Id2.16.840.1.113883.10.20.22.4.204Effective Date2017‑05‑01
Statusdraft DraftVersion LabelC-CDA R2.1
NameAdvanceCarePlanningInterventionV1Display NameAdvance Care Planning Intervention (V1)
Description
The Advance Care Planning Intervention template is used to record a planned intervention that will involve reviewing and verifying a person’s directives, or will involve educating and supporting a person on establishing or modifying his or her advance directives. It also can be used to record when the activity of reviewing and verifying a person’s directives has been completed or when educating and supporting a person to establish or update his or her advance directives has been completed. The Advance Care Planning Intervention template differs from the Advance Directive Observation template. Advance Care Planning Intervention template is used to document interactions (such as discussions and education) with the patient about advance directives and advance care planning. Advance Directive Observation template is used to record that a person’s advance directive document has been accessed and reviewed. Concepts from the Advance Care Planning Services value set can be used in the code element of the documentationOf/serviceEvent in the header to indicate when advance care planning services have been performed. In a Care Plan Document, this entry can be used in the Interventions Section. In a CCD, it can be used in the Plan of Treatment section when documenting planned activities or in the Procedures Section when documenting completed actitivities. This template uses moodCode to document temporal nuances of the information. The chart below describes available moodCodes, when to use each, and the meaning of effectiveTime in each case. moodCode moodCode Meaning Example Usage Meaning of effectiveTime APT Appointment Use when the advance care planning activity is scheduled. The date/time of the scheduled activity. (TS) ARQ Appointment Request Use when an appointment to perform the advance care planning activity has be requested. Use TS for a specific requested date/time. Use TS_IVL for a request for a appointment within a time range. The date/time of the requested appointment. (TS or TS_IVL) INT Intent Use when advance care planning activity is intended to happen during a range of time. The date/time when the request was made. (TS_IVL) PRMS Promise Use when advance care planning activity is promised to happen during a range of time. The date/time when the request was made. (TS_IVL) PRP Proposal Use when advance care planning activity is proposed to happen during a range of time. The date/time when the request was made. (TS_IVL) RQO Request Use when advance care planning activity has be requested. Use TS for a specific requested date/time. Use TS_IVL for a request for a appointment within a time range. The date/time of the requested activity will be perfomed. (TS or TS_IVL) EVN Event Use when advance care planning activity has been performed during a range of time or at a specified time. When indicating a single timestamp, use effectiveTime/low to indicate the start time of the activity, or use effectiveTime/high to indicate the end time of the activity The date/time when the request was made. (TS or TS_IVL) The author/time indicates the point in time when this temporal information was documented.
ContextParent nodes of template element with id 2.16.840.1.113883.10.20.22.4.204
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
RelationshipSpecialization: template 2.16.840.1.113883.10.12.306 CDA Procedure (2005‑09‑07)
ref
ad1bbr-
Example
Advance Care Planning Intervention (V1) - For a planned advance care planning activity
<section>
  <!-- This example could be used in the Plan of Treatment Section in a CCD or in the Intervention Section of a Care Plan Documement. -->
  <!-- This is an example of a planned activity that has not been completed yet.-->
  <!-- In the section.text-->
  <text>
     ...     <table border="1" width="100%">
      <thead>
        <tr>
          <th>Planned Care:</th>          <th>Status:</th>          <th>Date of Service:</th>          <th>Service Provider:</th>          <th>Planned As of (by):</th>        </tr>
      </thead>
      <tbody>
        <tr ID="ACPIntervention-01">
          <td ID="ACPInt-01-care">Advance Care Planning Consultation</td>          <td styleCode="Italic">Scheduled</td>          <td>Sept 15, 2017
2:00pm
</td>
          <td>Patricia Primary, MD</td>          <td>August 15, 2017 10:30am (Patricia Primary, MD)</td>        </tr>
      </tbody>
    </table>
     ...   </text>
  <!-- In the corresponding machine processable entry-->
  <entry>
    <!-- Advance Care Planning Intervention (V1) -->
    <procedure classCode="PROC" moodCode="APT">
      <templateId root="2.16.840.1.113883.10.20.22.4.204" extension="2017-05-01"/>      <id root="9a6d1bac-17d3-4195-89c4-1121bc809b5a"/>      <code code="713662007" displayName="Discussion about advance care planning (procedure)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
        <originalText>
          <reference value="#ACPInt-01-care"/>        </originalText>
      </code>
      <text>
        <reference value="#ACPIntervention-01"/>      </text>
      <statusCode code="active"/>      <effectiveTime value="20170915140000-0500"/>      <performer>
        <assignedEntity>
          <!-- This id points back to a participant in the header -->
          <id extension="555555555" root="2.16.840.1.113883.4.6"/>          <code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>          <assignedPerson>
            <name>Patricia Primary, MD</name>          </assignedPerson>
        </assignedEntity>
      </performer>
      <author typeCode="AUT">
        <templateId root="2.16.840.1.113883.10.20.22.4.119"/>        <time value="201708151030-0500"/>        <assignedAuthor>
          <!-- This id points back to a participant in the header -->
          <id extension="555555555" root="2.16.840.1.113883.4.6"/>          <code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>          <assignedPerson>
            <name>Patricia Primary,
MD
</name>
          </assignedPerson>
        </assignedAuthor>
      </author>
    </procedure>
  </entry>
</section>
Example
Advance Care Planning Intervention (V1) - For a completed advance care planning activity
<!-- This example could be used in the Procedure Section in a CCD or in the Intervention Section of a Care Plan Documement. -->
<!-- This is an example of a completed activity/intervention.-->
<section>
  <!-- In the section.text-->
  <text>
     ...     <table border="1" width="100%">
      <thead>
        <tr>
          <th>Procedure:</th>          <th>Status:</th>          <th>Date of Service:</th>          <th>Service Provider:</th>          <th>Documented by (time):</th>        </tr>
      </thead>
      <tbody>
        <tr ID="ACPActivity-01">
          <td ID="ACPAct-01-care">Advance Care Planning Consultation</td>          <td styleCode="Italic">Completed</td>          <td>August 15, 2017
10:00am
</td>
          <td>Patricia Primary, MD</td>          <td>Patricia Primary, MD (August 15, 2017 10:30am )</td>        </tr>
      </tbody>
    </table>
     ...   </text>
  <!-- In the corresponding machine processable entry-->
  <entry>
    <!-- Advance Care Planning Intervention (V1) That has been completed-->
    <procedure classCode="PROC" moodCode="EVN">
      <templateId root="2.16.840.1.113883.10.20.22.4.204" extension="2017-05-01"/>      <id root="9a6d1bac-17d3-4195-89c4-1121bc809b5a"/>      <code code="713662007" displayName="Discussion about advance care planning (procedure)" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT">
        <originalText>
          <reference value="#ACPInt-01-care"/>        </originalText>
      </code>
      <text>
        <reference value="#ACPIntervention-01"/>      </text>
      <statusCode code="completed"/>      <effectiveTime value="20170815100000-0500"/>      <performer>
        <assignedEntity>
          <!-- This id points back to a participant in the header -->
          <id extension="555555555" root="2.16.840.1.113883.4.6"/>          <code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>          <assignedPerson>
            <name>Patricia Primary, MD</name>          </assignedPerson>
        </assignedEntity>
      </performer>
      <author typeCode="AUT">
        <templateId root="2.16.840.1.113883.10.20.22.4.119"/>        <time value="201708151030-0500"/>        <assignedAuthor>
          <!-- This id points back to a participant in the header -->
          <id extension="555555555" root="2.16.840.1.113883.4.6"/>          <code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Healthcare Provider Taxonomy (HIPAA)"/>          <assignedPerson>
            <name>Patricia Primary,
MD
</name>
          </assignedPerson>
        </assignedAuthor>
      </author>
    </procedure>
  </entry>
</section>
ItemDTCardConfDescriptionLabel
cda:procedure
AdvadotsonV1
@nullFlavor
cs0 … 1 MAY contain zero or one [0..1] @nullFlavor (CONF:X-X).
@classCode
cs1 … 1RSHALL contain exactly one [1..1] @classCode (CONF:X-X).
@moodCode
cs1 … 1RSHALL contain exactly one [1..1] @moodCode (CONF:X-X).
@negationInd
bl0 … 1 MAY contain zero or one [0..1] @negationInd (CONF:X-X).
cda:realmCode
0 … *MAY contain zero or more [0..*] realmCode (CONF:X-X).AdvadotsonV1
cda:typeId
0 … 1MAY contain zero or one [0..1] typeId (CONF:X-X).AdvadotsonV1
cda:templateId
1 … 1MSHALL contain exactly one [1..1] templateId (CONF:3332-32946) such that itCONFdots2946
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.204:2017-05-01CONFdots2965
 SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.204:2017-05-01" (CONF:3332-32965).
@extension
st1 … 1F2017-05-01CONFdots2966
 SHALL contain exactly one [1..1] @extension="2017-05-01" (CONF:3332-32966).
cda:id
1 … *MSHALL contain at least one [1..*] id (CONF:3332-32993).CONFdots2993
cda:code
1 … 1MSHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet Advance Care Planning Services Grouping urn:oid:2.16.840.1.113883.11.20.9.69.1.3 DYNAMIC (CONF:3332-32947).CONFdots2947
cda:text
1 … 1MSHALL contain exactly one [1..1] text (CONF:3332-33062).CONFdots3062
cda:statusCode
1 … 1MSHALL contain exactly one [1..1] statusCode (CONF:3332-32949).CONFdots2949
cda:effectiveTime
1 … 1MSHALL contain exactly one [1..1] effectiveTime (CONF:3332-32950).CONFdots2950
cda:low
1 … 1MThis effectiveTime SHALL contain exactly one [1..1] low (CONF:3332-32971).

Record the effectiveTime information for acts in all moodCodes except EVN in the effectiveTime/low. Record the time of the act in moodCode EVN in effectiveTime/high (completion of planned intervention).
CONFdots2971
cda:high
0 … 1This effectiveTime MAY contain zero or one [0..1] high (CONF:3332-32951).

Record the time of the act in moodCode EVN in effectiveTime/high (completion of planned intervention). Note: Record the effectiveTime information for acts in all moodCodes except EVN in the effectiveTime/low.
CONFdots2951
cda:priorityCode
0 … 1MAY contain zero or one [0..1] priorityCode (CONF:X-X).AdvadotsonV1
cda:languageCode
0 … 1MAY contain zero or one [0..1] languageCode (CONF:X-X).AdvadotsonV1
cda:methodCode
0 … *MAY contain zero or more [0..*] methodCode (CONF:X-X).AdvadotsonV1
cda:approachSiteCode
0 … *MAY contain zero or more [0..*] approachSiteCode (CONF:X-X).AdvadotsonV1
cda:targetSiteCode
0 … *MAY contain zero or more [0..*] targetSiteCode (CONF:X-X).AdvadotsonV1
cda:subject
0 … 1MAY contain zero or one [0..1] subject (CONF:X-X).AdvadotsonV1
cda:specimen
0 … *MAY contain zero or more [0..*] specimen (CONF:X-X).AdvadotsonV1
cda:performer
0 … *RSHOULD contain zero or more [0..*] performer (CONF:3332-33014) such that it

The performer records the person who is intended to complete the planned action, or the person who completed the action when moodCode=EVN. The performer/time element records when the performer is expected to complete the action, or when the performer completed the action if moodCode=EVN.
CONFdots3014
cda:time
0 … 1RSHOULD contain zero or one [0..1] time (CONF:3332-33015).CONFdots3015
cda:assignedEntity
1 … 1MSHALL contain exactly one [1..1] assignedEntity (CONF:3332-33064).CONFdots3064
cda:assignedPerson
1 … 1MThis assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:3332-33065).CONFdots3065
cda:name
1 … 1MThis assignedPerson SHALL contain exactly one [1..1] name (CONF:3332-33066).CONFdots3066
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:3332-32994).CONFdots2994
cda:informant
0 … *MAY contain zero or more [0..*] informant (CONF:X-X).AdvadotsonV1
cda:participant
0 … *MAY contain zero or more [0..*] participant (CONF:X-X).AdvadotsonV1
cda:entryRelationship
0 … *MAY contain zero or more [0..*] entryRelationship (CONF:X-X).AdvadotsonV1
cda:reference
0 … *MAY contain zero or more [0..*] reference (CONF:X-X).AdvadotsonV1
cda:precondition
0 … *MAY contain zero or more [0..*] precondition (CONF:X-X).AdvadotsonV1
sdtc:precondition2
0 … *MAY contain zero or more [0..*] sdtc:precondition2 (CONF:X-X).AdvadotsonV1
sdtc:inFulfillmentOf1
0 … *MAY contain zero or more [0..*] sdtc:inFulfillmentOf1 (CONF:X-X).AdvadotsonV1