode
cs0 … 1 
 CONF
The value of @classCode shall be drawn from value set 2.16.840.1.113883.1.11.16927 RoleClassServiceDeliveryLocation (DYNAMIC)
hl7:id
II0 … *CCDcdotsntOf
hl7:code
CE0 … 1CCDcdotsntOf
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.17660 ServiceDeliveryLocationRoleType (DYNAMIC)
hl7:location
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.19 CCD Place (DYNAMIC)CCDcdotsntOf
hl7:serviceProviderOrganization
0 … 1Contains 2.16.840.1.113883.3.1937.777.4.10.2 CCD Organization (DYNAMIC)CCDcdotsntOf