Id2.16.840.1.113883.10.20.22.2.21.1Effective Date2015‑08‑01
Statusdraft DraftVersion Label2.1
NameAdvanceDirectivesSectionentriesrequiredV3Display NameAdvance Directives Section (entries required) (V3)
Description
This section contains data defining the patient’s advance directives and any reference to supporting documentation, including living wills, healthcare proxies, and CPR and resuscitation status. If the referenced documents are available, they can be included in the exchange package. The most recent directives are required, if known, and should be listed in as much detail as possible. This section differentiates between "advance directives" and "advance directive documents". The former is the directions to be followed whereas the latter refers to a legal document containing those directions.
ContextParent nodes of template element with id 2.16.840.1.113883.10.20.22.2.21.1
ClassificationCDA Section Level Template
Open/ClosedOpen (other than defined elements are allowed)
Used by / Uses
Used by 1 transaction and 1 template, Uses 2 templates
Used by as NameVersion
2.16.840.1.113883.3.1937.99.3.4.31Transactionfinal Transfer Summary (V2)2015‑08‑01
2.16.840.1.113883.10.20.22.1.13Containmentdraft Transfer Summary (V2) (2.1)2015‑08‑01
Uses as NameVersion
2.16.840.1.113883.10.20.22.4.48Includedraft Advance Directive Observation (V3) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.4.108Includedraft Advance Directive Organizer (V2) (2.1)2015‑08‑01
RelationshipSpecialization: template 2.16.840.1.113883.10.12.201 CDA Section (2005‑09‑07)
ref
ad1bbr-

Version: template 2.16.840.1.113883.10.20.22.2.21.1 Advance Directives Section (entries required) (2013‑01‑31)
ItemDTCardConfDescriptionLabel
cda:section
AdvadotsedV3
@nullFlavor
cs0 … 1FNICONFdots2800
 MAY contain zero or one [0..1] @nullFlavor="NI" No information (CodeSystem: HL7NullFlavor urn:oid:2.16.840.1.113883.5.1008) (CONF:1198-32800).
cda:templateId
II1 … 1MC-CDA R1.1 templateId root without an extensionCONFdots2936
@root
uid1 … 1F2.16.840.1.113883.10.20.22.2.21.1
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:1198-30227) such that itCONFdots0227
@root
uid1 … 1F2.16.840.1.113883.10.20.22.2.21.1CONFdots0228
 SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.2.21.1" (CONF:1198-30228).
@extension
st1 … 1F2015-08-01CONFdots2512
 SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32512).
cda:code
CE1 … 1MSHALL contain exactly one [1..1] code (CONF:1198-32929).CONFdots2929
@code
CONF1 … 1F42348-3
@codeSystem
1 … 1F2.16.840.1.113883.6.1
cda:title
ST1 … 1SHALL contain exactly one [1..1] title (CONF:1198-32932).CONFdots2932
cda:text
SD.TEXT1 … 1RSHALL contain exactly one [1..1] text (CONF:1198-32933).CONFdots2933
cda:entry
1 … *SHALL contain at least one [1..*] entry (CONF:1198-30235).
Contains 2.16.840.1.113883.10.20.22.4.48 Advance Directive Observation (V3) (2015‑08‑01)		CONFdots0235
Choice1 … 1
This entry SHALL contain EITHER an Advance Directive Observation (V3) OR an Advance Directive Organizer (CONF:1198-32881)
Elements to choose from:
Included0 … 1 from 2.16.840.1.113883.10.20.22.4.48 Advance Directive Observation (V3) (2015‑08‑01)
MAY contain zero or one [0..1] Advance Directive Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) (CONF:1198-30236).
cda:observation
0 … 1AdvadotsonV3
@classCode
cs1 … 1FOBSCONFdots8648
 SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-8648).
@moodCode
cs1 … 1FEVNCONFdots8649
 SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-8649).
cda:templateId
II1 … 1MC-CDA R1.1 templateId root without an extensionCONFdots2936
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.48
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:1198-8655) such that itCONFdots8655
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.48CONFdots0485
 SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.48" (CONF:1198-10485).
@extension
st1 … 1F2015-08-01CONFdots2496
 SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32496).
cda:id
II1 … *SHALL contain at least one [1..*] id (CONF:1198-8654).CONFdots8654
cda:code
CD (extensible)1 … 1SHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet AdvanceDirectiveTypeCode urn:oid:2.16.840.1.113883.1.11.20.2 DYNAMIC 2006-10-17 (CONF:1198-8651).CONFdots8651
 CONF
The value of @code should be drawn from value set 2.16.840.1.113883.1.11.20.2 AdvanceDirectiveTypeCode (DYNAMIC)
cda:translation
1 … 1This code SHALL contain exactly one [1..1] translation (CONF:1198-32842) such that itCONFdots2842
@code
1 … 1F75320-2CONFdots2843
 SHALL contain exactly one [1..1] @code="75320-2" Advance directive (CONF:1198-32843).
@codeSystem
1 … 1F2.16.840.1.113883.6.1CONFdots2844
 SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:1198-32844).
@code
CONF1 … 1F75320-2
@codeSystem
1 … 1F2.16.840.1.113883.6.1
cda:statusCode
CS1 … 1MSHALL contain exactly one [1..1] statusCode (CONF:1198-8652).CONFdots8652
@code
CONF1 … 1Fcompleted
cda:effectiveTime
IVL_TS1 … 1MSHALL contain exactly one [1..1] effectiveTime (CONF:1198-8656).CONFdots8656
cda:low
1 … 1RThis effectiveTime SHALL contain exactly one [1..1] low (CONF:1198-28719).CONFdots8719
cda:high
1 … 1RThis effectiveTime SHALL contain exactly one [1..1] high (CONF:1198-15521).CONFdots5521
 ConstraintIf the Advance Directive does not have a specified ending time, the element *SHALL* have the nullFlavor attribute set to *NA*
cda:value
1 … 1SHALL contain exactly one [1..1] value (CONF:1198-30804) such that itCONFdots0804
 Schematron assertrolered error 
 testnot(@xsi:type='CD') or @codeSystem='2.16.840.1.113883.6.96' 
 MessageIf type CD, then value will be SNOMED-CT 2.16.840.1.113883.6.96 
cda:author
0 … *RSHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1198-32406).
Contains 2.16.840.1.113883.10.20.22.4.119 Author Participation (2015‑08‑13)		CONFdots2406
cda:participant
0 … *RSHOULD contain zero or more [0..*] participant (CONF:1198-8662) such that it

The participant "VRF" represents the clinician(s) who verified the patient advance directive observation.

CONFdots8662
where [@typeCode='VRF']
@typeCode
cs1 … 1FVRFCONFdots8663
 SHALL contain exactly one [1..1] @typeCode="VRF" Verifier (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8663).
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:1198-8664) such that itCONFdots8664
@root
uid1 … 1F2.16.840.1.113883.10.20.1.58CONFdots0486
 SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.1.58" (CONF:1198-10486).
cda:time
0 … 1RSHOULD contain zero or one [0..1] time (CONF:1198-8665).CONFdots8665
 ConstraintThe data type of Observation/participant/time in a verification *SHALL* be *TS* (time stamp).
cda:participantRole
1 … 1MCONFdots8825
cda:code
CD0 … 1RThis participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-28446).CONFdots8446
 CONF
The value of @code shall be drawn from value set 2.16.840.1.114222.4.11.1066 Healthcare Provider Taxonomy (DYNAMIC)
cda:addr
AD0 … *RThis participantRole MAY contain zero or more [0..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-28451).CONFdots8451
Included from 2.16.840.1.113883.10.20.22.5.2 US Realm Address (AD.US.FIELDED) (2015‑08‑13)
cda:addr
USRedotsLDED
@nullFlavor
cs0 … 1 
@use
set_cs0 … 1 SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet PostalAddressUse urn:oid:2.16.840.1.113883.1.11.10637 STATIC 2005-05-01 (CONF:81-7290).CONFdots7290
 CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.1.11.10637 PostalAddressUse (DYNAMIC)
 Constraint*SHALL NOT* have mixed content except for white space
 ConstraintIf the country is US, the state element is required but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
cda:country
ADXP0 … 1RSHOULD contain zero or one [0..1] country, which SHALL be selected from ValueSet Country urn:oid:2.16.840.1.113883.3.88.12.80.63 DYNAMIC (CONF:81-7295).CONFdots7295
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.80.63 Country (DYNAMIC)
cda:state
ADXP0 … 1RSHOULD contain zero or one [0..1] state (ValueSet: StateValueSet urn:oid:2.16.840.1.113883.3.88.12.80.1 DYNAMIC) (CONF:81-7293).CONFdots7293
 ConstraintState is required if the country is US. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.80.1 StateValueSet (DYNAMIC)
 Schematron assertrolered error 
 test@nullFlavor or (cda:country='US' and cda:state) or (cda:country!='US') or (not(cda:country) and cda:state) 
 MessageState is required if the country is US. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies. 
cda:city
ADXP1 … 1RSHALL contain exactly one [1..1] city (CONF:81-7292).CONFdots7292
cda:postalCode
ADXP0 … 1RSHOULD contain zero or one [0..1] postalCode, which SHOULD be selected from ValueSet PostalCode urn:oid:2.16.840.1.113883.3.88.12.80.2 DYNAMIC (CONF:81-7294). 
CONFdots7294
 ConstraintIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.80.2 PostalCode (DYNAMIC)
 Schematron assertrolered error 
 test@nullFlavor or (cda:country='US' and cda:postalCode) or (cda:country!='US') or (not(cda:country) and cda:postalCode) 
 MessageIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). 
cda:streetAddressLine
ADXP1 … 4RCONFdots7291
 Schematron assertrolered error 
 test@nullFlavor or (count(cda:streetAddressLine) > 0 and count(cda:streetAddressLine) < 5) 
 MessageSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291) 
 Schematron assertrolered error 
 test@nullFlavor or (cda:city and cda:streetAddressLine)  
 Message 
cda:playingEntity
0 … 1Contains 2.16.840.1.113883.10.20.22.5.1.1 US Realm Person Name (PN.US.FIELDED) (2015‑08‑13)CONFdots8428
cda:participant
0 … *RSHOULD contain zero or more [0..*] participant (CONF:1198-8667) such that it

This custodian (CST) participant identifies a legal representative for the patient's advance directive. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. If there is more than one legal representative, a qualifier may be used to designate the legal representative as primary or secondary.

CONFdots8667
where [@typeCode='CST']
@typeCode
cs1 … 1FCSTCONFdots8668
 SHALL contain exactly one [1..1] @typeCode="CST" Custodian (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8668).
cda:participantRole
1 … 1MCONFdots8669
@classCode
cs1 … 1FAGNTCONFdots8670
 This participantRole SHALL contain exactly one [1..1] @classCode="AGNT" Agent (CodeSystem: RoleClass urn:oid:2.16.840.1.113883.5.110 STATIC) (CONF:1198-8670).
cda:code
CD0 … 1RThis participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:1198-28440).CONFdots8440
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.11.20.12.1 Personal And Legal Relationship Role Type (DYNAMIC)
Included0 … 1R from 2.16.840.1.113883.10.20.22.5.2 US Realm Address (AD.US.FIELDED) (2015‑08‑13)
cda:addr
0 … 1RUSRedotsLDED
@nullFlavor
cs0 … 1 
@use
set_cs0 … 1 SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet PostalAddressUse urn:oid:2.16.840.1.113883.1.11.10637 STATIC 2005-05-01 (CONF:81-7290).CONFdots7290
 CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.1.11.10637 PostalAddressUse (DYNAMIC)
 Constraint*SHALL NOT* have mixed content except for white space
 ConstraintIf the country is US, the state element is required but SHOULD have @nullFlavor if the state is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
cda:country
ADXP0 … 1RSHOULD contain zero or one [0..1] country, which SHALL be selected from ValueSet Country urn:oid:2.16.840.1.113883.3.88.12.80.63 DYNAMIC (CONF:81-7295).CONFdots7295
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.80.63 Country (DYNAMIC)
cda:state
ADXP0 … 1RSHOULD contain zero or one [0..1] state (ValueSet: StateValueSet urn:oid:2.16.840.1.113883.3.88.12.80.1 DYNAMIC) (CONF:81-7293).CONFdots7293
 ConstraintState is required if the country is US. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.80.1 StateValueSet (DYNAMIC)
 Schematron assertrolered error 
 test@nullFlavor or (cda:country='US' and cda:state) or (cda:country!='US') or (not(cda:country) and cda:state) 
 MessageState is required if the country is US. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies. 
cda:city
ADXP1 … 1RSHALL contain exactly one [1..1] city (CONF:81-7292).CONFdots7292
cda:postalCode
ADXP0 … 1RSHOULD contain zero or one [0..1] postalCode, which SHOULD be selected from ValueSet PostalCode urn:oid:2.16.840.1.113883.3.88.12.80.2 DYNAMIC (CONF:81-7294). 
CONFdots7294
 ConstraintIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.80.2 PostalCode (DYNAMIC)
 Schematron assertrolered error 
 test@nullFlavor or (cda:country='US' and cda:postalCode) or (cda:country!='US') or (not(cda:country) and cda:postalCode) 
 MessageIf the country is US, the postalCode element is required but SHOULD have @nullFlavor if the postalCode is unknown. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025). 
cda:streetAddressLine
ADXP1 … 4RCONFdots7291
 Schematron assertrolered error 
 test@nullFlavor or (count(cda:streetAddressLine) > 0 and count(cda:streetAddressLine) < 5) 
 MessageSHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291) 
 Schematron assertrolered error 
 test@nullFlavor or (cda:city and cda:streetAddressLine)  
 Message 
cda:telecom
TEL0 … *RThis participantRole SHOULD contain zero or more [0..*] telecom (CONF:1198-8672).CONFdots8672
cda:playingEntity
1 … 1MThis participantRole SHALL contain exactly one [1..1] playingEntity (CONF:1198-8824).CONFdots8824
cda:code
CD0 … 1RThis playingEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Agent Qualifier urn:oid:2.16.840.1.113883.11.20.9.51 DYNAMIC (CONF:1198-28444).CONFdots8444
 CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.11.20.9.51 Healthcare Agent Qualifier (DYNAMIC)
cda:name
1 … 1RThis playingEntity SHALL contain exactly one [1..1] name (CONF:1198-8673).

Record the name of the agent who can provide a copy of the Advance Directive in the name element.

CONFdots8673
cda:reference
0 … *RSHOULD contain at least one [1..*] reference (CONF:1198-8692) such that itCONFdots8692
@typeCode
cs1 … 1FREFRCONFdots8694
 SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8694).
cda:externalDocument
1 … 1MSHALL contain exactly one [1..1] externalDocument (CONF:1198-8693).CONFdots8693
cda:id
II1 … *This externalDocument SHALL contain at least one [1..*] id (CONF:1198-8695).CONFdots8695
cda:text
0 … 1This externalDocument MAY contain zero or one [0..1] text (CONF:1198-8696).CONFdots8696
cda:reference
0 … 1The text, if present, MAY contain zero or one [0..1] reference (CONF:1198-8697).CONFdots8697
 ConstraintThe URL of a referenced advance directive document *MAY* be present, and *SHALL* be represented in Observation/reference/ExternalDocument/text/reference.
If a URL is referenced, then it *SHOULD* have a corresponding linkHTML element in narrative block.
Included0 … 1 from 2.16.840.1.113883.10.20.22.4.108 Advance Directive Organizer (V2) (2015‑08‑01)
MAY contain zero or one [0..1] Advance Directive Organizer (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2015-08-01) (CONF:1198-32420).
cda:organizer
0 … 1AdvadotserV2
@classCode
cs1 … 1FCLUSTERCONFdots8410
 SHALL contain exactly one [1..1] @classCode="CLUSTER" Cluster (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:1198-28410).
@moodCode
cs1 … 1FEVNCONFdots8411
 SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-28411).
cda:templateId
II1 … 1MC-CDA R1.1 templateId root without an extensionCONFdots2936
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.108
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:1198-28412) such that itCONFdots8412
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.108CONFdots8413
 SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.108" (CONF:1198-28413).
@extension
st1 … 1F2015-08-01CONFdots2876
 SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32876).
cda:id
II1 … *SHALL contain at least one [1..*] id (CONF:1198-28414).CONFdots8414
cda:code
1 … 1MSHALL contain exactly one [1..1] code (CONF:1198-28415).CONFdots8415
@code
CONF1 … 1F45473-6
@codeSystem
1 … 1F2.16.840.1.113883.6.1
cda:statusCode
CS1 … 1MSHALL contain exactly one [1..1] statusCode (CONF:1198-28418).CONFdots8418
@code
CONF1 … 1Fcompleted
cda:author
0 … *RSHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1198-32407).
Contains 2.16.840.1.113883.10.20.22.4.119 Author Participation (2015‑08‑13)		CONFdots2407
cda:component
1 … *Contains 2.16.840.1.113883.10.20.22.4.48 Advance Directive Observation (V3) (2015‑08‑01)CONFdots8420