US Realm Header for Patient Generated Document (V2)_2.16.840.1.113883.10.20.29.1

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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 for Patient Generated Document (V2)

2.16.840.1.113883.10.20.29.1

 

Example: Patient Generated Document informationRecipient.xml download example view on GitHub 

<ClinicalDocument>
  <!-- ... -->
  <!-- The document is intended for multiple recipients, Adam himself and his PCP physician. -->
  <informationRecipient>
    <intendedRecipient>
      <!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
      <id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234" />
      <informationRecipient>
        <name>
          <given>Adam</given>
          <family>Everyman</family>
        </name>
      </informationRecipient>
      <receivedOrganization>
        <!-- id using HL7 example OID. -->
        <id extension="999.3" root="2.16.840.1.113883.19" />
        <name>MyPersonalHealthRecord.Com</name>
      </receivedOrganization>
    </intendedRecipient>
  </informationRecipient>
  <informationRecipient>
    <intendedRecipient>
      <!-- Unique/Trusted id using HL7 example OID. -->
      <id extension="999.4" root="2.16.840.1.113883.19" />
      <!-- The physician's NPI number -->
      <id extension="1122334455" root="2.16.840.1.113883.4.6" />
      <!-- The physician's Direct Address -->
      <!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
      <id extension="DrP@direct.sampleHISP2.com" root="2.16.123.123.12345.4321" />
      <telecom use="WP" value="tel:(781)555-1212" />
      <telecom use="WP" value="mailto:DrP@direct.sampleHISP2.com" />
      <informationRecipient>
        <name>
          <prefix>Dr.</prefix>
          <given>Patricia</given>
          <family>Primary</family>
        </name>
      </informationRecipient>
      <receivedOrganization>
        <!-- Unique/Trusted id using HL7 example OID. -->
        <id extension="999.2" root="2.16.840.1.113883.19" />
        <!-- NPI for the organization -->
        <id extension="1234567890" root="2.16.840.1.113883.4.6" />
        <name>Good Health Internal Medicine</name>
        <telecom use="WP" value="tel:(781)555-1212" />
        <addr>
          <streetAddressLine>100 Health Drive</streetAddressLine>
          <city>Boston</city>
          <state>MA</state>
          <postalCode>02368</postalCode>
          <country>USA</country>
        </addr>
      </receivedOrganization>
    </intendedRecipient>
  </informationRecipient>
</ClinicalDocument>

Example: Patient Generated Document author Example.xml download example view on GitHub 

<author>
  <time value="20121126145000-0500" />
  <assignedAuthor>
    <!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
    <id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234" />
    <!-- 
				The PGD Header Template includes further conformance constraints on the code element to encode the personal or legal 
				relationship of the author when they are person who is not acting in the role of a clinician.. 
			-->
    <code code="ONESELF" displayName="self" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 Role code" />
    <addr use="HP">
      <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
      <streetAddressLine>2222 Home Street</streetAddressLine>
      <city>Boston</city>
      <state>MA</state>
      <postalCode>02368</postalCode>
      <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      <country>US</country>
    </addr>
    <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
    <telecom value="tel:(555)555-2004" use="HP" />
    <assignedPerson>
      <name>
        <given>Adam</given>
        <family>Everyman</family>
      </name>
    </assignedPerson>
  </assignedAuthor>
</author>

Example: Patient Generated Document inFulfillmentOf Example.xml download example view on GitHub 

<inFulfillmentOf>
  <order>
    <!-- The root identifies the EMR system at the Good Health Internal Medicine Practice -->
    <id extension="Ord12345" root="2.16.840.1.113883.4.6.1234567890.4" />
  </order>
</inFulfillmentOf>

Example: Patient Generated Document informant RelEnt Example.xml download example view on GitHub 

<informant>
  <!-- An Errata has been accepted to allow relatedEntity under Informant. #XXXX -->
  <relatedEntity classCode="IND">
    <!-- id using HL7 example OID. -->
    <id extension="999.17" root="2.16.840.1.113883.19" />
    <code code="SIS" displayName="Sister" codeSystem="2.16.840.1.113883.11.20.12.1" codeSystemName="Personal And Legal Relationship Role Type" />
    <addr use="HP">
      <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
      <streetAddressLine>2222 Home Street</streetAddressLine>
      <city>Boston</city>
      <state>MA</state>
      <postalCode>02368</postalCode>
      <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      <country>US</country>
    </addr>
    <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
    <telecom value="tel:(555)555-2004" use="HP" />
    <assignedPerson>
      <name>
        <given>Alice</given>
        <family>Everyman</family>
      </name>
    </assignedPerson>
  </relatedEntity>
</informant>

Example: Patient Generated Document participant Example.xml download example view on GitHub 

<participant typeCode="IND">
  <time xsi:type="IVL_TS">
    <low value="19551125" />
    <high value="20121126" />
  </time>
  <associatedEntity classCode="NOK">
    <code code="MTH" codeSystem="2.16.840.1.113883.5.111" displayName="mother" />
    <addr>
      <streetAddressLine>17 Daws Rd.</streetAddressLine>
      <city>Blue Bell</city>
      <state>MA</state>
      <postalCode>02368</postalCode>
      <country>US</country>
    </addr>
    <telecom value="tel:(555)555-2006" use="WP" />
    <associatedPerson>
      <name>
        <prefix>Mrs.</prefix>
        <given>Martha</given>
        <family>Mum</family>
      </name>
    </associatedPerson>
  </associatedEntity>
</participant>

Example: Patient Generated Document authenticator Example.xml download example view on GitHub 

<authenticator>
  <time value="20121126145000-0500" />
  <signatureCode code="S" />
  <assignedEntity>
    <!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
    <id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234" />
    <addr use="HP">
      <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
      <streetAddressLine>2222 Home Street</streetAddressLine>
      <city>Boston</city>
      <state>MA</state>
      <postalCode>02368</postalCode>
      <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      <country>US</country>
    </addr>
    <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
    <telecom value="tel:(555)555-2004" use="HP" />
    <assignedPerson>
      <name>
        <given>Adam</given>
        <family>Everyman</family>
      </name>
    </assignedPerson>
  </assignedEntity>
</authenticator>

Example: Patient Generated Document custodian Example.xml download example view on GitHub 

<custodian>
  <assignedCustodian>
    <representedCustodianOrganization>
      <!-- id using HL7 example OID. -->
      <id extension="999.3" root="2.16.840.1.113883.19" />
      <name>MyPersonalHealthRecord.Com</name>
      <telecom value="tel:(555)555-1212" use="WP" />
      <addr use="WP">
        <streetAddressLine>123 Boylston Street</streetAddressLine>
        <city>Blue Hill</city>
        <state>MA</state>
        <postalCode>02368</postalCode>
        <country>USA</country>
      </addr>
    </representedCustodianOrganization>
  </assignedCustodian>
</custodian>

Example: Patient Generated Document dataEnterer Example.xml download example view on GitHub 

<dataEnterer>
  <assignedEntity>
    <!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
    <id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234" />
    <code code="ONESELF" displayName="self" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 Role code" />
    <addr use="HP">
      <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
      <streetAddressLine>2222 Home Street</streetAddressLine>
      <city>Boston</city>
      <state>MA</state>
      <postalCode>02368</postalCode>
      <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      <country>US</country>
    </addr>
    <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
    <telecom value="tel:(555)555-2004" use="HP" />
    <assignedPerson>
      <name>
        <given>Adam</given>
        <family>Everyman</family>
      </name>
    </assignedPerson>
  </assignedEntity>
</dataEnterer>

Example: Patient Generated Document informant Example informant.xml download example view on GitHub 

<informant>
  <assignedEntity>
    <!-- id using HL7 example OID. -->
    <id extension="999.1" root="2.16.840.1.113883.19" />
    <code code="ONESELF" displayName="self" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 Role code" />
    <addr use="HP">
      <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
      <streetAddressLine>2222 Home Street</streetAddressLine>
      <city>Boston</city>
      <state>MA</state>
      <postalCode>02368</postalCode>
      <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      <country>US</country>
    </addr>
    <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
    <telecom value="tel:(555)555-2004" use="HP" />
    <assignedPerson>
      <name>
        <given>Adam</given>
        <family>Everyman</family>
      </name>
    </assignedPerson>
  </assignedEntity>
</informant>

Example: Patient Generated Document legalAuthenticator Example.xml download example view on GitHub 

<legalAuthenticator>
  <time value="20121126145000-0500" />
  <signatureCode code="S" />
  <assignedEntity>
    <!-- Identifier based on the person's Direct Address which is a secure and trusted mechanism for identifying 
				a person discretely. The root of the id is the OID of the HISP Assigning Authority for the Direct Address-->
    <id extension="adameveryman@direct.sampleHISP.com" root="2.16.123.123.12345.1234" />
    <addr use="HP">
      <!-- HP is "primary home" from codeSystem 2.16.840.1.113883.5.1119 -->
      <streetAddressLine>2222 Home Street</streetAddressLine>
      <city>Boston</city>
      <state>MA</state>
      <postalCode>02368</postalCode>
      <!-- US is "United States" from ISO 3166-1 Country Codes: 1.0.3166.1 -->
      <country>US</country>
    </addr>
    <!-- HP is "primary home" from HL7 AddressUse 2.16.840.1.113883.5.1119 -->
    <telecom value="tel:(555)555-2004" use="HP" />
    <assignedPerson>
      <name>
        <given>Adam</given>
        <family>Everyman</family>
      </name>
    </assignedPerson>
  </assignedEntity>
</legalAuthenticator>

Example: Patient Generated Document 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>
        <id root="2.16.840.1.113883.4.1" extension="111-22-3333" />
        <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: Patient Generated Document author device Example.xml download example view on GitHub 

<!-- The Author below documents the system used to create the Patient Generated Document.
		In this scenario the Patient is using a fictitious PHR Service called MyPersonalHealthRecord.com. 
		It is a service which consumers purchase to receive and create their electronic health records. 
		It is not a Patient Portal that is tethered to some other EMR or medical insurance records system.
		The service is developed by a company call ACME PHR Solutions, Inc. -->
<author>
  <time value="20121126145000-0500" />
  <assignedAuthor>
    <id extension="777.11" root="2.16.840.1.113883.19" />
    <addr nullFlavor="NA" />
    <telecom nullFlavor="NA" />
    <assignedAuthoringDevice>
      <manufacturerModelName>ACME PHR</manufacturerModelName>
      <softwareName>MyPHR v1.0</softwareName>
    </assignedAuthoringDevice>
    <representedOrganization>
      <id extension="999" root="1.2.3.4.5.6.7.8.9.12345" />
      <name>ACME PHR Solutions, Inc.</name>
      <telecom use="WP" value="tel:123-123-12345" />
      <addr>
        <streetAddressLine>4 Future Way</streetAddressLine>
        <city>Provenance</city>
        <state>RI</state>
        <postalCode>02919</postalCode>
      </addr>
    </representedOrganization>
  </assignedAuthor>
</author>

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