Problem Section (entries required) (V3)_2.16.840.1.113883.10.20.22.2.5.1

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SDWG Supported Sample from Implementation Guide

The initial load of this repository in January 2021 includes all examples (figures) from the June 2019 Errata published PDF of C-CDA 2.1 and 2019 release of C-CDA Companion Guide.

These examples were reviewed through the HL7 ballot process. They have not been formally reviewed/approved by the examples task force.

Keywords:

Problem Section (entries required) (V3)

2.16.840.1.113883.10.20.22.2.5.1

 

Example: Problem Section (entries required) (V3) Example.xml download example view on GitHub

<section>
  <!-- [C-CDA R2.1] Problem Section (entries optional) -->
  <templateId root="2.16.840.1.113883.10.20.22.2.5" extension="2015-08-01" />
  <!-- [C-CDA R2.1] Problem Section (entries required) -->
  <templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-01" />
  <code code="11450-4" 
        codeSystem="2.16.840.1.113883.6.1" 
        codeSystemName="LOINC" 
        displayName="PROBLEM LIST" />
  <title>PROBLEMS</title>
  <text>
    <list listType="ordered">
      <item>Pneumonia: Resolved in March 1998</item>
      <item>...</item>
    </list>
  </text>
  <entry typeCode="DRIV">
    <act classCode="ACT" moodCode="EVN">
      <!-- [C-CDA R2.1] Problem Concern Act (V3) -->
      <templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01" />
      ...
      
    
    </act>
  </entry>
</section>

Example: No Known Problems Section Example.xml download example view on GitHub

<section>
  <!-- [C-CDA R2.1] Problem Section (entries optional) -->
  <templateId root="2.16.840.1.113883.10.20.22.2.5" extension="2015-08-01" />
  <!-- [C-CDA R2.1] Problem Section (entries required) -->
  <templateId root="2.16.840.1.113883.10.20.22.2.5.1" extension="2015-08-01" />
  <code code="11450-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Problem List" />
  <title>PROBLEMS</title>
  <text ID="Concern_1">
    Problem Concern:
    
    <br />
    Concern Tracker Start Date: 06/07/2013 16:05:06
    
    <br />
    Concern Tracker End Date: 
    
    <br />
    Concern Status: Active    
    
    <br />
    <content ID="problems1">No known 
      
      <content ID="problemType1">problems.</content>
    </content>
  </text>
  <entry typeCode="DRIV">
    <act classCode="ACT" moodCode="EVN">
      <!-- [C-CDA R2.1] Problem Concern Act (V3) -->
      <templateId root="2.16.840.1.113883.10.20.22.4.3" extension="2015-08-01" />
      <id root="36e3e930-7b14-11db-9fe1-0800200c9a66" />
      <!-- SDWG supports 48765-2 or CONC in the code element -->
      <code code="CONC" codeSystem="2.16.840.1.113883.5.6" />
      <text>
        <reference value="#Concern_1" />
      </text>
      <statusCode code="active" />
      <!-- The concern is not active, in terms of there being an active condition
           to be managed.-->
      <effectiveTime>
        <low value="20130607160506" />
        <!-- Time at which THIS �concern� began being tracked.-->
      </effectiveTime>
      <!-- status is active so high is not applicable. If high is present it 
           should have nullFlavor of NA-->
      <!-- Optional Author Element-->
      <author>
        <!--_ [C-CDA R2] Author Participation -->
        <templateId root="2.16.840.1.113883.10.20.22.4.119" />
        <time value="20130607160506" />
        <assignedAuthor>
          ...
        </assignedAuthor>
      </author>
      <entryRelationship typeCode="SUBJ">
        <observation classCode="OBS" moodCode="EVN" negationInd="true">
          <!-- Model of Meaning for No Problems -->
          <!-- This is more consistent with how we did no known allergies.
               The use of negationInd corresponds with the newer 
               Observation.ValueNegationInd.
               The negationInd = true negates the value element. -->
          <!-- [C-CDA R2.1] Problem Observation (V3) -->
          <templateId root="2.16.840.1.113883.10.20.22.4.4" extension="2015-08-01" />
          <id root="4adc1021-7b14-11db-9fe1-0800200c9a67" />
          <code code="ASSERTION" codeSystem="2.16.840.1.113883.5.4" />
          <text>
            <reference value="#problems1" />
          </text>
          <statusCode code="completed" />
          <effectiveTime>
            <low value="20130607160506" />
          </effectiveTime>
          <!-- The time when this was biologically relevant ie True 
               for the patient. As a minimum time interval over which 
               this is true, populate the effectiveTime/low with the 
               current time. 
               It would be equally valid to have a longer range of 
               time over which this statement was represented as 
               being true. As a maximum, you would never indicate 
               an effectiveTime/high that was greater than the 
               current point in time. This idea assumes that the 
               value element could come from the Problem value set, 
               or when negationInd was true, is could also come from 
               the ProblemType value set (and code would be ASSERTION). -->
          <value xsi:type="CD" 
                code="55607006" 
                displayName="Problem" 
                codeSystem="2.16.840.1.113883.6.96" 
                codeSystemName="SNOMED CT">
            <originalText>
              <reference value="#problemType1" />
            </originalText>
          </value>
        </observation>
      </entryRelationship>
    </act>
  </entry>
</section>
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