Id2.16.840.1.113883.10.20.22.4.61Effective Date2013‑01‑31
Statusdraft DraftVersion Label1.1
NamePolicyActivityDisplay NamePolicy Activity
Description
A policy activity represents the policy or program providing the coverage. The person for whom payment is being provided (i.e., the patient) is the covered party. The subscriber of the policy or program is represented as a participant that is the holder the coverage. The payer is represented as the performer of the policy activity.
ContextParent nodes of template element with id 2.16.840.1.113883.10.20.22.4.61
ClassificationCDA Entry Level Template
Open/ClosedOpen (other than defined elements are allowed)
Used by / Uses
Used by 1 transaction and 3 templates, Uses 0 templates
Used by as NameVersion
2.16.840.1.113883.3.1937.99.3.4.1Transactionfinal Continuity of Care Document (CCD) (Release 1.1)2013‑01‑31
2.16.840.1.113883.10.20.22.1.2linkdraft Continuity of Care Document (CCD) (1.1)2013‑01‑31
2.16.840.1.113883.10.20.22.2.18linkdraft Payers Section (1.1)2013‑01‑31
2.16.840.1.113883.10.20.22.4.60Containmentdraft Coverage Activity (1.1)2013‑01‑31
ItemDTCardConfDescriptionLabel
cda:act
Polidotsvity
@classCode
cs1 … 1FACTconf‑8898
@moodCode
cs1 … 1FEVNconf‑8899
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:8900) such that itconf‑8900
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.61confdots0516
cda:id
II1 … *RSHALL contain at least one [1..*] id (CONF:8901).conf‑8901
cda:code
CD1 … 1RSHALL contain exactly one [1..1] code (CONF:8903).conf‑8903
cda:statusCode
CS1 … 1MSHALL contain exactly one [1..1] statusCode (CONF:8902).conf‑8902
@code
CONF1 … 1Fcompleted
cda:performer
1 … 1MSHALL contain exactly one [1..1] performer (CONF:8906) such that itconf‑8906
where [cda:templateId/@root='2.16.840.1.113883.10.20.22.4.87']
@typeCode
cs1 … 1FPRFconf‑8907
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:16808).confdots6808
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.87confdots6809
cda:assignedEntity
1 … 1MSHALL contain exactly one [1..1] assignedEntity (CONF:8908).conf‑8908
cda:id
II1 … *RThis assignedEntity SHALL contain at least one [1..*] id (CONF:8909).conf‑8909
cda:code
CE0 … 1RThis assignedEntity SHOULD contain zero or one [0..1] code (CONF:8914).conf‑8914
cda:addr
AD0 … 1This assignedEntity MAY contain zero or one [0..1] addr (CONF:8910).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)		conf‑8910
 Schematron assertrolered error 
 testcda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode)) 
 MessageThe content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2) 
cda:telecom
TEL0 … 1This assignedEntity MAY contain zero or one [0..1] telecom (CONF:8911).conf‑8911
cda:representedOrganization
0 … 1RThis assignedEntity SHOULD contain zero or one [0..1] representedOrganization (CONF:8912).conf‑8912
cda:name
0 … 1RThe representedOrganization, if present, SHOULD contain zero or one [0..1] name (CONF:8913).conf‑8913
cda:performer
0 … 1RSHOULD contain zero or one [0..1] performer="PRF" Performer (CodeSystem: HL7ParticipationType 2.16.840.1.113883.5.90 STATIC) (CONF:8961) such that itconf‑8961
where [cda:templateId/@root='2.16.840.1.113883.10.20.22.4.88']
@typeCode
cs0 … 1FPRFCONF:8961
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:16810).confdots6810
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.88confdots6811
cda:time
0 … 1RSHOULD contain zero or one [0..1] time (CONF:8963).conf‑8963
cda:assignedEntity
1 … 1MSHALL contain exactly one [1..1] assignedEntity (CONF:8962).

SHOULD include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name		conf‑8962
cda:code
CE1 … 1MThis assignedEntity SHALL contain exactly one [1..1] code (CONF:8968).
This code SHALL contain exactly one [1..1] @code="GUAR" Guarantor (CodeSystem: RoleClass 2.16.840.1.113883.5.110) (CONF:16096).
conf‑8968
@code
CONF1 … 1FGUAR
@codeSystem
1 … 1F2.16.840.1.113883.5.110
cda:addr
AD0 … 1RThis assignedEntity SHOULD contain zero or one [0..1] addr (CONF:8964).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)		conf‑8964
 Schematron assertrolered error 
 testcda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode)) 
 MessageThe content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2) 
cda:telecom
TEL0 … 1RThis assignedEntity SHOULD contain zero or one [0..1] telecom (CONF:8965).conf‑8965
 Schematron assertrolered error 
 testcda:assignedPerson/cda:name | cda:representedOrganization/cda:name 
 MessageSHOULD include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name 
cda:participant
1 … 1MSHALL contain exactly one [1..1] participant (CONF:8916) such that itconf‑8916
where [@typeCode='COV']
@typeCode
cs1 … 1FCOVconf‑8917
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:16812).confdots6812
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.89confdots6814
cda:time
0 … 1RSHOULD contain zero or one [0..1] time (CONF:8918).conf‑8918
cda:low
0 … 1RThe time, if present, SHOULD contain zero or one [0..1] low (CONF:8919).conf‑8919
cda:high
0 … 1RThe time, if present, SHOULD contain zero or one [0..1] high (CONF:8920).conf‑8920
cda:participantRole
1 … 1MSHALL contain exactly one [1..1] participantRole (CONF:8921).conf‑8921
cda:id
II1 … *RThis participantRole SHALL contain at least one [1..*] id (CONF:8922).

This id is a unique identifier for the covered party member. Implementers SHOULD use the same GUID for each instance of a member identifier from the same health plan		conf‑8922
cda:code
CD1 … 1RThis participantRole SHALL contain exactly one [1..1] code (CONF:8923).conf‑8923
cda:addr
AD0 … 1RThis participantRole SHOULD contain zero or one [0..1] addr (CONF:8956).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)		conf‑8956
 Schematron assertrolered error 
 testcda:streetAddressLine and cda:city and (cda:country!='US' or ((not(cda:country) or cda:country!='US') and cda:state and cda:postalCode)) 
 MessageThe content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2) 
cda:playingEntity
0 … 1RThis participantRole SHOULD contain zero or one [0..1] playingEntity (CONF:8932).

If the member date of birth as recorded by the health plan differs from the patient date of birth as recorded in the registration/medication summary, then the member date of birth SHALL be recorded in sdtc:birthTime. The prefix sdtc: SHALL be bound to the namespace “urn:hl7-org:sdtc”. The use of the namespace provides a necessary extension to CDA R2 for the use of the birthTime element.		conf‑8932
cda:name
1 … *RThe playingEntity, if present, SHALL contain at least one [1..*] name (CONF:8930).
conf‑8930
sdtc:birthTime
TS0 … 1conf‑8932
cda:participant
0 … 1RSHOULD contain zero or one [0..1] participant (CONF:8934) such that it

When the Subscriber is the patient, the participant element describing the subscriber SHALL NOT be present. This information will be recorded instead in the data elements used to record member information		conf‑8934
where [@typeCode='HLD']
@typeCode
cs1 … 1FHLDconf‑8935
cda:templateId
II1 … 1MSHALL contain exactly one [1..1] templateId (CONF:16813).confdots6813
@root
uid1 … 1F2.16.840.1.113883.10.20.22.4.90confdots6815
cda:time
0 … 1MAY contain zero or one [0..1] time (CONF:8938).conf‑8938
cda:participantRole
1 … 1MSHALL contain exactly one [1..1] participantRole (CONF:8936).conf‑8936
cda:id
II1 … *RThis participantRole SHALL contain at least one [1..*] id (CONF:8937).

This id is a unique identifier for the subscriber of the coverage		conf‑8937
cda:addr
AD0 … 1RThis participantRole SHOULD contain zero or one [0..1] addr (CONF:8925).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)		conf‑8925
 Schematron assertrolered error 
 testcda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode)) 
 MessageThe content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2) 
cda:entryRelationship
1 … *MSHALL contain at least one [1..*] entryRelationship (CONF:8939) such that it

The target of a policy activity with act/entryRelationship/@typeCode="REFR" SHALL be an authorization activity (templateId 2.16.840.1.113883.10.20.1.19) OR an act, with act[@classCode="ACT"] and act[@moodCode="DEF"], representing a description of the coverage plan

A description of the coverage plan SHALL contain one or more act/id, to represent the plan identifier, and an act/text with the name of the plan		conf‑8939
@typeCode
cs1 … 1FREFRconf‑8940