| Item | DT | Card | Conf | Description | Label |
|---|
cda:act
| | | | | Poli tyV3 |
@classCode
| cs | 1 … 1 | F | ACT | CONF8898 |
| | SHALL contain exactly one [1..1] @classCode="ACT" Act (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-8898). |
@moodCode
| cs | 1 … 1 | F | EVN | CONF8899 |
| | SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-8899). |
cda:templateId
| II | 1 … 1 | M | C-CDA R1.1 templateId root without an extension | CONF2936 |
@root
| uid | 1 … 1 | F | 2.16.840.1.113883.10.20.22.4.61 |
cda:templateId
| II | 1 … 1 | M | SHALL contain exactly one [1..1] templateId (CONF:1198-8900) such that it | CONF8900 |
@root
| uid | 1 … 1 | F | 2.16.840.1.113883.10.20.22.4.61 | CONF0516 |
| | SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.61" (CONF:1198-10516). |
@extension
| st | 1 … 1 | F | 2015-08-01 | CONF2595 |
| | SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32595). |
cda:id
| II | 1 … * | | SHALL contain at least one [1..*] id (CONF:1198-8901). This id is a unique identifier for the policy or program providing the coverage | CONF8901 |
cda:code
| CD (extensible) | 1 … 1 | | SHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet Health Insurance Type urn:oid:2.16.840.1.113883.3.88.12.3221.5.2 DYNAMIC (CONF:1198-8903). | CONF8903 |
| | CONF | |
cda:translation
| (extensible) | 1 … * | | This code SHALL contain at least one [1..*] translation, which SHOULD be selected from ValueSet Payer urn:oid:2.16.840.1.114222.4.11.3591 (CONF:1198-32852). | CONF2852 |
| | CONF | |
cda:statusCode
| CS | 1 … 1 | M | SHALL contain exactly one [1..1] statusCode (CONF:1198-8902). | CONF8902 |
@code
| CONF | 1 … 1 | F | completed |
cda:performer
| | 1 … 1 | M | SHALL contain exactly one [1..1] performer (CONF:1198-8906) such that it This performer represents the Payer. | CONF8906 |
| where [cda:templateId/@root='2.16.840.1.113883.10.20.22.4.87'] | |
@typeCode
| cs | 1 … 1 | F | PRF | CONF8907 |
| | SHALL contain exactly one [1..1] @typeCode="PRF" Performer (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8907). |
cda:templateId
| II | 1 … 1 | M | SHALL contain exactly one [1..1] templateId (CONF:1198-16808). | CONF6808 |
@root
| uid | 1 … 1 | F | 2.16.840.1.113883.10.20.22.4.87 | CONF6809 |
| | This templateId SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.87" Payer Performer (CONF:1198-16809). |
cda:assignedEntity
| | 1 … 1 | M | | CONF8908 |
cda:id
| II | 1 … * | | This assignedEntity SHALL contain at least one [1..*] id (CONF:1198-8909). | CONF8909 |
cda:code
| CE | 0 … 1 | R | | CONF8914 |
cda:addr
| AD | 0 … 1 | R | This assignedEntity MAY contain zero or one [0..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-8910). | CONF8910 |
| Included | | | from 2.16.840.1.113883.10.20.22.5.2 US Realm Address (AD.US.FIELDED) (2015‑08‑13) |
cda:addr
| | | | | USReLDED |
@nullFlavor
| cs | 0 … 1 | | |
@use
| set_cs | 0 … 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). | CONF7290 |
| | CONF | |
| | Constraint | *SHALL NOT* have mixed content except for white space |
| | Constraint | If 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
| ADXP | 0 … 1 | R | SHOULD 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). | CONF7295 |
| | CONF | |
cda:state
| ADXP | 0 … 1 | R | SHOULD 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). | CONF7293 |
| | Constraint | State 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 | |
| | Schematron assert | role |  error | |
| | test | @nullFlavor or (cda:country='US' and cda:state) or (cda:country!='US') or (not(cda:country) and cda:state) | |
| | Message | State 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
| ADXP | 1 … 1 | R | SHALL contain exactly one [1..1] city (CONF:81-7292). | CONF7292 |
cda:postalCode
| ADXP | 0 … 1 | R | SHOULD 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).
| CONF7294 |
| | Constraint | If 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 | |
| | Schematron assert | role | error | |
| | test | @nullFlavor or (cda:country='US' and cda:postalCode) or (cda:country!='US') or (not(cda:country) and cda:postalCode) | |
| | Message | If 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
| ADXP | 1 … 4 | R | | CONF7291 |
| | Schematron assert | role | error | |
| | test | @nullFlavor or (count(cda:streetAddressLine) > 0 and count(cda:streetAddressLine) < 5) | |
| | Message | SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291) | |
| | Schematron assert | role | error | |
| | test | @nullFlavor or (cda:city and cda:streetAddressLine) | |
| | Message | | |
cda:telecom
| TEL | 0 … * | | This assignedEntity MAY contain zero or more [0..*] telecom (CONF:1198-8911). | CONF8911 |
cda:representedOrganization
| | 0 … 1 | R | | CONF8912 |
| | Schematron assert | role | error | |
| | test | cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.87']]/cda:assignedEntity[count(cda:representedOrganization) < 2] | |
| | Message | This assignedEntity SHOULD contain zero or one [0..1] representedOrganization (CONF:1198-8912). | |
cda:name
| | 0 … 1 | R | The representedOrganization, if present, SHOULD contain zero or one [0..1] name (CONF:1198-8913). | CONF8913 |
cda:performer
| | 0 … * | R | SHOULD contain zero or more [0..*] performer="PRF" Performer (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8961) such that it This performer represents the Guarantor. | CONF8961 |
| where [cda:templateId/@root='2.16.840.1.113883.10.20.22.4.88'] | |
@typeCode
| cs | 0 … 1 | F | PRF | CONF8961 |
cda:templateId
| II | 1 … 1 | M | SHALL contain exactly one [1..1] templateId (CONF:1198-16810). | CONF6810 |
@root
| uid | 1 … 1 | F | 2.16.840.1.113883.10.20.22.4.88 | CONF6811 |
| | This templateId SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.88" Guarantor Performer (CONF:1198-16811). |
cda:time
| | 0 … 1 | R | SHOULD contain zero or one [0..1] time (CONF:1198-8963). | CONF8963 |
cda:assignedEntity
| | 1 … 1 | M | | CONF8962 |
cda:code
| CE | 1 … 1 | M | This assignedEntity SHALL contain exactly one [1..1] code (CONF:1198-8968). | CONF8968 |
@code
| CONF | 1 … 1 | F | GUAR |
@codeSystem
| 1 … 1 | F | 2.16.840.1.113883.5.110 |
cda:addr
| AD | 0 … 1 | R | This assignedEntity SHOULD contain zero or one [0..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-8964). | CONF8964 |
| Included | | | from 2.16.840.1.113883.10.20.22.5.2 US Realm Address (AD.US.FIELDED) (2015‑08‑13) |
cda:addr
| | | | | USReLDED |
@nullFlavor
| cs | 0 … 1 | | |
@use
| set_cs | 0 … 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). | CONF7290 |
| | CONF | |
| | Constraint | *SHALL NOT* have mixed content except for white space |
| | Constraint | If 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
| ADXP | 0 … 1 | R | SHOULD 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). | CONF7295 |
| | CONF | |
cda:state
| ADXP | 0 … 1 | R | SHOULD 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). | CONF7293 |
| | Constraint | State 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 | |
| | Schematron assert | role | error | |
| | test | @nullFlavor or (cda:country='US' and cda:state) or (cda:country!='US') or (not(cda:country) and cda:state) | |
| | Message | State 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
| ADXP | 1 … 1 | R | SHALL contain exactly one [1..1] city (CONF:81-7292). | CONF7292 |
cda:postalCode
| ADXP | 0 … 1 | R | SHOULD 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).
| CONF7294 |
| | Constraint | If 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 | |
| | Schematron assert | role | error | |
| | test | @nullFlavor or (cda:country='US' and cda:postalCode) or (cda:country!='US') or (not(cda:country) and cda:postalCode) | |
| | Message | If 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
| ADXP | 1 … 4 | R | | CONF7291 |
| | Schematron assert | role | error | |
| | test | @nullFlavor or (count(cda:streetAddressLine) > 0 and count(cda:streetAddressLine) < 5) | |
| | Message | SHALL contain at least one and not more than 4 streetAddressLine (CONF:81-7291) | |
| | Schematron assert | role | error | |
| | test | @nullFlavor or (cda:city and cda:streetAddressLine) | |
| | Message | | |
cda:telecom
| TEL | 0 … * | R | This assignedEntity SHOULD contain zero or more [0..*] telecom (CONF:1198-8965). | CONF8965 |
| | Schematron assert | role | error | |
| | test | cda:assignedPerson/cda:name | cda:representedOrganization/cda:name | |
| | Message | *SHOULD* include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name | |
cda:participant
| | 1 … 1 | M | SHALL contain exactly one [1..1] participant (CONF:1198-8916) such that it | CONF8916 |
| where [@typeCode='COV'] | |
@typeCode
| cs | 1 … 1 | F | COV | CONF8917 |
| | SHALL contain exactly one [1..1] @typeCode="COV" Coverage target (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8917). |
cda:templateId
| II | 1 … 1 | M | SHALL contain exactly one [1..1] templateId (CONF:1198-16812). | CONF6812 |
@root
| uid | 1 … 1 | F | 2.16.840.1.113883.10.20.22.4.89 | CONF6814 |
| | This templateId SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.89" Covered Party Participant (CONF:1198-16814). |
cda:time
| | 0 … 1 | R | SHOULD contain zero or one [0..1] time (CONF:1198-8918). | CONF8918 |
cda:low
| | 0 … 1 | R | The time, if present, SHOULD contain zero or one [0..1] low (CONF:1198-8919). | CONF8919 |
cda:high
| | 0 … 1 | R | The time, if present, SHOULD contain zero or one [0..1] high (CONF:1198-8920). | CONF8920 |
cda:participantRole
| | 1 … 1 | M | SHALL contain exactly one [1..1] participantRole (CONF:1198-8921). | CONF8921 |
cda:id
| II | 1 … * | | This participantRole SHALL contain at least one [1..*] id (CONF:1198-8922). | CONF8922 |
| | Constraint | 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 |
cda:code
| CD | 1 … 1 | | This participantRole SHALL contain exactly one [1..1] code (CONF:1198-8923). | CONF8923 |
cda:addr
| AD | 0 … 1 | R | This participantRole SHOULD contain zero or one [0..1] addr (CONF:1198-8956). | CONF8956 |
| | Schematron assert | role | error | |
| | test | cda:addr[cda:streetAddressLine and cda:city and (cda:country!='US' or ((not(cda:country) or cda:country!='US') and cda:state and cda:postalCode))] | |
| | Message | The 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 … 1 | R | | CONF8932 |
cda:name
| | 1 … * | R | The playingEntity, if present, SHALL contain at least one [1..*] name (CONF:1198-8930). If the covered party’s name is recorded differently in the health plan and in the registration/pharmacy benefit summary (due to marriage or for other reasons), use the name as it is recorded in the health plan. | CONF8930 |
sdtc:birthTime
| TS | 1 … 1 | R | The playingEntity, if present, SHALL contain exactly one [1..1] sdtc:birthTime (CONF:1198-31344). If the covered party’s date of birth is recorded differently in the health plan and in the registration/pharmacy benefit summary, use the date of birth as it is recorded in the health plan. | CONF1344 |
| | Constraint | 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. |
cda:participant
| | 0 … 1 | R | SHOULD contain zero or one [0..1] participant (CONF:1198-8934) 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. | CONF8934 |
| where [@typeCode='HLD'] | |
@typeCode
| cs | 1 … 1 | F | HLD | CONF8935 |
| | SHALL contain exactly one [1..1] @typeCode="HLD" Holder (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198-8935). |
| | Constraint | 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 |
cda:templateId
| II | 1 … 1 | M | SHALL contain exactly one [1..1] templateId (CONF:1198-16813). | CONF6813 |
@root
| uid | 1 … 1 | F | 2.16.840.1.113883.10.20.22.4.90 | CONF6815 |
| | This templateId SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.90" Policy Holder Participant (CONF:1198-16815). |
cda:time
| | 0 … 1 | | MAY contain zero or one [0..1] time (CONF:1198-8938). | CONF8938 |
cda:participantRole
| | 1 … 1 | M | SHALL contain exactly one [1..1] participantRole (CONF:1198-8936). | CONF8936 |
cda:id
| II | 1 … * | | This participantRole SHALL contain at least one [1..*] id (CONF:1198-8937). | CONF8937 |
| | Constraint | This id is a unique identifier for the subscriber of the coverage |
cda:addr
| AD | 0 … 1 | R | This participantRole SHOULD contain zero or one [0..1] addr (CONF:1198-8925). | CONF8925 |
| | Schematron assert | role | error | |
| | test | cda:addr[cda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode))] | |
| | Message | The 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 … * | M | SHALL contain at least one [1..*] entryRelationship (CONF:1198-8939) such that it | CONF8939 |
@typeCode
| cs | 1 … 1 | F | REFR | CONF8940 |
| | SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8940). |
| | Constraint | 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. |
Draft
Transfer Summary (V2)