US Realm Header (V3)_2.16.840.1.113883.10.20.22.1.1

back to homepage

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:

US Realm Header (V3)

2.16.840.1.113883.10.20.22.1.1

 

Example: custodian Example.xml download example view on GitHub

<custodian>
  <assignedCustodian>
    <representedCustodianOrganization>
      <id extension="321CX" root="1.1.1.1.1.1.1.1.3" />
      <name>Good Health HIE</name>
      <telecom use="WP" value="tel:+1(555)555-1009" />
      <addr use="WP">
        <streetAddressLine>1009 Healthcare Drive </streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>99123</postalCode>
        <country>US</country>
      </addr>
    </representedCustodianOrganization>
  </assignedCustodian>
</custodian>

Example: informationRecipient Example.xml download example view on GitHub

<informationRecipient>
  <intendedRecipient>
    <informationRecipient>
      <name>
        <given>Sara</given>
        <family>Specialize</family>
        <suffix qualifier="AC">M.D.</suffix>
      </name>
    </informationRecipient>
    <receivedOrganization>
      <name>The DoctorsApart Physician Group</name>
    </receivedOrganization>
  </intendedRecipient>
</informationRecipient>

Example: authenticator Example.xml download example view on GitHub

<authenticator>
  <time value="201209151030-0800" />
  <signatureCode code="S" />
  <assignedEntity>
    <id extension="5555555555" root="2.16.840.1.113883.4.6" />
    <code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.5.53" codeSystemName="Health Care Provider Taxonomy" />
    <addr>
      <streetAddressLine>1004 Healthcare Drive</streetAddressLine>
      <city>Portland</city>
      <state>OR</state>
      <postalCode>99123</postalCode>
      <country>US</country>
    </addr>
    <telecom use="WP" value="tel:+1(555)555-1004" />
    <assignedPerson>
      <name>
        <given>Patricia</given>
        <given qualifier="CL">Patty</given>
        <family>Primary</family>
        <suffix qualifier="AC">M.D.</suffix>
      </name>
    </assignedPerson>
  </assignedEntity>
</authenticator>

Example: authorization Example.xml download example view on GitHub

<authorization typeCode="AUTH">
  <consent classCode="CONS" moodCode="EVN">
    <id root="629deb70-5306-11df-9879-0800200c9a66" />
    <code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="64293-4" displayName="Procedure consent" />
    <statusCode code="completed" />
  </consent>
</authorization>

Example: US Realm Header (V3) Example.xml download example view on GitHub

<ClinicalDocument>
  <realmCode code="US" />
  <typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3" />
  <!-- CCD template -->
  <templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01" />
  <!-- Globally unique identifier for the document  -->
  <id extension="TT988" root="2.16.840.1.113883.19.5.99999.1" />
  <code code="34133-9" displayName="Summary of episode note" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
  <!-- Title of the document -->
  <title>Patient Chart Summary</title>
  <effectiveTime value="201209151030-0800" />
  <confidentialityCode code="N" displayName="normal" codeSystem="2.16.840.1.113883.5.25" codeSystemName="Confidentiality" />
  <languageCode code="en-US" />
  <setId extension="sTT988" root="2.16.840.1.113883.19.5.99999.19" />
  <!-- Version of the document -->
  <versionNumber value="1" />
     . . .


</ClinicalDocument>

Example: inFulfillmentOf Example.xml download example view on GitHub

<inFulfillmentOf typeCode="FLFS">
  <order classCode="ACT" moodCode="RQO">
    <id root="2.16.840.1.113883.6.96" extension="1298989898" />
    <code code="388975008" displayName="Weight reduction consultation" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" />
  </order>
</inFulfillmentOf>

Example: documentationOf Example.xml download example view on GitHub

<documentationOf>
  <serviceEvent classCode="PCPR">
    <!-- The effectiveTime reflects the provision of care summarized in the document. 
				In this scenario, the provision of care summarized is the lifetime for the patient -->
    <effectiveTime>
      <low value="19750501" />
      <!-- The low value represents when the summarized provision of care began. 
					In this scenario, the patient's date of birth -->
      <high value="20120915" />
      <!-- The high value represents when the summarized provision of care being ended. 
					In this scenario, when chart summary was created -->
    </effectiveTime>
    <performer typeCode="PRF">
      <functionCode code="PCP" 
                displayName="primary care physician"
                codeSystem="2.16.840.1.113883.5.88"
                codeSystemName="ParticipationFunction">
        <originalText>Primary Care Provider</originalText>
      </functionCode>
      <assignedEntity>
        <id extension="5555555555" root="2.16.840.1.113883.4.6" />
        <code code="207QA0505X" displayName="Adult Medicine" 
                    codeSystem="2.16.840.1.113883.5.53" 
                    codeSystemName="Health Care Provider Taxonomy" />
        <addr>
          <streetAddressLine>1004 Healthcare Drive </streetAddressLine>
          <city>Portland</city>
          <state>OR</state>
          <postalCode>99123</postalCode>
          <country>US</country>
        </addr>
        <telecom use="WP" value="tel:+1(555)555-1004" />
        <assignedPerson>
          <name>
            <given>Patricia</given>
            <given qualifier="CL">Patty</given>
            <family>Primary</family>
            <suffix qualifier="AC">M.D.</suffix>
          </name>
        </assignedPerson>
        <representedOrganization>
          <id extension="219BX" root="1.1.1.1.1.1.1.1.2" />
          <name>The DoctorsTogether Physician Group</name>
          <telecom use="WP" value="tel: +(555)-555-5000" />
          <addr>
            <streetAddressLine>1004 Health Drive</streetAddressLine>
            <city>Portland</city>
            <state>OR</state>
            <postalCode>99123</postalCode>
            <country>US</country>
          </addr>
        </representedOrganization>
      </assignedEntity>
    </performer>
  </serviceEvent>
</documentationOf>

Example: Assigned Health Care Provider informant Example.xml download example view on GitHub

<informant>
  <assignedEntity>
    <id extension="888888888" root="1.1.1.1.1.1.1.3" />
    <addr>
      <streetAddressLine>1007 Healthcare Drive</streetAddressLine>
      <city>Portland</city>
      <state>OR</state>
      <postalCode>99123</postalCode>
      <country>US</country>
    </addr>
    <telecom use="WP" value="tel:+1(555)555-1003" />
    <assignedPerson>
      <name>
        <given>Harold</given>
        <family>Hippocrates</family>
        <suffix qualifier="AC">M.D.</suffix>
      </name>
    </assignedPerson>
    <representedOrganization>
      <name>The DoctorsApart Physician Group</name>
    </representedOrganization>
  </assignedEntity>
</informant>

Example: recordTarget Example.xml download example view on GitHub

<recordTarget>
  <patientRole>
    <id extension="444-22-2222" root="2.16.840.1.113883.4.1" />
    <!-- Example Social Security Number using the actual SSN OID. -->
    <addr use="HP">
      <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
      <streetAddressLine>2222 Home Street</streetAddressLine>
      <city>Beaverton</city>
      <state>OR</state>
      <postalCode>97867</postalCode>
      <country>US</country>
      <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
    </addr>
    <telecom value="tel:+1(555)555-2003" use="HP" />
    <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
    <patient>
      <!-- The first name element represents what the patient is known as -->
      <name use="L">
        <given>Eve</given>
        <!-- The "SP" is "Spouse" from
                     HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
        <family qualifier="SP">Betterhalf</family>
      </name>
      <!-- The second name element represents another name 
                 associated with the patient -->
      <name>
        <given>Eve</given>
        <!-- The "BR" is "Birth" from 
                     HL7 Code System EntityNamePartQualifier 2.16.840.1.113883.5.43 -->
        <family qualifier="BR">Everywoman</family>
      </name>
      <administrativeGenderCode code="F" displayName="Female" codeSystem="2.16.840.1.113883.5.1" codeSystemName="AdministrativeGender" />
      <!-- Date of birth need only be precise to the day -->
      <birthTime value="19750501" />
      <maritalStatusCode code="M" displayName="Married" codeSystem="2.16.840.1.113883.5.2" codeSystemName="MaritalStatusCode" />
      <religiousAffiliationCode code="1013" displayName="Christian (non-Catholic, non-specific)" codeSystem="2.16.840.1.113883.5.1076" codeSystemName="HL7 Religious Affiliation" />
      <!-- CDC Race and Ethnicity code set contains the five minimum
                 race and ethnicity categories defined by OMB Standards -->
      <raceCode code="2106-3" displayName="White" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" />
      <!-- The raceCode extension is only used if raceCode is valued -->
      <sdtc:raceCode code="2076-8" displayName="Native Hawaiian or Other Pacific Islander" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" />
      <ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race &amp; Ethnicity - CDC" />
      <guardian>
        <code code="POWATT" displayName="Power of Attorney" codeSystem="2.16.840.1.113883.1.11.19830" codeSystemName="ResponsibleParty" />
        <addr use="HP">
          <streetAddressLine>2222 Home Street</streetAddressLine>
          <city>Beaverton</city>
          <state>OR</state>
          <postalCode>97867</postalCode>
          <country>US</country>
        </addr>
        <telecom value="tel:+1(555)555-2008" use="MC" />
        <guardianPerson>
          <name>
            <given>Boris</given>
            <given qualifier="CL">Bo</given>
            <family>Betterhalf</family>
          </name>
        </guardianPerson>
      </guardian>
      <birthplace>
        <place>
          <addr>
            <streetAddressLine>4444 Home Street</streetAddressLine>
            <city>Beaverton</city>
            <state>OR</state>
            <postalCode>97867</postalCode>
            <country>US</country>
          </addr>
        </place>
      </birthplace>
      <languageCommunication>
        <languageCode code="eng" />
        <!-- "eng" is ISO 639-2 alpha-3 code for "English" -->
        <modeCode code="ESP" displayName="Expressed spoken" codeSystem="2.16.840.1.113883.5.60" codeSystemName="LanguageAbilityMode" />
        <proficiencyLevelCode code="G" displayName="Good" codeSystem="2.16.840.1.113883.5.61" codeSystemName="LanguageAbilityProficiency" />
        <!-- Patient's preferred language -->
        <preferenceInd value="true" />
      </languageCommunication>
    </patient>
    <providerOrganization>
      <id extension="219BX" root="1.1.1.1.1.1.1.1.2" />
      <name>The DoctorsTogether Physician Group</name>
      <telecom use="WP" value="tel: +(555)-555-5000" />
      <addr>
        <streetAddressLine>1007 Health Drive</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>99123</postalCode>
        <country>US</country>
      </addr>
    </providerOrganization>
  </patientRole>
</recordTarget>

Example: Supporting Person participant Example.xml download example view on GitHub

<ClinicalDocument>
  <!-- ... -->
  <participant typeCode="IND">
    <!-- typeCode "IND" represents an individual -->
    <associatedEntity classCode="NOK">
      <!-- classCode "NOK" represents the patient's next of kin-->
      <addr use="HP">
        <streetAddressLine>2222 Home Street</streetAddressLine>
        <city>Beaverton</city>
        <state>OR</state>
        <postalCode>97867</postalCode>
        <country>US</country>
      </addr>
      <telecom value="tel:+1(555)555-2008" use="MC" />
      <associatedPerson>
        <name>
          <given>Boris</given>
          <given qualifier="CL">Bo</given>
          <family>Betterhalf</family>
        </name>
      </associatedPerson>
    </associatedEntity>
  </participant>
  <!-- Entities playing multiple roles are recorded in multiple participants -->
  <participant typeCode="IND">
    <associatedEntity classCode="ECON">
      <!-- classCode "ECON" represents an emergency contact -->
      <addr use="HP">
        <streetAddressLine>2222 Home Street</streetAddressLine>
        <city>Beaverton</city>
        <state>OR</state>
        <postalCode>97867</postalCode>
        <country>US</country>
      </addr>
      <telecom value="tel:+1(555)555-2008" use="MC" />
      <associatedPerson>
        <name>
          <given>Boris</given>
          <given qualifier="CL">Bo</given>
          <family>Betterhalf</family>
        </name>
      </associatedPerson>
    </associatedEntity>
  </participant>
</ClinicalDocument>

Example: Digital signature Example.xml download example view on GitHub

<sdtc:signatureText mediaType="text/xml" representation="B64">omSJUEdmde9j44zmMiromSJUEdmde9j44zmMirdMDSsWdIJdksIJR3373jeu83
			6edjzMMIjdMDSsWdIJdksIJR3373jeu83MNYD83jmMdomSJUEdmde9j44zmMir
			... MNYD83jmMdomSJUEdmde9j44zmMir6edjzMMIjdMDSsWdIJdksIJR3373jeu83
			4zmMir6edjzMMIjdMDSsWdIJdksIJR3373jeu83==</sdtc:signatureText>

Example: author Example.xml download example view on GitHub

<author>
  <time value="201209151030-0800" />
  <assignedAuthor>
    <id extension="5555555555" root="2.16.840.1.113883.4.6" />
    <code code="163W00000X" displayName="Registered nurse" codeSystem="2.16.840.1.113883.5.53" codeSystemName="Health Care Provider Taxonomy" />
    <addr>
      <streetAddressLine>1004 Healthcare Drive </streetAddressLine>
      <city>Portland</city>
      <state>OR</state>
      <postalCode>99123</postalCode>
      <country>US</country>
    </addr>
    <telecom use="WP" value="tel:+1(555)555-1004" />
    <assignedPerson>
      <name>
        <given>Patricia</given>
        <given qualifier="CL">Patty</given>
        <family>Primary</family>
        <suffix qualifier="AC">M.D.</suffix>
      </name>
    </assignedPerson>
  </assignedAuthor>
</author>

Example: Personal Relation informant Example.xml download example view on GitHub

<informant>
  <relatedEntity classCode="PRS">
    <!-- classCode "PRS" represents a person with personal relationship with the patient -->
    <code code="SPS" displayName="SPOUSE" codeSystem="2.16.840.1.113883.1.11.19563" codeSystemName="Personal Relationship Role Type Value Set" />
    <relatedPerson>
      <name>
        <given>Boris</given>
        <given qualifier="CL">Bo</given>
        <family>Betterhalf</family>
      </name>
    </relatedPerson>
  </relatedEntity>
</informant>

Example: legalAuthenticator Example.xml download example view on GitHub

<legalAuthenticator>
  <time value="20120915223615-0800" />
  <signatureCode code="S" />
  <assignedEntity>
    <id extension="5555555555" root="2.16.840.1.113883.4.6" />
    <code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.5.53" codeSystemName="Health Care Provider Taxonomy" />
    <addr>
      <streetAddressLine>1004 Healthcare Drive </streetAddressLine>
      <city>Portland</city>
      <state>OR</state>
      <postalCode>99123</postalCode>
      <country>US</country>
    </addr>
    <telecom use="WP" value="tel:+1(555)555-1004" />
    <assignedPerson>
      <name>
        <given>Patricia</given>
        <given qualifier="CL">Patty</given>
        <family>Primary</family>
        <suffix qualifier="AC">M.D.</suffix>
      </name>
    </assignedPerson>
  </assignedEntity>
</legalAuthenticator>

Example: dateEnterer Example.xml download example view on GitHub

<dataEnterer>
  <assignedEntity>
    <id extension="333777777" root="2.16.840.1.113883.4.6" />
    <addr>
      <streetAddressLine>1007 Healthcare Drive</streetAddressLine>
      <city>Portland</city>
      <state>OR</state>
      <postalCode>99123</postalCode>
      <country>US</country>
    </addr>
    <telecom use="WP" value="tel:+1(555)555-1050" />
    <assignedPerson>
      <name>
        <given>Ellen</given>
        <family>Enter</family>
      </name>
    </assignedPerson>
  </assignedEntity>
</dataEnterer>

Example: performer Example.xml download example view on GitHub

<performer typeCode="PRF">
  <functionCode code="PCP" 
              displayName="primary care physician"
              codeSystem="2.16.840.1.113883.5.88"
              codeSystemName="ParticipationFunction">
    <originalText>Primary Care Provider</originalText>
  </functionCode>
  <assignedEntity>
    <id extension="5555555555" root="2.16.840.1.113883.4.6" />
    <code code="207QA0505X" displayName="Adult Medicine" codeSystem="2.16.840.1.113883.5.53" codeSystemName="Health Care Provider Taxonomy" />
    <addr>
      <streetAddressLine>1004 Healthcare Drive </streetAddressLine>
      <city>Portland</city>
      <state>OR</state>
      <postalCode>99123</postalCode>
      <country>US</country>
    </addr>
    <telecom use="WP" value="tel:+1(555)555-1004" />
    <assignedPerson>
      <name>
        <given>Patricia</given>
        <given qualifier="CL">Patty</given>
        <family>Primary</family>
        <suffix qualifier="AC">M.D.</suffix>
      </name>
    </assignedPerson>
    <representedOrganization>
      <id extension="219BX" root="1.1.1.1.1.1.1.1.2" />
      <name>The DoctorsTogether Physician Group</name>
      <telecom use="WP" value="tel: +(555)-555-5000" />
      <addr>
        <streetAddressLine>1004 Health Drive</streetAddressLine>
        <city>Portland</city>
        <state>OR</state>
        <postalCode>99123</postalCode>
        <country>US</country>
      </addr>
    </representedOrganization>
  </assignedEntity>
</performer>
  1. C-CDA Example Search Help

    C-CDA Example Search Results
    This screen displays the results of executing the example search criteria against the existing examples recorded in the example database.

  2. Search Criteria Panel

    This panel allow you to further refine your queries and narrow the results

  3. Text Search Words

    Use this field to enter words related to your search. These words can appear in the title, the comments or as part of a special list of keywords associated with the example. The search words should be entered with spaces separating the items.

  4. Filter by example status

    By selecting the various statuses, the search results can be limited to only the example that are set to the selected status(es). By removing all status selections, the filtering is removed and examples from all statuses will be returned (based on any other filtering).

  5. Select only ONC Certified examples

    These are samples referenced in a government rule or certification companion guide.

  6. Execute the search based on the criteria entered (or retrieve all examples if no criteria specified).

  7. The number of results that match the query parameters can be found here.

  8. Use this link to jump back to the initial page of the application (that lists the sections).

  9. This columns list the names of the examples that match the criteria (and the comment for each example).

  10. This columns lists the area in the C-CDA specification (the specification is broken into distinct topics for the various exchangeable documents, the common header, and the sections that occur within the exchangeable documents) that the example demonstrates.

  11. This columns lists the state of the example in the example verification and approval process.

  12. You can select to download the examples directly or navigate to page with the full detailed description of the example.

  13. Tour Complete

    Return to the C-CDA Example Search Results page.