Narrative Reference - Act

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 6/1/2017
  • SDWG: 7/6/2017

C-CDA 2.1 Example:

  • Applies to all C-CDA/CDA templates with this entry type

Reference to full CDA sample:

  • This sample will not validate

Validation location

  • Not applicable


  • This example demonstrates how to link the section narrative (section.text) to the coded information (entry) below. The example includes several comments and does not conform to any specific C-CDA/CDA template. The principles agreed to in this sample should be present in all other examples.


  • Brett Marquard, (GitHub: brettmarquard) (original design courtesy of George Cole)


  • narrative, narrative-entry, linking text




Example: download example view on GitHub

	<!-- The following section is fictitious - it exists solely for the purpose of showing examples of text/reference and originalText/reference from discrete entry children. As such, many elements are omitted and replaced by ... comments. The text and content in the discrete entry elements does not use actual clinical content, but instead relies on filler text commonly used in publishing and graphic design. -->
		<!--  ... -->
			<!-- The text in this section is created strictly to illustrate how discrete entry child elements make references into the human readable text. -->
			<!-- this paragraph is used for a simple act; the ID values are meant to be unique across the whole document -->
			<paragraph ID="simpleActFullTextReference1">
				<content ID="simpleActCodeReference1">Lorem ipsum dolor sit amet</content>, consectetur adipiscing elit.</paragraph>
			labetText: DD-mmm-YYYY
		<!-- this illustrates an act, the basic class of the RIM, but in C-CDA terms the act is used for both Allergy and Problem Concerns, Authorization Activity, Comment Activity and a few other acts.
			<!-- illustrating a simple act -->
			<act classCode="ACT" moodCode="EVN">
				<!-- ... -->
				<!-- the code is a required element of act; @displayName is an optional attribute, and when present it should represent a name (some say the name) as defined for the @code in the given @codeSystem -->
				<code code="12345" codeSystem="" displayName="loreum ipsum">
					<!-- it is not unusual for the code of an act to be specified in an Implementation Guide and often times text of the code is not in the human readable text, so originalText SHALL NOT be present in those cases
									however, If some of the human readable text is a representation of the code, we SHOULD include a reference to that text using the originalText/reference construct 
						<!-- the value of this reference begins with hashtag, and is followed by text that is the value of an ID element in the human readable text 
											notice that the referenced text is similar to but different than the @displayName  of the code element
											from an interoperability perspective, this pattern is a SHOULD as access to the human readable text reflecting the (code, codeSystem) in use is beneficial to consuming systems
						<reference value="#simpleActCodeReference1"/>
				<!-- when present, the text/reference points to the entire text of the act 
									from an interoperability perspective, this pattern is a MAY as access to the entire human readable text of the act is sometimes useful, but generally not programatically useful (NLP may be needed)
					<!-- notice that the ID containing the referenced value is on an element that includes all text of the act.
					     in this case, the element is a paragraph, but might be a table, tbody, tr, etc....elements that typically wrap more entire concepts, not just pieces of content
					     Example referenced content, using Comment Activity: Patient is having difficulty paying co-pays for these medications.
					<reference value="#simpleActFullTextReference1"/>
				<!-- ... -->
				<effectiveTime value="YYYMMDD"/>
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