Id2.16.840.1.113883.10.20.22.4.48Effective Date2015‑08‑01
Statusdraft DraftVersion Label2.1
NameAdvanceDirectiveObservationV3Display NameAdvance Directive Observation (V3)
Description
This clinical statement represents Advance Directive Observation findings (e.g., “resuscitation status is Full Code”) rather than orders. It should not be considered a legal document or a substitute for the actual Advance Directive document. The related legal documents are referenced using the reference/externalReference element. The Advance Directive Observation describes the patient’s directives, including but not limited to: • Medications • Transfer of Care to Hospital • Treatment • Procedures • Intubation and Ventilation • Diagnostic Tests • Tests The observation/value element contains the detailed patient directive which may be coded or text. For example, a category directive may be antibiotics, and the details would be intravenous antibiotics only.  
ContextParent nodes of template element with id 2.16.840.1.113883.10.20.22.4.48
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Used by / Uses
Used by 6 transactions and 12 templates, Uses 3 templates
Used by as NameVersion
2.16.840.1.113883.3.1937.99.3.4.31Transactionfinal Transfer Summary (V2)2015‑08‑01
2.16.840.1.113883.3.1937.99.3.4.29Transactionfinal Progress Note (V3)2015‑08‑01
2.16.840.1.113883.3.1937.99.3.4.22Transactionfinal Consultation Note (V3)2015‑08‑01
2.16.840.1.113883.3.1937.99.3.4.23Transactionfinal Continuity of Care Document (CCD) (V3)2015‑08‑01
2.16.840.1.113883.3.1937.99.3.4.30Transactionfinal Referral Note (V2)2015‑08‑01
2.16.840.1.113883.3.1937.99.3.4.21Transactionfinal Care Plan (V2)2015‑08‑01
2.16.840.1.113883.10.20.21.2.3linkdraft Interventions Section (V3) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.1.2linkdraft Continuity of Care Document (CCD) (V3) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.1.4linkdraft Consultation Note (V3) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.1.9linkdraft Progress Note (V3) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.1.13linkdraft Transfer Summary (V2) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.1.14linkdraft Referral Note (V2) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.1.15linkdraft Care Plan (V2) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.2.21Containmentdraft Advance Directives Section (entries optional) (V3) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.2.21.1Includedraft Advance Directives Section (entries required) (V3) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.4.108Containmentdraft Advance Directive Organizer (V2) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.4.131Containmentdraft Intervention Act (V2) (2.1)2015‑08‑01
2.16.840.1.113883.10.20.22.4.146linkdraft Planned Intervention Act (V2) (2.1)2015‑08‑01
Uses as NameVersion
2.16.840.1.113883.10.20.22.4.119Containmentdraft Author Participation (2.1)2015‑08‑13
2.16.840.1.113883.10.20.22.5.1.1Containmentdraft US Realm Person Name (PN.US.FIELDED) (2.1)2015‑08‑13
2.16.840.1.113883.10.20.22.5.2Includedraft US Realm Address (AD.US.FIELDED) (2.1)2015‑08‑13
RelationshipSpecialization: template 2.16.840.1.113883.10.12.303 CDA Observation (2005‑09‑07)
ref
ad1bbr-

Version: template 2.16.840.1.113883.10.20.22.4.48 Advance Directive Observation (2013‑01‑31)
ItemDTCardConfDescriptionLabel
cda:observation
AdvadotsonV3
@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.