| Item | DT | Card | Conf | Description | Label |
|---|
hl7:ClinicalDocument
| | 1 … 1 | M | | CDA‑ P‑V1 |
| | Variable let | Name | languageCode | |
| | Value | substring(cda:ClinicalDocument/cda:languageCode/@code,1,2) | |
| Included | 1 … 1 | M | from 2.16.756.5.30.1.1.10.2.25 Document Realm (DYNAMIC) |
hl7:realmCode
| CS | 1 … 1 | M | Swiss Realm (CHE) of HL7 CDA. | CDA‑CH V2 |
@code
| CONF | 1 … 1 | F | CHE |
hl7:typeId
| II | 1 … 1 | M | | CDA‑P‑V1 |
@root
| uid | 1 … 1 | F | 2.16.840.1.113883.1.3 |
@extension
| st | 1 … 1 | F | POCD_HD000040 |
| Included | | | from 2.16.756.5.30.1.1.1.1.3.9.1.10.2.1 (DYNAMIC) |
| | Include |  | Error: Cannot find template "2.16.756.5.30.1.1.1.1.3.9.1.10.2.1" (DYNAMIC) |
|
| Included | 1 … 1 | M | from 2.16.756.5.30.1.1.10.2.23 Document Id (DYNAMIC) |
hl7:id
| II | 1 … 1 | M | A unique identifier for each CDA document instance. | CDA‑CH V2 |
@root
| uid | 1 … 1 | R | The document's id as Globally Unique Identifier (GUID). |
@extension
| st | 0 | NP | NP/not present |
| Included | 1 … 1 | M | from 2.16.756.5.30.1.1.1.1.3.9.1.10.2.2 (DYNAMIC) |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.1.1.3.9.1.10.2.2" (DYNAMIC) |
|
| Included | 1 … 1 | M | from 2.16.756.5.30.1.1.1.1.3.9.1.10.2.8 (DYNAMIC) |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.1.1.3.9.1.10.2.8" (DYNAMIC) |
|
hl7:effectiveTime
| TS.CH.TZ | 1 … 1 | M | ClinicalDocument/effectiveTime MUST exist. It contains the creation date and time of the laboratory report. If this document replaces a previous version (linked via parentDocument), this is the date and time of the new version. | CDA‑P‑V1 |
| Included | 1 … 1 | M | from 2.16.756.5.30.1.1.10.2.19 Document Confidentiality Code (DYNAMIC) |
hl7:confidentialityCode
| CE (required) | 1 … 1 | M | Swiss Realm of Confidentiality Code according to the Swiss EPR regulation. | CDA‑CH V2 |
@code
| cs | 1 … 1 | R | The value of @code MUST be drawn from value set DocumentEntry.confidentialityCode |
@codeSystem
| oid | 1 … 1 | R | |
@codeSystemName
| st | 1 … 1 | R | |
@displayName
| st | 1 … 1 | R | The value of @displayName MUST be drawn from value set DocumentEntry.confidentialityCode |
| | CONF | |
| Included | 1 … 1 | M | from 2.16.756.5.30.1.1.10.2.22 Document Language (DYNAMIC) |
hl7:languageCode
| CS | 1 … 1 | M | The RFC5646 based language in which the narrative texts in this CDA document instance are written. | CDA‑CH V2 |
| Included | 1 … 1 | M | from 2.16.756.5.30.1.1.10.2.20 Document Set Id and Version Number (DYNAMIC) |
hl7:setId
| II | 1 … 1 | M | The setId element MUST match the document id of the very first version of that document. It MUST remain the same for all document versions. | CDA‑CH V2 |
@root
| uid | 1 … 1 | R | The root attribute MUST contain the setId as Globally Unique Identifier (GUID). |
@extension
| st | 0 | NP | NP/not present |
| | Schematron assert | role |  error | |
| | test | (parent::*/hl7:versionNumber[@value='1'] and @root=parent::*/hl7:id/@root and (@extension=parent::*/hl7:id/@extension or (not(@extension) and not(parent::*/hl7:id/@extension)))) or (parent::*/hl7:versionNumber[not(@value ='1')] and ((@root=parent::*/hl7:id/@root and @extension and not(@extension=parent::*/hl7:id/@extension)) or(not(@root=parent::*/hl7:id/@root)))) | |
| | Message | The setId MUST be equal with the document id for version 1 and it MUST differ for all other versions. | |
hl7:versionNumber
| INT.NONNEG | 1 … 1 | M | The versionNumber element MUST contain the value 1 for the very first version of that document. For later versions, the version number MUST be increased by 1 each. | CDA‑CH V2 |
| Choice | 1 … 1 | | recordTarget MUST be present in one of the following characteristics: - Human Patient: The laboratory report contain test results from samples taken exclusively from a human patient.
- Non-Human Subject: The laboratory report contains test results from samples taken from a non-human material (e.g., water, milk, etc.) or a living being (e.g., animal), but not related to a human patient.
- Human Patient with Non-Human Subject: The laboratory report contains test results from samples taken from a non-human material that is related to a human patient (e.g., food eaten by the patient or animal that has bitten the patient).
|
| Included | 0 … 1 | | from 2.16.756.5.30.1.1.1.1.3.9.1.10.2.4 (DYNAMIC)
Human Patient: The laboratory results contain test results from samples taken exclusively from a human patient.
All persons (including patients) and organizations, MUST according to XD-LAB contain name, addr and telecom. |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.1.1.3.9.1.10.2.4" (DYNAMIC) |
|
| Included | 0 … 1 | | from 2.16.756.5.30.1.1.10.2.26 (DYNAMIC)
Non-Human Subject: The laboratory report contains test results from samples taken from a non-human material (e.g., water, milk, etc.) or a living being (e.g., animal), but not related to a human patient. |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.10.2.26" (DYNAMIC) |
|
| Included | 0 … 1 | | from 2.16.756.5.30.1.1.10.2.27 (DYNAMIC)
Human Patient with Non-Human Subject: The laboratory report contains test results from samples taken from a non-human material that is related to a human patient (e.g., food eaten by the patient or animal that has bitten the patient). |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.10.2.27" (DYNAMIC) |
|
| Included | 1 … * | M | from 2.16.756.5.30.1.1.1.1.3.9.1.10.2.5 (DYNAMIC) |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.1.1.3.9.1.10.2.5" (DYNAMIC) |
|
| Included | 0 … 1 | | from 2.16.756.5.30.1.1.10.2.7 Data Enterer (DYNAMIC) |
hl7:dataEnterer
| | 0 … 1 | | Information about the person that entered information in this CDA document. It SHALL be declared, when data recorded in this document has been entered by a person other than the author but only when this is relevant for some reason. | CDA‑CH V2 |
hl7:templateId
| II | 1 … 1 | M | | CDA‑CH V2 |
@root
| uid | 1 … 1 | F | 2.16.756.5.30.1.1.10.2.7 |
hl7:time
| TS.CH.TZ | 0 … 1 | | Timestamp of the data input. | CDA‑CH V2 |
hl7:assignedEntity
| | 1 … 1 | R | Contains 2.16.756.5.30.1.1.10.9.12 Assigned Entity Compilation with id (DYNAMIC) | CDA‑CH V2 |
| Included | 1 … 1 | M | from 2.16.756.5.30.1.1.1.1.3.9.1.10.2.6 (DYNAMIC) |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.1.1.3.9.1.10.2.6" (DYNAMIC) |
|
| Included | 1 … * | M | from 2.16.756.5.30.1.1.1.1.3.9.1.10.2.3 (DYNAMIC) |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.1.1.3.9.1.10.2.3" (DYNAMIC) |
|
| Included | 0 … 1 | | from 2.16.756.5.30.1.1.1.1.3.9.1.10.2.7 (DYNAMIC) |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.1.1.3.9.1.10.2.7" (DYNAMIC) |
|
hl7:authenticator
| | 0 … * | | Contains 2.16.756.5.30.1.1.10.4.8 Laboratory Results Validator - participant Containment (DYNAMIC) | CDA‑P‑V1 |
| Included | 0 … 1 | R | from 2.16.756.5.30.1.1.10.2.16 Order Reference - inFulfillmentOf (DYNAMIC) |
hl7:inFulfillmentOf
| | 0 … 1 | R | Reference to one or more orders which led to the creation of this CDA document. It SHALL be declared, when the order reference is relevant for some reason. | CDA‑CH V2 |
hl7:templateId
| II | 1 … 1 | M | | CDA‑CH V2 |
@root
| uid | 1 … 1 | F | 2.16.756.5.30.1.1.10.2.16 |
hl7:order
| | 1 … 1 | R | | CDA‑CH V2 |
hl7:id
| II | 1 … * | R | Order number. | CDA‑CH V2 |
@root
| uid | 1 … 1 | R | Either the same GUID (order id) or the same OID (order issuing system) as the order itself. |
@extension
| st | 0 … 1 | | Contains the order ID itself. The ID MUST be unique within the system that issued the ID. |
| Included | 0 … * | | from 2.16.756.5.30.1.1.10.2.28 (DYNAMIC) |
| | Include | | Error: Cannot find template "2.16.756.5.30.1.1.10.2.28" (DYNAMIC) |
|
| Included | 0 … * | | from 2.16.756.5.30.1.1.10.2.14 Insurance Card - participant (DYNAMIC) |
hl7:participant
| | 0 … * | | Information on a patient's insurance card. | CDA‑CH V2 |
@typeCode
| cs | 1 … 1 | F | HLD |
hl7:templateId
| II | 1 … 1 | M | | CDA‑CH V2 |
@root
| uid | 1 … 1 | F | 2.16.756.5.30.1.1.10.2.14 |
hl7:time
| IVL_TS.CH.TZ | 1 … 1 | R | Validity period of the insurance card. | CDA‑CH V2 |
hl7:low
| TS.CH.TZ | 1 … 1 | | | CDA‑CH V2 |
@nullFlavor
| cs | 1 … 1 | F | NASK |
hl7:high
| TS.CH.TZ | 1 … 1 | R | Expiration date of the insurance card. | CDA‑CH V2 |
hl7:associatedEntity
| | 1 … 1 | R | | CDA‑CH V2 |
@classCode
| cs | 1 … 1 | F | POLHOLD |
hl7:id
| II | 1 … 1 | R | The insurance card's id. | CDA‑CH V2 |
@root
| uid | 1 … 1 | F | 2.16.756.5.30.1.123.100.1.1.1 |
@extension
| st | 1 … 1 | R | Number of the insurance card. |
hl7:associatedPerson
| | 0 … 1 | | Family and given name on the insurance card.
Contains 2.16.756.5.30.1.1.10.9.34 Person Name Information Compilation - eCH-0011 (DYNAMIC) | CDA‑CH V2 |
hl7:scopingOrganization
| | 0 … 1 | | The insurance company which issued the insurance card.
Contains 2.16.756.5.30.1.1.10.9.24 Organization Compilation with name (DYNAMIC) | CDA‑CH V2 |
| Included | 0 … * | | from 2.16.756.5.30.1.1.10.2.15 Insurance - participant (DYNAMIC) |
hl7:participant
| | 0 … * | | Information on a patient's insurance. | CDA‑CH V2 |
@typeCode
| cs | 1 … 1 | F | COV |
hl7:templateId
| II | 1 … 1 | M | | CDA‑CH V2 |
@root
| uid | 1 … 1 | F | 2.16.756.5.30.1.1.10.2.15 |
hl7:time
| IVL_TS.CH.TZ | 0 … 1 | | Validity period of the contract. | CDA‑CH V2 |
hl7:low
| TS.CH.TZ | 1 … 1 | R | Start of the contract. | CDA‑CH V2 |
hl7:high
| TS.CH.TZ | 1 … 1 | R | End of the contract. | CDA‑CH V2 |
hl7:associatedEntity
| | 1 … 1 | R | | CDA‑CH V2 |
@classCode
| cs | 1 … 1 | F | PAYOR |
hl7:id
| II | 1 … 1 | R | The id of the contract ([ge]: Versichertennummer; [fr]: Numéro d'assuré). | CDA‑CH V2 |
@root
| uid | 1 … 1 | R | The OID of the system that issued the id. OIDs of code systems, which are published in a public OID registry are REQUIRED. Others are NOT ALLOWED. |
@extension
| st | 0 … 1 | | The id itself. It MUST be unique within the issuing system. |
hl7:code
| CE | 1 … 1 | R | The underlying law for the contract. | CDA‑CH V2 |
@nullFlavor
| cs | 0 … 1 | F | NAV |
@code
| cs | 0 … 1 | | 832.10, 832.20, 221.229.1, 833.1, 831.20 |
@codeSystem
| oid | 0 … 1 | F | 2.16.756.5.30.2.1.1.11 |
@codeSystemName
| st | 0 … 1 | F | ins-laws |
@displayName
| st | 0 … 1 | | Federal Act on Health Insurance (HIA), Federal Act on Accident Insurance (AIA), Federal Act on Insurance Policies (Insurance Policies Act, IPA), Federal Act on Military Insurance (MilIA), Federal Act on Invalidity Insurance (InvIA) |
| | Schematron assert | role | error | |
| | test | (@nullFlavor='NAV' and not(@codeSystem or @codeSystemName or @code or @displayName)) or (@codeSystem='2.16.756.5.30.2.1.1.11' and @codeSystemName='ins-laws' and @code and @displayName) | |
| | Message | Either a valid insurance law or nullFlavor="NAV" is REQUIRED. | |
hl7:associatedPerson
| | 0 … 1 | | Contact person at the insurance company.
Contains 2.16.756.5.30.1.1.10.9.34 Person Name Information Compilation - eCH-0011 (DYNAMIC) | CDA‑CH V2 |
hl7:scopingOrganization
| | 1 … 1 | | The insurance company.
Contains 2.16.756.5.30.1.1.10.9.26 Organization Compilation with GLN, name, addr and telecom (DYNAMIC) | CDA‑CH V2 |
| Included | 0 … * | | from 2.16.756.5.30.1.1.10.2.13 Document Replacement - relatedDocument (DYNAMIC) |
hl7:relatedDocument
| | 0 … * | | Relationship to another CDA-CH V2 based document that is replaced by the current one. Notes: For correction of wrong information, a new document that replaces the earlier document MUST be created. The new document corrects previously incorrect information. This also applies to the case where information in the CDA header has been corrected (e.g., if the original document has been issued to the wrong patient). While processing the new document at the recipient, all values from the previous document MUST be interpreted as deprecated (deleted/marked as deleted/deprecated) and all values in the new document MUST be marked as valid: - Values that were only contained in the previous document have to be treated as deleted.
- Values that are present in both documents are overwritten with the contents of the new document.
- Values that are only contained in the new document are to be added.
| CDA‑CH V2 |
@typeCode
| cs | 1 … 1 | F | RPLC |
| | Indicates that it is a relationship to another document that needs to be replaced. |
hl7:templateId
| II | 1 … 1 | M | | CDA‑CH V2 |
@root
| uid | 1 … 1 | F | 2.16.756.5.30.1.1.10.2.13 |
hl7:parentDocument
| | 1 … 1 | R | Relationship to the document that needs to be replaced. | CDA‑CH V2 |
hl7:id
| II | 1 … 1 | M | The id of the document to be replaced MUST be declared. | CDA‑CH V2 |
@root
| uid | 1 … 1 | R | The id (GUID) of the document to be replaced. |
@extension
| st | 0 | NP | NP/not present |
hl7:setId
| II | 1 … 1 | M | The setId of the document to be replaced MUST be declared. | CDA‑CH V2 |
@extension
| st | 0 | NP | NP/not present |
@root
| uid | 1 … 1 | R | The setId (GUID) of the document to be replaced and MUST be identical with the content of the setId of the current document. |
| | Schematron assert | role | error | |
| | test | (@root=/hl7:ClinicalDocument/hl7:setId/@root) and not(@extension) and not(/hl7:ClinicalDocument/hl7:setId/@extension) | |
| | Message | ClinicalDocument/setId: MUST be identical to the one of the replaced document | |
hl7:versionNumber
| INT | 1 … 1 | M | The version number of the document to be replaced. | CDA‑CH V2 |
| | Schematron assert | role | error | |
| | test | /hl7:ClinicalDocument/hl7:versionNumber/@value > @value | |
| | Message | ClinicalDocument/versionNumber: MUST be higher than the one of the replaced document | |
hl7:component
| | 1 … 1 | R | | CDA‑P‑V1 |
hl7:structuredBody
| | 1 … 1 | R | | CDA‑P‑V1 |
hl7:component
| | 1 … * | M | Main section for laboratory reports
A laboratory report MUST contain at least one main chapter in the structured body element, which MAY contain one or more sub-chapters. No further nesting is allowed.
Each main section (Laboratory Specialty Section) contains laboratory tests of a particular discipline (e.g., microbiology or serology) and MUST contain either text and entry elements or sub-chapter (Laboratory Report Item Section).
In the first case, the human-readable text in the text element MUST be generated automatically from the entry and its sub-elements, and sub-chapters ARE NOT ALLOWED.
In the second case, all subsections (Laboratory Report Item Sections) must contain the examination results.
Contains 2.16.756.5.30.1.1.10.3.3 Laboratory Speciality Section - coded (DYNAMIC) | CDA‑P‑V1 |
hl7:component
| | 0 … 1 | | Main section for vital signs
A laboratory report MAY include a main section in the structuredBody element that contains vital signs of the patient (e.g., body temperature, body height and weight), if this is of particular interest to the interpretation of the laboratory results.
Note:
This section was imported "as is" from ART-DECOR (project CDA-CH) and is currently not further specified.
Contains 2.16.756.5.30.1.1.10.3.4 Vital Signs Section - coded (DYNAMIC) | CDA‑P‑V1 |
hl7:component
| | 0 … 1 | | Main section for coded results
A laboratory report MAY include a main section in the structuredBody element that contains coded results of the patient (e.g., gestational age), if this is of particular interest to the interpretation of the laboratory results.
Note:
This section was imported "as is" from ART-DECOR (project CDA-CH-VACD) and is currently not further specified.
Contains | Error: Cannot find template "2.16.756.5.30.1.127.10.3.5" (DYNAMIC) |
| CDA‑P‑V1 |
Draft