Unknown Smoking Status

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 6/26/2014
  • SDWG: 7/3/2014

  • SDWG C-CDA R2.1 Upgrade: 12/1/2016

C-CDA 2.1 Example:

  • 2.16.840.1.113883.
  • 2.16.840.1.113883.
  • 2.16.840.1.113883.

Reference to full CDA sample:

  • Social history in empty CCD

Validation location


  • This is an example of unknown smoking status. There is a major variation in how no information is managed for smoking status. C-CDA explicitly guides to not utilize a nullFlavor for this information. Instead a SNOMED code should be used as demonstrated in the example. A best practice to avoid confusion is for each social history section to only include a single smoking status.


  • John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)


  • Social History, Smoking




Example: download example view on GitHub

	<templateId root="2.16.840.1.113883."/>
	<templateId root="2.16.840.1.113883." extension="2015-08-01"/>
	<code code="29762-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Social History"/>
	<title>Social History</title>
			<caption>Smoking Status</caption>
			<item ID="SmokingStatus">
				<content>Unknown if ever smoked</content>
				<content>Started: </content>
				<content>Recorded June 6, 2014 10:32am</content>
	<!-- A best practice is to only include one smoking status per patient to avoid confusion. -->
		<observation classCode="OBS" moodCode="EVN">
			<templateId root="2.16.840.1.113883."/>
			<templateId root="2.16.840.1.113883." extension="2014-06-09"/>
			<id extension="123456789" root="2.16.840.1.113883.19" />
			<code code="72166-2" codeSystem="2.16.840.1.113883.6.1" displayName="Tobacco smoking status NHIS"/>
				<reference value="#SmokingStatus" />
			<statusCode code="completed"/>
			<effectiveTime value="201406061032-0500"/>
				<!--Note: This template represents a “snapshot in time” observation, simply reflecting what the patient’s 
					current smoking status is at the time of the observation. As a result, the effectiveTime is constrained 
					to just a time stamp, and will approximately correspond with the author/time. -->
			<!-- The use of a specfic SNOMED code for unknown smoker is an encouraged variation from C-CDA practices in other sections -->
			<value xsi:type="CD" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" code="266927001" displayName="Tobacco smoking consumption unknown"/>
				<templateId root="2.16.840.1.113883."/>
				<time value="201406061032-0500"/>
					<id root="2.16.840.1.113883.4.6" extension="99999999"/>
					<!-- Root means NPI number. -->
					<code code="200000000X" codeSystem="2.16.840.1.113883.6.101"
						displayName="Allopathic and Osteopathic Physicians"/>
					<telecom use="WP" value="tel:+1(555)555-1002"/>
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