Consolidated CDA
3.0.0-ballot - ballot
Consolidated CDA
3.0.0-ballot - ballot
Publication Build: This will be filled in by the publication tooling
//
Title: Consultation Note
Filename: C-CDA_R2_Consultation_Note.xml
Created by: Lantana Consulting Group, LLC
$LastChangedDate: 2014-11-12 23:25:09 -0500 (Wed, 12 Nov 2014) $
********************************************************
Disclaimer: This sample file contains representative data elements to represent a Consultation Note.
The file depicts a fictional character's health data. Any resemblance to a real person is coincidental.
To illustrate as many data elements as possible, the clinical scenario may not be plausible.
The data in this sample file is not intended to represent real patients, people or clinical events.
This sample is designed to be used in conjunction with the C-CDA Clinical Notes Implementation Guide.
********************************************************
{
"resourceType" : "ClinicalDocument",
"realmCode" : [
// ** CDA Header **
{
"code" : "US"
}
],
"typeId" : {
"extension" : "POCD_HD000040",
"root" : "2.16.840.1.113883.1.3"
},
"templateId" : [
// Identifies document as conformant to US Realm Header (V2) Template
{
"extension" : "2023-05-01",
"root" : "2.16.840.1.113883.10.20.22.1.1"
},
{
"extension" : "2015-08-01",
"root" : "2.16.840.1.113883.10.20.22.1.4"
}
],
"id" : // Consultation Note V2
{
"extension" : "TT988",
"root" : "2.16.840.1.113883.19.5.99999.1"
},
"code" : {
"code" : "11488-4",
"codeSystem" : "2.16.840.1.113883.6.1",
"codeSystemName" : "LOINC",
"displayName" : "Consultation Note"
},
"title" : {
"xmlText" : "Community Health Consult Note"
},
"effectiveTime" : {
"value" : "2013-08-01T05:00:00-08:00"
},
"confidentialityCode" : {
"code" : "N",
"codeSystem" : "2.16.840.1.113883.5.25"
},
"languageCode" : {
"code" : "en-US"
},
"setId" : {
"extension" : "sTT988",
"root" : "2.16.840.1.113883.19.5.99999.19"
},
"versionNumber" : {
"value" : 1
},
"recordTarget" : [
{
"patientRole" : {
"id" : [
// Example Social Security Number using the actual SSN OID.
{
"extension" : "444-22-2222",
"root" : "2.16.840.1.113883.4.1"
}
],
"addr" : [
// HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119
{
"use" : [
"HP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "2222 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "97867"
}
},
{
"country" : // US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1
{
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
// HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119
{
"use" : [
"HP"
],
"value" : "tel:+1(555)555-2003"
}
],
"patient" : {
"name" : [
// The first name element represents what the patient is known as
{
"use" : [
"L"
],
"item" : [
{
"given" : [
{
"xmlText" : "Eve"
}
]
},
{
"family" : [
{
"xmlText" : "Betterhalf",
"qualifier" : [
"SP"
]
}
]
}
]
},
{
"use" : [
"SRCH"
],
"item" : [
{
"given" : [
{
"xmlText" : "Eve"
}
]
},
{
"family" : [
{
"xmlText" : "Everywoman",
"qualifier" : [
"BR"
]
}
]
}
]
}
],
"administrativeGenderCode" : // The second name element represents another name associated with the patient
{
"code" : "F",
"codeSystem" : "2.16.840.1.113883.5.1",
"codeSystemName" : "AdministrativeGender",
"displayName" : "Female"
},
"birthTime" : // Date of birth need only be precise to the day
{
"value" : "1975-05-01"
},
"maritalStatusCode" : {
"code" : "M",
"codeSystem" : "2.16.840.1.113883.5.2",
"codeSystemName" : "MaritalStatusCode",
"displayName" : "Married"
},
"religiousAffiliationCode" : {
"code" : "1013",
"codeSystem" : "2.16.840.1.113883.5.1076",
"codeSystemName" : "HL7 Religious Affiliation",
"displayName" : "Christian (non-Catholic, non-specific)"
},
"raceCode" : // CDC Race and Ethnicity code set contains the five minimum race and ethnicity
categories defined by OMB Standards
{
"code" : "2106-3",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "White"
},
"sdtcRaceCode" : [
// The raceCode extension is only used if raceCode is valued
{
"code" : "2076-8",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "Hawaiian or Other Pacific Islander"
}
],
"ethnicGroupCode" : {
"code" : "2186-5",
"codeSystem" : "2.16.840.1.113883.6.238",
"codeSystemName" : "Race & Ethnicity - CDC",
"displayName" : "Not Hispanic or Latino"
},
"guardian" : [
{
"code" : {
"code" : "POWATT",
"codeSystem" : "2.16.840.1.113883.1.11.19830",
"codeSystemName" : "ResponsibleParty",
"displayName" : "Power of Attorney"
},
"addr" : [
{
"use" : [
"HP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "2222 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "97867"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"MC"
],
"value" : "tel:+1(555)555-2008"
}
],
"guardianPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Boris"
}
]
},
{
"given" : [
{
"xmlText" : "Bo",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Betterhalf"
}
]
}
]
}
]
}
}
],
"birthplace" : {
"place" : {
"addr" : {
"item" : [
{
"streetAddressLine" : {
"xmlText" : "4444 Home Street"
}
},
{
"city" : {
"xmlText" : "Beaverton"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "97867"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
}
},
"languageCommunication" : [
{
"languageCode" : {
"code" : "en"
},
"modeCode" : {
"code" : "ESP",
"codeSystem" : "2.16.840.1.113883.5.60",
"codeSystemName" : "LanguageAbilityMode",
"displayName" : "Expressed spoken"
},
"proficiencyLevelCode" : {
"code" : "G",
"codeSystem" : "2.16.840.1.113883.5.61",
"codeSystemName" : "LanguageAbilityProficiency",
"displayName" : "Good"
},
"preferenceInd" : // Patient's preferred language
{
"value" : true
}
}
]
},
"providerOrganization" : {
"id" : [
// Organizations SHOULD have an NPI; this is a real root; fake extension
{
"extension" : "219BX",
"root" : "2.16.840.1.113883.4.6"
}
],
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsTogether Physician Group"
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel: +1(555)555-5000"
}
],
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Health Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
]
}
}
}
],
"author" : [
{
"time" : {
"value" : "2013-07-31"
},
"assignedAuthor" : {
"id" : [
{
"extension" : "555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine"
},
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Patricia"
}
]
},
{
"given" : [
{
"xmlText" : "Patty",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Primary"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
}
],
"dataEnterer" : {
"assignedEntity" : {
"id" : [
{
"extension" : "333777777",
"root" : "2.16.840.1.113883.4.6"
}
],
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)-1050"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Ellen"
}
]
},
{
"family" : [
{
"xmlText" : "Enter"
}
]
}
]
}
]
}
}
},
"informant" : [
{
"assignedEntity" : {
"id" : [
{
"extension" : "888888888",
"root" : "2.16.840.1.113883.19.5"
}
],
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1007 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)-1003"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Harold"
}
]
},
{
"family" : [
{
"xmlText" : "Hippocrates"
}
]
},
{
"suffix" : [
{
"xmlText" : "D.O.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
}
],
"custodian" : {
"assignedCustodian" : {
"representedCustodianOrganization" : {
"id" : [
{
"extension" : "321CX",
"root" : "2.16.840.1.113883.4.6"
}
],
"name" : {
"item" : [
{
"xmlText" : "Good Health HIE"
}
]
},
"telecom" : {
"use" : [
"WP"
],
"value" : "tel:+1(555)-1009"
},
"addr" : {
"use" : [
"WP"
],
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1009 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
}
}
},
"informationRecipient" : [
{
"intendedRecipient" : {
"informationRecipient" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Sara"
}
]
},
{
"family" : [
{
"xmlText" : "Specialize"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
},
"receivedOrganization" : {
"name" : [
{
"item" : [
{
"xmlText" : "The DoctorsApart Physician Group"
}
]
}
]
}
}
}
],
"legalAuthenticator" : {
"time" : {
"value" : "2013-08-01T22:36:15-08:00"
},
"signatureCode" : {
"code" : "S"
},
"assignedEntity" : {
"id" : [
{
"extension" : "555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine"
},
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Patricia"
}
]
},
{
"given" : [
{
"xmlText" : "Patty",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Primary"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
},
"authenticator" : [
{
"time" : {
"value" : "2013-08-01T10:30:00-08:00"
},
"signatureCode" : {
"code" : "S"
},
"assignedEntity" : {
"id" : [
{
"extension" : "555555555",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "207QA0505X",
"codeSystem" : "2.16.840.1.113883.6.101",
"codeSystemName" : "Healthcare Provider Taxonomy (HIPAA)",
"displayName" : "Adult Medicine"
},
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1004 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Portland"
}
},
{
"state" : {
"xmlText" : "OR"
}
},
{
"postalCode" : {
"xmlText" : "99123"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:+1(555)-1004"
}
],
"assignedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Patricia"
}
]
},
{
"given" : [
{
"xmlText" : "Patty",
"qualifier" : [
"CL"
]
}
]
},
{
"family" : [
{
"xmlText" : "Primary"
}
]
},
{
"suffix" : [
{
"xmlText" : "M.D.",
"qualifier" : [
"AC"
]
}
]
}
]
}
]
}
}
}
],
"participant" : [
// This participant represents the person to contact for questions about the consult summary
{
"typeCode" : "CALLBCK",
"time" : {
"value" : "2005-03-29T22:44:11+05:00"
},
"associatedEntity" : {
"classCode" : "ASSIGNED",
"id" : [
{
"extension" : "99999999",
"root" : "2.16.840.1.113883.4.6"
}
],
"code" : {
"code" : "200000000X",
"codeSystem" : "2.16.840.1.113883.6.101",
"displayName" : "Allopathic & Osteopathic Physicians"
},
"addr" : [
{
"item" : [
{
"streetAddressLine" : {
"xmlText" : "1002 Healthcare Drive"
}
},
{
"city" : {
"xmlText" : "Ann Arbor"
}
},
{
"state" : {
"xmlText" : "MI"
}
},
{
"postalCode" : {
"xmlText" : "97857"
}
},
{
"country" : {
"xmlText" : "US"
}
}
]
}
],
"telecom" : [
{
"use" : [
"WP"
],
"value" : "tel:555-555-1002"
}
],
"associatedPerson" : {
"name" : [
{
"item" : [
{
"given" : [
{
"xmlText" : "Henry"
}
]
},
{
"family" : [
{
"xmlText" : "Seven"
}
]
},
{
"suffix" : [
{
"xmlText" : "DO"
}
]
}
]
}
]
}
}
}
],
"inFulfillmentOf" : [
// Describes prior orders that are fulfilled (in whole or part) by the service events described in the Consultation Note
{
"typeCode" : "FLFS",
"order" : {
"classCode" : "ACT",
"moodCode" : "RQO",
"id" : [
{
"extension" : "1298989898",
"root" : "2.16.840.1.113883.6.96"
}
],
"code" : {
"code" : "388975008",
"codeSystem" : "2.16.840.1.113883.6.96",
"codeSystemName" : "SNOMED CT",
"displayName" : "Weight Reduction Consultation"
}
}
}
],
"componentOf" : {
"encompassingEncounter" : {
"id" : [
{
"extension" : "9937012",
"root" : "2.16.840.1.113883.19"
}
],
"code" : {
"code" : "99213",
"codeSystem" : "2.16.840.1.113883.6.12",
"codeSystemName" : "CPT-4",
"displayName" : "Evaluation and Management"
},
"effectiveTime" : {
"low" : {
"value" : "2013-07-31"
},
"high" : {
"value" : "2013-07-31"
}
},
"location" : {
"healthCareFacility" : {
"id" : [
{
"root" : "2.16.540.1.113883.19.2"
}
]
}
}
}
},
"component" : //
*******************************************************
CDA Body
*******************************************************
{
}
}
IG © 2019+ Health Level Seven. Package hl7.cda.us.ccda#3.0.0-ballot based on FHIR 5.0.0. Generated 2023-12-21
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