3.2.2.3 Advance directive references

The template identifier for an advance directive reference is 2.16.840.1.113883.10.20.1.36.

Referenced advance directive documents are represented with the ExternalDocument class.

CONF-101: An advance directive reference (templateId 2.16.840.1.113883.10.20.1.36) SHALL be represented with Observation / reference / ExternalDocument.
CONF-102: An advance directive observation MAY contain exactly one advance directive reference.
CONF-103: The value for “Observation / reference / @typeCode” in an advance directive reference SHALL be “REFR” 2.16.840.1.113883.5.1002 ActRelationshipType STATIC.
CONF-104: ExternalDocument SHALL contain at least one ExternalDocument / id.
CONF-105: The URL of a referenced advance directive document MAY be present, and SHALL be represented in Observation / reference / ExternalDocument / text / reference. A <linkHTML> element containing the same URL SHOULD be present in the associated CDA Narrative Block.
CONF-106: The MIME type of a referenced advance directive document MAY be present, and SHALL be represented in Observation / reference / ExternalDocument / text / @mediaType.
CONF-107: Where the value of Observation / reference / seperatableInd is “false”, the referenced advance directive 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).