Unknown Smoking Statusreturn to Main screen return to result list
Example metadata last updated 2017-08-06 10:15:50.738000 UTC
Approval Status: Approved
- Approval Status: Approved
- Example Task Force: 6/26/2014
- SDWG: 7/3/2014
- SDWG C-CDA R2.1 Upgrade: 12/1/2016
- This is an example of unknown smoking status. There is a major variation in how no information is managed for smoking status. C-CDA explicitly guides to not utilize a nullFlavor for this information. Instead a SNOMED code should be used as demonstrated in the example. A best practice to avoid confusion is for each social history section to only include a single smoking status.
Custodian: John D'Amore email@example.com (GitHub: jddamore)
Full sample: Social history in empty CCD
<section> <templateId root="2.16.840.1.113818.104.22.168.2.17"/> <templateId root="2.16.840.1.113822.214.171.124.2.17" extension="2015-08-01"/> <code code="29762-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Social History"/> <title>Social History</title> <text> <list> <caption>Smoking Status</caption> <item> <content>Unknown if ever smoked</content> <content>Started: </content> <content>Stopped:</content> <content>Recorded June 6, 2014 10:32am</content> </item> </list> </text> <!-- A best practice is to only include one smoking status per patient to avoid confusion. --> <entry> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.1138126.96.36.199.4.78"/> <templateId root="2.16.840.1.1138188.8.131.52.4.78" extension="2014-06-09"/> <id extension="123456789" root="2.16.840.1.113883.19" /> <code code="72166-2" codeSystem="2.16.840.1.113883.6.1" displayName="Tobacco smoking status NHIS"/> <statusCode code="completed"/> <effectiveTime value="201406061032+0500"/> <!--Note: This template represents a “snapshot in time” observation, simply reflecting what the patient’s current smoking status is at the time of the observation. As a result, the effectiveTime is constrained to just a time stamp, and will approximately correspond with the author/time. --> <!-- The use of a specfic SNOMED code for unknown smoker is an encouraged variation from C-CDA practices in other sections --> <value xsi:type="CD" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="266927001" displayName="Unknown if ever smoked"/> <author> <templateId root="2.16.840.1.1138184.108.40.206.4.119"/> <time value="201406061032+0500"/> <assignedAuthor> <id root="2.16.840.1.113883.4.6" extension="99999999"/> <!-- Root means NPI number. --> <code code="200000000X" codeSystem="2.16.840.1.113883.6.101" displayName="Allopathic and Osteopathic Physicians"/> <telecom use="WP" value="tel:+1(555)555-1002"/> <assignedPerson> <name> <given>Henry</given> <family>Seven</family> </name> </assignedPerson> </assignedAuthor> </author> </observation> </entry> </section>
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