RTF Note

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 10/8/2020
  • SDWG: 12/17/2020

C-CDA 2.1 Example:

  • 2.16.840.1.113883. (Companion Guide Appendix A)

Reference to full CDA sample:

  • N/A

Validation location


  • This is an example of how to include rich text in a C-CDA Note Activity.


  • Matt Szczepankiewicz, mszczepa@epic.com (GitHub: mjszczep)


  • Note, Note Activity, Notes, RTF, Rich Text


  • TBD


Example: download example view on GitHub

    <!-- Notes Section -->
    <templateId root="2.16.840.1.113883." extension="2016-11-01"/>
    <code code="34746-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Nurse Note"/>
    <title>Nursing Notes</title>
            <!-- This is the Plain Text representation of the RTF, it must FULLY preserve the meaning of the embedded RTF. -->
            <!-- Systems receiving a section with RTF SHALL be capable of displaying the section.text. -->
            <item ID="note1"> 
                <caption>Nursing Note written by Nick Nurse</caption>
                <paragraph>0700-1900 Nursing Note: Patient’s vital signs were stable as documented throughout shift on 2L Oxygen via nasal cannula. His lungs are diminished with scattered crackles. Bowel sounds are active and the patient had a bowel movement x 2 today, both soft. Incontinent of urine and wearing a diaper. Skin intact at this time. Skin color is pale. 2+ non-pitting edema noted in bilateral calves and ankles. Assessed patient and reconciled medications. Spoke with daughter, pt’s power of attorney, to provide updates and education on the patient's condition. Laboratory obtained morning labs without problem and vascular therapy placed a new 18g peripheral IV as the previous one was due for a change. Pt took all morning meds without problem. Reoriented patient and provided opportunities for toileting and for making needs known every 1-2 hours today to lessen risk of fall.</paragraph>
    <!-- When converting RTF to Plain Text, it's important to preserve the meaning in RTF. For example, strikethrough and other formatting which change the meaning SHALL be considered -->
    <!-- Systems that render RTF (OPTIONAL) should use caution since malicious content may be embedded in RTF-->
    <!-- Note Activity (extra markup removed to focus on <text>) -->
    <entry typeCode="DRIV">
        <act classCode="ACT" moodCode="EVN">
            <templateId root="2.16.840.1.113883." extension="2016-11-01"/>
            <code code="34109-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Note">
                <translation code="34746-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Nurse Note" />
            <!-- This Base64 example includes line breaks which is optional --> 
            <text mediaType="text/rtf" representation="B64">
                <reference value="#note1"/>
            <!-- Author Participant information here -->
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