US Realm Header (V3)_2.16.840.1.113883.10.20.22.1.1

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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:

US Realm Header (V3)

2.16.840.1.113883.10.20.22.1.1

 

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="CPT4" />
  </order>
</inFulfillmentOf>

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: 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: 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 Provider"
                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: 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: 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: performer Example.xml download example view on GitHub

<performer typeCode="PRF">
  <functionCode code="PCP" 
              displayName="Primary Care Provider"
              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>

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

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

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

<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>

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 & Ethnicity - CDC" />
      <!-- The raceCode extension is only used if raceCode is valued -->
      <sdtc:raceCode code="2076-8" displayName="Hawaiian or Other Pacific Islander" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race & Ethnicity - CDC" />
      <ethnicGroupCode code="2186-5" displayName="Not Hispanic or Latino" codeSystem="2.16.840.1.113883.6.238" codeSystemName="Race & 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: 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: 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: 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>
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