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.
********************************************************
-->
<ClinicalDocument xmlns="urn:hl7-org:v3">
<!-- ** CDA Header ** -->
<realmCode code="US"/>
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<!-- Identifies document as conformant to US Realm Header (V2) Template -->
<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2023-05-01"/>
<!-- Consultation Note V2 -->
<templateId root="2.16.840.1.113883.10.20.22.1.4" extension="2015-08-01"/>
<id root="2.16.840.1.113883.19.5.99999.1" extension="TT988"/>
<code displayName="Consultation Note" codeSystemName="LOINC"
codeSystem="2.16.840.1.113883.6.1" code="11488-4"/>
<title>Community Health Consult Note</title>
<effectiveTime value="20130801050000-0800"/>
<confidentialityCode codeSystem="2.16.840.1.113883.5.25" code="N"/>
<languageCode code="en-US"/>
<setId root="2.16.840.1.113883.19.5.99999.19" extension="sTT988"/>
<versionNumber value="1"/>
<recordTarget>
<patientRole>
<!-- Example Social Security Number using the actual SSN OID. -->
<id root="2.16.840.1.113883.4.1" extension="444-22-2222"/>
<!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
<addr use="HP">
<item>
<streetAddressLine>2222 Home Street</streetAddressLine>
</item>
<item>
<city>Beaverton</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>97867</postalCode>
</item>
<item>
<!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
<country>US</country>
</item>
</addr>
<!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
<telecom value="tel:+1(555)555-2003" use="HP"/>
<patient>
<!-- The first name element represents what the patient is known as -->
<name use="L">
<item>
<given>Eve</given>
</item>
<item>
<family qualifier="SP">Betterhalf</family>
</item>
</name>
<!-- The second name element represents another name associated with the patient -->
<name use="SRCH">
<item>
<given>Eve</given>
</item>
<item>
<family qualifier="BR">Everywoman</family>
</item>
</name>
<administrativeGenderCode displayName="Female"
codeSystemName="AdministrativeGender" codeSystem="2.16.840.1.113883.5.1"
code="F"/>
<!-- Date of birth need only be precise to the day -->
<birthTime value="19750501"/>
<maritalStatusCode displayName="Married"
codeSystemName="MaritalStatusCode" codeSystem="2.16.840.1.113883.5.2" code="M"/>
<religiousAffiliationCode
displayName="Christian (non-Catholic, non-specific)" codeSystemName="HL7 Religious Affiliation"
codeSystem="2.16.840.1.113883.5.1076" code="1013"/>
<!-- CDC Race and Ethnicity code set contains the five minimum race and ethnicity
categories defined by OMB Standards -->
<raceCode displayName="White"
codeSystemName="Race & Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" code="2106-3"/>
<!-- The raceCode extension is only used if raceCode is valued -->
<sdtc:sdtcRaceCode xmlns:sdtc="urn:hl7-org:sdtc"
displayName="Hawaiian or Other Pacific Islander" codeSystemName="Race & Ethnicity - CDC"
codeSystem="2.16.840.1.113883.6.238" code="2076-8"/>
<ethnicGroupCode displayName="Not Hispanic or Latino"
codeSystemName="Race & Ethnicity - CDC" codeSystem="2.16.840.1.113883.6.238" code="2186-5"/>
<guardian>
<code displayName="Power of Attorney"
codeSystemName="ResponsibleParty" codeSystem="2.16.840.1.113883.1.11.19830" code="POWATT"/>
<addr use="HP">
<item>
<streetAddressLine>2222 Home Street</streetAddressLine>
</item>
<item>
<city>Beaverton</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>97867</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
<telecom value="tel:+1(555)555-2008" use="MC"/>
<guardianPerson>
<name>
<item>
<given>Boris</given>
</item>
<item>
<given qualifier="CL">Bo</given>
</item>
<item>
<family>Betterhalf</family>
</item>
</name>
</guardianPerson>
</guardian>
<birthplace>
<place>
<addr>
<item>
<streetAddressLine>4444 Home Street</streetAddressLine>
</item>
<item>
<city>Beaverton</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>97867</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
</place>
</birthplace>
<languageCommunication>
<languageCode code="en"/>
<modeCode displayName="Expressed spoken"
codeSystemName="LanguageAbilityMode" codeSystem="2.16.840.1.113883.5.60" code="ESP"/>
<proficiencyLevelCode displayName="Good"
codeSystemName="LanguageAbilityProficiency" codeSystem="2.16.840.1.113883.5.61" code="G"/>
<!-- Patient's preferred language -->
<preferenceInd value="true"/>
</languageCommunication>
</patient>
<providerOrganization>
<!-- Organizations SHOULD have an NPI; this is a real root; fake extension -->
<id root="2.16.840.1.113883.4.6" extension="219BX"/>
<name>
<item>The DoctorsTogether Physician Group</item>
</name>
<telecom value="tel: +1(555)555-5000" use="WP"/>
<addr>
<item>
<streetAddressLine>1007 Health Drive</streetAddressLine>
</item>
<item>
<city>Portland</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>99123</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>
<author>
<time value="20130731"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.6" extension="555555555"/>
<code displayName="Adult Medicine"
codeSystemName="Healthcare Provider Taxonomy (HIPAA)" codeSystem="2.16.840.1.113883.6.101" code="207QA0505X"/>
<addr>
<item>
<streetAddressLine>1004 Healthcare Drive</streetAddressLine>
</item>
<item>
<city>Portland</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>99123</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
<telecom value="tel:+1(555)-1004" use="WP"/>
<assignedPerson>
<name>
<item>
<given>Patricia</given>
</item>
<item>
<given qualifier="CL">Patty</given>
</item>
<item>
<family>Primary</family>
</item>
<item>
<suffix qualifier="AC">M.D.</suffix>
</item>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<dataEnterer>
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="333777777"/>
<addr>
<item>
<streetAddressLine>1007 Healthcare Drive</streetAddressLine>
</item>
<item>
<city>Portland</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>99123</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
<telecom value="tel:+1(555)-1050" use="WP"/>
<assignedPerson>
<name>
<item>
<given>Ellen</given>
</item>
<item>
<family>Enter</family>
</item>
</name>
</assignedPerson>
</assignedEntity>
</dataEnterer>
<informant>
<assignedEntity>
<id root="2.16.840.1.113883.19.5" extension="888888888"/>
<addr>
<item>
<streetAddressLine>1007 Healthcare Drive</streetAddressLine>
</item>
<item>
<city>Portland</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>99123</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
<telecom value="tel:+1(555)-1003" use="WP"/>
<assignedPerson>
<name>
<item>
<given>Harold</given>
</item>
<item>
<family>Hippocrates</family>
</item>
<item>
<suffix qualifier="AC">D.O.</suffix>
</item>
</name>
</assignedPerson>
</assignedEntity>
</informant>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id root="2.16.840.1.113883.4.6" extension="321CX"/>
<name>
<item>Good Health HIE</item>
</name>
<telecom value="tel:+1(555)-1009" use="WP"/>
<addr use="WP">
<item>
<streetAddressLine>1009 Healthcare Drive</streetAddressLine>
</item>
<item>
<city>Portland</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>99123</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<informationRecipient>
<intendedRecipient>
<informationRecipient>
<name>
<item>
<given>Sara</given>
</item>
<item>
<family>Specialize</family>
</item>
<item>
<suffix qualifier="AC">M.D.</suffix>
</item>
</name>
</informationRecipient>
<receivedOrganization>
<name>
<item>The DoctorsApart Physician Group</item>
</name>
</receivedOrganization>
</intendedRecipient>
</informationRecipient>
<legalAuthenticator>
<time value="20130801223615-0800"/>
<signatureCode code="S"/>
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="555555555"/>
<code displayName="Adult Medicine"
codeSystemName="Healthcare Provider Taxonomy (HIPAA)" codeSystem="2.16.840.1.113883.6.101" code="207QA0505X"/>
<addr>
<item>
<streetAddressLine>1004 Healthcare Drive</streetAddressLine>
</item>
<item>
<city>Portland</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>99123</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
<telecom value="tel:+1(555)-1004" use="WP"/>
<assignedPerson>
<name>
<item>
<given>Patricia</given>
</item>
<item>
<given qualifier="CL">Patty</given>
</item>
<item>
<family>Primary</family>
</item>
<item>
<suffix qualifier="AC">M.D.</suffix>
</item>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<authenticator>
<time value="20130801103000-0800"/>
<signatureCode code="S"/>
<assignedEntity>
<id root="2.16.840.1.113883.4.6" extension="555555555"/>
<code displayName="Adult Medicine"
codeSystemName="Healthcare Provider Taxonomy (HIPAA)" codeSystem="2.16.840.1.113883.6.101" code="207QA0505X"/>
<addr>
<item>
<streetAddressLine>1004 Healthcare Drive</streetAddressLine>
</item>
<item>
<city>Portland</city>
</item>
<item>
<state>OR</state>
</item>
<item>
<postalCode>99123</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
<telecom value="tel:+1(555)-1004" use="WP"/>
<assignedPerson>
<name>
<item>
<given>Patricia</given>
</item>
<item>
<given qualifier="CL">Patty</given>
</item>
<item>
<family>Primary</family>
</item>
<item>
<suffix qualifier="AC">M.D.</suffix>
</item>
</name>
</assignedPerson>
</assignedEntity>
</authenticator>
<!-- This participant represents the person to contact for questions about the consult summary -->
<participant typeCode="CALLBCK">
<time value="20050329224411+0500"/>
<associatedEntity classCode="ASSIGNED">
<id root="2.16.840.1.113883.4.6" extension="99999999"/>
<code displayName="Allopathic & Osteopathic Physicians"
codeSystem="2.16.840.1.113883.6.101" code="200000000X"/>
<addr>
<item>
<streetAddressLine>1002 Healthcare Drive</streetAddressLine>
</item>
<item>
<city>Ann Arbor</city>
</item>
<item>
<state>MI</state>
</item>
<item>
<postalCode>97857</postalCode>
</item>
<item>
<country>US</country>
</item>
</addr>
<telecom value="tel:555-555-1002" use="WP"/>
<associatedPerson>
<name>
<item>
<given>Henry</given>
</item>
<item>
<family>Seven</family>
</item>
<item>
<suffix>DO</suffix>
</item>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<!-- Describes prior orders that are fulfilled (in whole or part) by the service events described in the Consultation Note -->
<inFulfillmentOf typeCode="FLFS">
<order moodCode="RQO" classCode="ACT">
<id root="2.16.840.1.113883.6.96" extension="1298989898"/>
<code displayName="Weight Reduction Consultation"
codeSystemName="SNOMED CT" codeSystem="2.16.840.1.113883.6.96" code="388975008"/>
</order>
</inFulfillmentOf>
<componentOf>
<encompassingEncounter>
<id root="2.16.840.1.113883.19" extension="9937012"/>
<code displayName="Evaluation and Management" codeSystemName="CPT-4"
codeSystem="2.16.840.1.113883.6.12" code="99213"/>
<effectiveTime>
<low value="20130731"/>
<high value="20130731"/>
</effectiveTime>
<location>
<healthCareFacility>
<id root="2.16.540.1.113883.19.2"/>
</healthCareFacility>
</location>
</encompassingEncounter>
</componentOf>
<!--
*******************************************************
CDA Body
*******************************************************
-->
<component>
<!-- TODO - Structured Body -->
<structuredBody/>
</component>
</ClinicalDocument>
IG © 2019+ Health Level Seven. Package hl7.cda.us.ccda#3.0.0-ballot based on FHIR 5.0.0. Generated 2023-12-21
Links: Table of Contents |
QA Report
| Version History 
|
|
Propose a change