Template Definitions

Template Definitions Table of Contents

Table of Figures

Table of Tables

Advance Directives - Template Revisions March 29 Page 1 1 D O C U M E N T

US Realm Header (V3) [ClinicalDocument: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.1.1:2015- 08-01 (open)] Published as part of Consolidated CDA Templates for Clinical Notes (US Realm) DSTU R2.1

Table 1: US Realm Header (V3) Contexts

Contained By: Contains: US Realm Address (AD.US.FIELDED) US Realm Date and Time (DTM.US.FIELDED) US Realm Person Name (PN.US.FIELDED)

This template defines constraints that represent common administrative and demographic concepts for US Realm CDA documents. Further specification, such as ClinicalDocument/code, are provided in document templates that conform to this template.

Table 2: US Realm Header (V3) Constraints Overview

XPath Card. Verb Data CONF# Value Type ClinicalDocument (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.1.1:2015-08-01) realmCode 1..1 SHALL 1198- US 16791 typeId 1..1 SHALL 1198- 5361 @root 1..1 SHALL 1198- 2.16.840.1.113883.1.3 5250 @extension 1..1 SHALL 1198- POCD_HD000040 5251 templateId 1..1 SHALL 1198- 5252 @root 1..1 SHALL 1198- 2.16.840.1.113883.10.20.22.1.1 10036 @extension 1..1 SHALL 1198- 2015-08-01 32503 id 1..1 SHALL 1198- 5363 code 1..1 SHALL 1198- 5253 title 1..1 SHALL 1198- 5254 effectiveTime 1..1 SHALL 1198- US Realm Date and Time

Advance Directives - Template Revisions March 29 Page 2 5256 (DTM.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.4 confidentialityCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.1.11.16926 5259 (HL7 BasicConfidentialityKind) languageCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.1.11.11526 5372 (Language) setId 0..1 MAY 1198- 5261 versionNumber 0..1 MAY 1198- 5264 recordTarget 1..* SHALL 1198- 5266 patientRole 1..1 SHALL 1198- 5267 id 1..* SHALL 1198- 5268 addr 1..* SHALL 1198- US Realm Address 5271 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 telecom 1..* SHALL 1198- 5280 @use 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.20 5375 (Telecom Use (US Realm Header)) patient 1..1 SHALL 1198- 5283 name 1..* SHALL 1198- US Realm Person Name 5284 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 administrativeGenderCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.1.11.1 6394 (Administrative Gender (HL7 V3)) birthTime 1..1 SHALL 1198- 5298 maritalStatusCode 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.1.11.12212 5303 (Marital Status) religiousAffiliationCode 0..1 MAY 1198- urn:oid:2.16.840.1.113883.1.11.19185 5317 (Religious Affiliation) raceCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.3.2074.1.1.3 5322 (Race Category Excluding Nulls) sdtc:raceCode 0..* MAY 1198- urn:oid:2.16.840.1.113883.1.11.14914 7263 (Race) ethnicGroupCode 1..1 SHALL 1198- urn:oid:2.16.840.1.114222.4.11.837 5323 (Ethnicity) sdtc:ethnicGroupCode 0..* MAY 1198- urn:oid:2.16.840.1.114222.4.11.877 32901 (Detailed Ethnicity) guardian 0..* MAY 1198-

Advance Directives - Template Revisions March 29 Page 3 5325 code 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.12.1 5326 (Personal And Legal Relationship Role Type) addr 0..* SHOULD 1198- US Realm Address 5359 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 telecom 0..* SHOULD 1198- 5382 @use 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.20 7993 (Telecom Use (US Realm Header)) guardianPerson 1..1 SHALL 1198- 5385 name 1..* SHALL 1198- US Realm Person Name 5386 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 birthplace 0..1 MAY 1198- 5395 place 1..1 SHALL 1198- 5396 addr 1..1 SHALL 1198- 5397 country 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.3.88.12.80.6 5404 3 (Country) postalCode 0..1 MAY 1198- urn:oid:2.16.840.1.113883.3.88.12.80.2 5403 (PostalCode) languageCommunication 0..* SHOULD 1198- 5406 languageCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.1.11.11526 5407 (Language) modeCode 0..1 MAY 1198- urn:oid:2.16.840.1.113883.1.11.12249 5409 (LanguageAbilityMode) proficiencyLevelCode 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.1.11.12199 9965 (LanguageAbilityProficiency) preferenceInd 0..1 SHOULD 1198- 5414 providerOrganization 0..1 MAY 1198- 5416 id 1..* SHALL 1198- 5417 @root 0..1 SHOULD 1198- 2.16.840.1.113883.4.6 16820 name 1..* SHALL 1198- 5419 telecom 1..* SHALL 1198- 5420

Advance Directives - Template Revisions March 29 Page 4 @use 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.20 7994 (Telecom Use (US Realm Header)) addr 1..* SHALL 1198- US Realm Address 5422 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 author 1..* SHALL 1198- 5444 time 1..1 SHALL 1198- US Realm Date and Time 5445 (DTM.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.4 assignedAuthor 1..1 SHALL 1198- 5448 id 1..* SHALL 1198- 5449 id 0..1 SHOULD 1198- 32882 @nullFlavor 0..1 MAY 1198- urn:oid:2.16.840.1.113883.5.1008 32883 (HL7NullFlavor) = UNK @root 1..1 SHALL 1198- 2.16.840.1.113883.4.6 32884 @extension 0..1 SHOULD 1198- 32885 code 0..1 SHOULD 1198- 16787 @code 1..1 SHALL 1198- urn:oid:2.16.840.1.114222.4.11.1066 16788 (Healthcare Provider Taxonomy (HIPAA)) addr 1..* SHALL 1198- US Realm Address 5452 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 telecom 1..* SHALL 1198- 5428 @use 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.20 7995 (Telecom Use (US Realm Header)) assignedPerson 0..1 SHOULD 1198- 5430 name 1..* SHALL 1198- US Realm Person Name 16789 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 assignedAuthoringDevice 0..1 SHOULD 1198- 16783 manufacturerModelName 1..1 SHALL 1198- 16784 softwareName 1..1 SHALL 1198- 16785

Advance Directives - Template Revisions March 29 Page 5 dataEnterer 0..1 MAY 1198- 5441 assignedEntity 1..1 SHALL 1198- 5442 id 1..* SHALL 1198- 5443 @root 0..1 SHOULD 1198- 2.16.840.1.113883.4.6 16821 code 0..1 MAY 1198- urn:oid:2.16.840.1.114222.4.11.1066 32173 (Healthcare Provider Taxonomy (HIPAA)) addr 1..* SHALL 1198- US Realm Address 5460 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 telecom 1..* SHALL 1198- 5466 @use 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.20 7996 (Telecom Use (US Realm Header)) assignedPerson 1..1 SHALL 1198- 5469 name 1..* SHALL 1198- US Realm Person Name 5470 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 informant 0..* MAY 1198- 8001 assignedEntity 1..1 SHALL 1198- 8002 id 1..* SHALL 1198- 9945 code 0..1 MAY 1198- urn:oid:2.16.840.1.114222.4.11.1066 32174 (Healthcare Provider Taxonomy (HIPAA)) addr 1..* SHALL 1198- US Realm Address 8220 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 assignedPerson 1..1 SHALL 1198- 8221 name 1..* SHALL 1198- US Realm Person Name 8222 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 informant 0..* MAY 1198- 31355 relatedEntity 1..1 SHALL 1198- 31356 custodian 1..1 SHALL 1198-

Advance Directives - Template Revisions March 29 Page 6 5519 assignedCustodian 1..1 SHALL 1198- 5520 representedCustodianOrganization 1..1 SHALL 1198- 5521 id 1..* SHALL 1198- 5522 @root 0..1 SHOULD 1198- 2.16.840.1.113883.4.6 16822 name 1..1 SHALL 1198- 5524 telecom 1..1 SHALL 1198- 5525 @use 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.20 7998 (Telecom Use (US Realm Header)) addr 1..1 SHALL 1198- US Realm Address 5559 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 informationRecipient 0..* MAY 1198- 5565 intendedRecipient 1..1 SHALL 1198- 5566 id 0..* MAY 1198- 32399 informationRecipient 0..1 MAY 1198- 5567 name 1..* SHALL 1198- US Realm Person Name 5568 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 receivedOrganization 0..1 MAY 1198- 5577 name 1..1 SHALL 1198- 5578 legalAuthenticator 0..1 SHOULD 1198- 5579 time 1..1 SHALL 1198- US Realm Date and Time 5580 (DTM.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.4 signatureCode 1..1 SHALL 1198- 5583 @code 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.89 5584 (HL7ParticipationSignature) = S sdtc:signatureText 0..1 MAY 1198- 30810 assignedEntity 1..1 SHALL 1198-

Advance Directives - Template Revisions March 29 Page 7 5585 id 1..* SHALL 1198- 5586 @root 0..1 MAY 1198- 2.16.840.1.113883.4.6 16823 code 0..1 MAY 1198- urn:oid:2.16.840.1.114222.4.11.1066 17000 (Healthcare Provider Taxonomy (HIPAA)) addr 1..* SHALL 1198- US Realm Address 5589 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 telecom 1..* SHALL 1198- 5595 @use 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.20 7999 (Telecom Use (US Realm Header)) assignedPerson 1..1 SHALL 1198- 5597 name 1..* SHALL 1198- US Realm Person Name 5598 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 authenticator 0..* MAY 1198- 5607 time 1..1 SHALL 1198- US Realm Date and Time 5608 (DTM.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.4 signatureCode 1..1 SHALL 1198- 5610 @code 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.89 5611 (HL7ParticipationSignature) = S sdtc:signatureText 0..1 MAY 1198- 30811 assignedEntity 1..1 SHALL 1198- 5612 id 1..* SHALL 1198- 5613 @root 0..1 SHOULD 1198- 2.16.840.1.113883.4.6 16824 code 0..1 MAY 1198- 16825 @code 0..1 MAY 1198- urn:oid:2.16.840.1.114222.4.11.1066 16826 (Healthcare Provider Taxonomy (HIPAA)) addr 1..* SHALL 1198- US Realm Address 5616 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2

Advance Directives - Template Revisions March 29 Page 8 telecom 1..* SHALL 1198- 5622 @use 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.20 8000 (Telecom Use (US Realm Header)) assignedPerson 1..1 SHALL 1198- 5624 name 1..* SHALL 1198- US Realm Person Name 5625 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 participant 0..* MAY 1198- 10003 time 0..1 MAY 1198- 10004 inFulfillmentOf 0..* MAY 1198- 9952 order 1..1 SHALL 1198- 9953 id 1..* SHALL 1198- 9954 documentationOf 0..* MAY 1198- 14835 serviceEvent 1..1 SHALL 1198- 14836 effectiveTime 1..1 SHALL 1198- 14837 low 1..1 SHALL 1198- 14838 performer 0..* SHOULD 1198- 14839 @typeCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.1.11.19601 14840 (x_ServiceEventPerformer) functionCode 0..1 MAY 1198- 16818 @code 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.1.11.10267 32889 (ParticipationFunction) assignedEntity 1..1 SHALL 1198- 14841 id 1..* SHALL 1198- 14846 @root 0..1 SHOULD 1198- 2.16.840.1.113883.4.6 14847 code 0..1 SHOULD 1198- urn:oid:2.16.840.1.114222.4.11.1066 14842 (Healthcare Provider Taxonomy (HIPAA)) authorization 0..* MAY 1198- 16792 consent 1..1 SHALL 1198-

Advance Directives - Template Revisions March 29 Page 9 16793 id 0..* MAY 1198- 16794 code 0..1 MAY 1198- 16795 statusCode 1..1 SHALL 1198- 16797 @code 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.6 16798 (HL7ActClass) = completed componentOf 0..1 MAY 1198- 9955 encompassingEncounter 1..1 SHALL 1198- 9956 id 1..* SHALL 1198- 9959 effectiveTime 1..1 SHALL 1198- 9958

Properties realmCode 1. SHALL contain exactly one [1..1] realmCode="US" (CONF:1198-16791). 2. SHALL contain exactly one [1..1] typeId (CONF:1198-5361). a. This typeId SHALL contain exactly one [1..1] @root="2.16.840.1.113883.1.3" (CONF:1198-5250). b. This typeId SHALL contain exactly one [1..1] @extension="POCD_HD000040" (CONF:1198- 5251). 3. SHALL contain exactly one [1..1] templateId (CONF:1198-5252) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.1.1" (CONF:1198-10036). b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32503). 4. SHALL contain exactly one [1..1] id (CONF:1198-5363). a. This id SHALL be a globally unique identifier for the document (CONF:1198-9991).

5. SHALL contain exactly one [1..1] code (CONF:1198-5253). a. This code SHALL specify the particular kind of document (e.g., History and Physical, Discharge Summary, Progress Note) (CONF:1198-9992).

6. SHALL contain exactly one [1..1] title (CONF:1198-5254). Note: The title can either be a locally defined name or the displayName corresponding to clinicalDocument/code 7. SHALL contain exactly one [1..1] US Realm Date and Time (DTM.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.4) (CONF:1198-5256). 8. SHALL contain exactly one [1..1] confidentialityCode, which SHOULD be selected from ValueSet HL7 BasicConfidentialityKind urn:oid:2.16.840.1.113883.1.11.16926 STATIC (CONF:1198-5259).

Advance Directives - Template Revisions March 29 Page 10 9. SHALL contain exactly one [1..1] languageCode, which SHALL be selected from ValueSet Language urn:oid:2.16.840.1.113883.1.11.11526 DYNAMIC (CONF:1198-5372). 10. MAY contain zero or one [0..1] setId (CONF:1198-5261). a. If setId is present versionNumber SHALL be present (CONF:1198-6380).

11. MAY contain zero or one [0..1] versionNumber (CONF:1198-5264). a. If versionNumber is present setId SHALL be present (CONF:1198-6387). recordTarget The recordTarget records the administrative and demographic data of the patient whose health information is described by the clinical document; each recordTarget must contain at least one patientRole element

12. SHALL contain at least one [1..*] recordTarget (CONF:1198-5266). a. Such recordTargets SHALL contain exactly one [1..1] patientRole (CONF:1198-5267). a.i. This patientRole SHALL contain at least one [1..*] id (CONF:1198-5268). a.ii. This patientRole SHALL contain at least one [1..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198- 5271). a.iii.This patientRole SHALL contain at least one [1..*] telecom (CONF:1198-5280). a.iii.1. Such telecoms SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet Telecom Use (US Realm Header) urn:oid:2.16.840.1.113883.11.20.9.20 DYNAMIC (CONF:1198- 5375). a.iv.This patientRole SHALL contain exactly one [1..1] patient (CONF:1198-5283). a.iv.1. This patient SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-5284). a.iv.2. This patient SHALL contain exactly one [1..1] administrativeGenderCode, which SHALL be selected from ValueSet Administrative Gender (HL7 V3) urn:oid:2.16.840.1.113883.1.11.1 DYNAMIC (CONF:1198-6394). a.iv.3. This patient SHALL contain exactly one [1..1] birthTime (CONF:1198-5298). a.iv.3.a. SHALL be precise to year (CONF:1198-5299). a.iv.3.b. SHOULD be precise to day (CONF:1198-5300). For cases where information about newborn's time of birth needs to be captured. a.iv.3.c. MAY be precise to the minute (CONF:1198-32418).

a.iv.4. This patient SHOULD contain zero or one [0..1] maritalStatusCode, which SHALL be selected from ValueSet Marital Status urn:oid:2.16.840.1.113883.1.11.12212 DYNAMIC (CONF:1198- 5303). a.iv.5. This patient MAY contain zero or one [0..1] religiousAffiliationCode, which SHALL be selected from ValueSet Religious Affiliation urn:oid:2.16.840.1.113883.1.11.19185 DYNAMIC (CONF:1198- 5317).

Advance Directives - Template Revisions March 29 Page 11 a.iv.6. This patient SHALL contain exactly one [1..1] raceCode, which SHALL be selected from ValueSet Race Category Excluding Nulls urn:oid:2.16.840.1.113883.3.2074.1.1.3 DYNAMIC (CONF:1198- 5322). a.iv.7. This patient MAY contain zero or more [0..*] sdtc:raceCode, which SHALL be selected from ValueSet Race urn:oid:2.16.840.1.113883.1.11.14914 DYNAMIC (CONF:1198-7263). Note: The sdtc:raceCode is only used to record additional values when the patient has indicated multiple races or additional race detail beyond the five categories required for Meaningful Use Stage 2. The prefix sdtc: SHALL be bound to the namespace “urn:hl7-org:sdtc”. The use of the namespace provides a necessary extension to CDA R2 for the use of the additional raceCode elements. a.iv.7.a. If sdtc:raceCode is present, then the patient SHALL contain [1..1] raceCode (CONF:1198-31347).

a.iv.8. This patient SHALL contain exactly one [1..1] ethnicGroupCode, which SHALL be selected from ValueSet Ethnicity urn:oid:2.16.840.1.114222.4.11.837 DYNAMIC (CONF:1198-5323). a.iv.9. This patient MAY contain zero or more [0..*] sdtc:ethnicGroupCode, which SHALL be selected from ValueSet Detailed Ethnicity urn:oid:2.16.840.1.114222.4.11.877 DYNAMIC (CONF:1198-32901). a.iv.10. This patient MAY contain zero or more [0..*] guardian (CONF:1198-5325). a.iv.10.a. The guardian, if present, SHOULD contain zero or one [0..1] code, which SHALL be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:1198-5326). a.iv.10.b. The guardian, if present, SHOULD contain zero or more [0..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198- 5359). a.iv.10.c. The guardian, if present, SHOULD contain zero or more [0..*] telecom (CONF:1198-5382). a.iv.10.c.i. The telecom, if present, SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet Telecom Use (US Realm Header) urn:oid:2.16.840.1.113883.11.20.9.20 DYNAMIC (CONF:1198-7993). a.iv.10.d. The guardian, if present, SHALL contain exactly one [1..1] guardianPerson (CONF:1198-5385). a.iv.10.d.i.This guardianPerson SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-5386). a.iv.11. This patient MAY contain zero or one [0..1] birthplace (CONF:1198-5395). a.iv.11.a. The birthplace, if present, SHALL contain exactly one [1..1] place (CONF:1198-5396).

Advance Directives - Template Revisions March 29 Page 12 a.iv.11.a.i. This place SHALL contain exactly one [1..1] addr (CONF:1198-5397). a.iv.11.a.i.1.This addr SHOULD contain zero or one [0..1] country, which SHALL be selected from ValueSet Country urn:oid:2.16.840.1.113883.3.88.12.80.63 DYNAMIC (CONF:1198-5404). a.iv.11.a.i.2.This addr MAY contain zero or one [0..1] postalCode, which SHALL be selected from ValueSet PostalCode urn:oid:2.16.840.1.113883.3.88.12.80.2 DYNAMIC (CONF:1198-5403). a.iv.11.a.i.3.If country is US, this addr SHALL contain exactly one [1..1] state, which SHALL be selected from ValueSet StateValueSet 2.16.840.1.113883.3.88.12.80.1 DYNAMIC (CONF:1198-5402). Note: A nullFlavor of ' UNK' may be used if the state is unknown.

a.iv.12. This patient SHOULD contain zero or more [0..*] languageCommunication (CONF:1198-5406). a.iv.12.a. The languageCommunication, if present, SHALL contain exactly one [1..1] languageCode, which SHALL be selected from ValueSet Language urn:oid:2.16.840.1.113883.1.11.11526 DYNAMIC (CONF:1198-5407). a.iv.12.b. The languageCommunication, if present, MAY contain zero or one [0..1] modeCode, which SHALL be selected from ValueSet LanguageAbilityMode urn:oid:2.16.840.1.113883.1.11.12249 DYNAMIC (CONF:1198-5409). a.iv.12.c. The languageCommunication, if present, SHOULD contain zero or one [0..1] proficiencyLevelCode, which SHALL be selected from ValueSet LanguageAbilityProficiency urn:oid:2.16.840.1.113883.1.11.12199 DYNAMIC (CONF:1198-9965). a.iv.12.d. The languageCommunication, if present, SHOULD contain zero or one [0..1] preferenceInd (CONF:1198-5414). a.v. This patientRole MAY contain zero or one [0..1] providerOrganization (CONF:1198- 5416). a.v.1. The providerOrganization, if present, SHALL contain at least one [1..*] id (CONF:1198-5417). a.v.1.a. Such ids SHOULD contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-16820). a.v.2. The providerOrganization, if present, SHALL contain at least one [1..*] name (CONF:1198-5419). a.v.3. The providerOrganization, if present, SHALL contain at least one [1..*] telecom (CONF:1198-5420). a.v.3.a. Such telecoms SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet Telecom Use (US Realm Header)

Advance Directives - Template Revisions March 29 Page 13 urn:oid:2.16.840.1.113883.11.20.9.20 DYNAMIC (CONF:1198-7994). a.v.4. The providerOrganization, if present, SHALL contain at least one [1..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-5422). author The author element represents the creator of the clinical document. The author may be a device or a person.

13. SHALL contain at least one [1..*] author (CONF:1198-5444). a. Such authors SHALL contain exactly one [1..1] US Realm Date and Time (DTM.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.4) (CONF:1198-5445). b. Such authors SHALL contain exactly one [1..1] assignedAuthor (CONF:1198-5448). b.i. This assignedAuthor SHALL contain at least one [1..*] id (CONF:1198-5449). If this assignedAuthor is an assignedPerson

b.ii. This assignedAuthor SHOULD contain zero or one [0..1] id (CONF:1198-32882) such that it If id with @root="2.16.840.1.113883.4.6" National Provider Identifier is unknown then

b.ii.1. MAY contain zero or one [0..1] @nullFlavor="UNK" Unknown (CodeSystem: HL7NullFlavor urn:oid:2.16.840.1.113883.5.1008) (CONF:1198- 32883). b.ii.2. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-32884). b.ii.3. SHOULD contain zero or one [0..1] @extension (CONF:1198-32885). Only if this assignedAuthor is an assignedPerson should the assignedAuthor contain a code.

b.iii. This assignedAuthor SHOULD contain zero or one [0..1] code (CONF:1198-16787). b.iii.1.The code, if present, SHALL contain exactly one [1..1] @code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198- 16788). b.iv.This assignedAuthor SHALL contain at least one [1..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-5452). b.v. This assignedAuthor SHALL contain at least one [1..*] telecom (CONF:1198-5428). b.v.1. Such telecoms SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet Telecom Use (US Realm Header) urn:oid:2.16.840.1.113883.11.20.9.20 DYNAMIC (CONF:1198- 7995). b.vi.This assignedAuthor SHOULD contain zero or one [0..1] assignedPerson (CONF:1198- 5430). b.vi.1. The assignedPerson, if present, SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-16789).

Advance Directives - Template Revisions March 29 Page 14 b.vii.This assignedAuthor SHOULD contain zero or one [0..1] assignedAuthoringDevice (CONF:1198-16783). b.vii.1. The assignedAuthoringDevice, if present, SHALL contain exactly one [1..1] manufacturerModelName (CONF:1198-16784). b.vii.2. The assignedAuthoringDevice, if present, SHALL contain exactly one [1..1] softwareName (CONF:1198-16785). b.viii. There SHALL be exactly one assignedAuthor/assignedPerson or exactly one assignedAuthor/assignedAuthoringDevice (CONF:1198-16790). dataEnterer The dataEnterer element represents the person who transferred the content, written or dictated, into the clinical document. To clarify, an author provides the content found within the header or body of a document, subject to their own interpretation; a dataEnterer adds an author's information to the electronic system.

14. MAY contain zero or one [0..1] dataEnterer (CONF:1198-5441). a. The dataEnterer, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:1198- 5442). a.i. This assignedEntity SHALL contain at least one [1..*] id (CONF:1198-5443). a.i.1. Such ids SHOULD contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-16821). a.ii. This assignedEntity MAY contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-32173). a.iii.This assignedEntity SHALL contain at least one [1..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-5460). a.iv.This assignedEntity SHALL contain at least one [1..*] telecom (CONF:1198-5466). a.iv.1. Such telecoms SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet Telecom Use (US Realm Header) urn:oid:2.16.840.1.113883.11.20.9.20 DYNAMIC (CONF:1198- 7996). a.v. This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:1198- 5469). a.v.1. This assignedPerson SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-5470). informant The informant element describes an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient.

15. MAY contain zero or more [0..*] informant (CONF:1198-8001) such that it a. SHALL contain exactly one [1..1] assignedEntity (CONF:1198-8002). a.i. This assignedEntity SHALL contain at least one [1..*] id (CONF:1198-9945).

Advance Directives - Template Revisions March 29 Page 15 a.i.1. If assignedEntity/id is a provider then this id, SHOULD include zero or one [0..1] id where id/@root ="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-9946).

a.ii. This assignedEntity MAY contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-32174). a.iii.This assignedEntity SHALL contain at least one [1..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-8220). a.iv.This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:1198- 8221). a.iv.1. This assignedPerson SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-8222). informant The informant element describes an information source (who is not a provider) for any content within the clinical document. This informant would be used when the source of information has a personal relationship with the patient or is the patient.

16. MAY contain zero or more [0..*] informant (CONF:1198-31355) such that it a. SHALL contain exactly one [1..1] relatedEntity (CONF:1198-31356). custodian The custodian element represents the organization that is in charge of maintaining and is entrusted with the care of the document. There is only one custodian per CDA document. Allowing that a CDA document may not represent the original form of the authenticated document, the custodian represents the steward of the original source document. The custodian may be the document originator, a health information exchange, or other responsible party.

17. SHALL contain exactly one [1..1] custodian (CONF:1198-5519). a. This custodian SHALL contain exactly one [1..1] assignedCustodian (CONF:1198-5520). a.i. This assignedCustodian SHALL contain exactly one [1..1] representedCustodianOrganization (CONF:1198-5521). a.i.1. This representedCustodianOrganization SHALL contain at least one [1..*] id (CONF:1198-5522). a.i.1.a. Such ids SHOULD contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-16822). a.i.2. This representedCustodianOrganization SHALL contain exactly one [1..1] name (CONF:1198-5524). a.i.3. This representedCustodianOrganization SHALL contain exactly one [1..1] telecom (CONF:1198-5525). a.i.3.a. This telecom SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet Telecom Use (US Realm Header)

Advance Directives - Template Revisions March 29 Page 16 urn:oid:2.16.840.1.113883.11.20.9.20 DYNAMIC (CONF:1198-7998). a.i.4. This representedCustodianOrganization SHALL contain exactly one [1..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-5559). informationRecipient The informationRecipient element records the intended recipient of the information at the time the document was created. In cases where the intended recipient of the document is the patient's health chart, set the receivedOrganization to the scoping organization for that chart.

18. MAY contain zero or more [0..*] informationRecipient (CONF:1198-5565). a. The informationRecipient, if present, SHALL contain exactly one [1..1] intendedRecipient (CONF:1198-5566). a.i. This intendedRecipient MAY contain zero or more [0..*] id (CONF:1198-32399). a.ii. This intendedRecipient MAY contain zero or one [0..1] informationRecipient (CONF:1198-5567). a.ii.1. The informationRecipient, if present, SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-5568). a.iii.This intendedRecipient MAY contain zero or one [0..1] receivedOrganization (CONF:1198-5577). a.iii.1. The receivedOrganization, if present, SHALL contain exactly one [1..1] name (CONF:1198-5578). legalAuthenticator The legalAuthenticator identifies the single person legally responsible for the document and must be present if the document has been legally authenticated. A clinical document that does not contain this element has not been legally authenticated. The act of legal authentication requires a certain privilege be granted to the legal authenticator depending upon local policy. Based on local practice, clinical documents may be released before legal authentication. All clinical documents have the potential for legal authentication, given the appropriate credentials. Local policies MAY choose to delegate the function of legal authentication to a device or system that generates the clinical document. In these cases, the legal authenticator is a person accepting responsibility for the document, not the generating device or system. Note that the legal authenticator, if present, must be a person.

19. SHOULD contain zero or one [0..1] legalAuthenticator (CONF:1198-5579). a. The legalAuthenticator, if present, SHALL contain exactly one [1..1] US Realm Date and Time (DTM.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.4) (CONF:1198-5580). b. The legalAuthenticator, if present, SHALL contain exactly one [1..1] signatureCode (CONF:1198- 5583).

Advance Directives - Template Revisions March 29 Page 17 b.i. This signatureCode SHALL contain exactly one [1..1] @code="S" (CodeSystem: HL7ParticipationSignature urn:oid:2.16.840.1.113883.5.89 STATIC) (CONF:1198-5584). sdtc:signatureText The sdtc:signatureText extension provides a location in CDA for a textual or multimedia depiction of the signature by which the participant endorses and accepts responsibility for his or her participation in the Act as specified in the Participation.typeCode. Details of what goes in the field are described in the HL7 CDA Digital Signature Standard balloted in Fall 2013.

c. The legalAuthenticator, if present, MAY contain zero or one [0..1] sdtc:signatureText (CONF:1198-30810). Note: The signature can be represented either inline or by reference according to the ED data type. Typical cases for CDA are: 1) Electronic signature: this attribute can represent virtually any electronic signature scheme. 2) Digital signature: this attribute can represent digital signatures by reference to a signature data block that is constructed in accordance to a digital signature standard, such as XML-DSIG, PKCS#7, PGP, etc.

d. The legalAuthenticator, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:1198-5585). d.i. This assignedEntity SHALL contain at least one [1..*] id (CONF:1198-5586). d.i.1. Such ids MAY contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-16823). d.ii. This assignedEntity MAY contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-17000). d.iii. This assignedEntity SHALL contain at least one [1..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-5589). d.iv.This assignedEntity SHALL contain at least one [1..*] telecom (CONF:1198-5595). d.iv.1. Such telecoms SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet Telecom Use (US Realm Header) urn:oid:2.16.840.1.113883.11.20.9.20 DYNAMIC (CONF:1198- 7999). d.v. This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:1198- 5597). d.v.1. This assignedPerson SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-5598). authenticator The authenticator identifies a participant or participants who attest to the accuracy of the information in the document.

Advance Directives - Template Revisions March 29 Page 18 20. MAY contain zero or more [0..*] authenticator (CONF:1198-5607) such that it a. SHALL contain exactly one [1..1] US Realm Date and Time (DTM.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.4) (CONF:1198-5608). b. SHALL contain exactly one [1..1] signatureCode (CONF:1198-5610). b.i. This signatureCode SHALL contain exactly one [1..1] @code="S" (CodeSystem: HL7ParticipationSignature urn:oid:2.16.840.1.113883.5.89 STATIC) (CONF:1198-5611). The sdtc:signatureText extension provides a location in CDA for a textual or multimedia depiction of the signature by which the participant endorses and accepts responsibility for his or her participation in the Act as specified in the Participation.typeCode. Details of what goes in the field are described in the HL7 CDA Digital Signature Standard balloted in Fall of 2013.

c. MAY contain zero or one [0..1] sdtc:signatureText (CONF:1198-30811). Note: The signature can be represented either inline or by reference according to the ED data type. Typical cases for CDA are: 1) Electronic signature: this attribute can represent virtually any electronic signature scheme. 2) Digital signature: this attribute can represent digital signatures by reference to a signature data block that is constructed in accordance to a digital signature standard, such as XML-DSIG, PKCS#7, PGP, etc.

d. SHALL contain exactly one [1..1] assignedEntity (CONF:1198-5612). d.i. This assignedEntity SHALL contain at least one [1..*] id (CONF:1198-5613). d.i.1. Such ids SHOULD contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-16824). d.ii. This assignedEntity MAY contain zero or one [0..1] code (CONF:1198-16825). d.ii.1. The code, if present, MAY contain zero or one [0..1] @code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 STATIC (CONF:1198-16826). d.iii. This assignedEntity SHALL contain at least one [1..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-5616). d.iv.This assignedEntity SHALL contain at least one [1..*] telecom (CONF:1198-5622). d.iv.1. Such telecoms SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet Telecom Use (US Realm Header) urn:oid:2.16.840.1.113883.11.20.9.20 DYNAMIC (CONF:1198- 8000). d.v. This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:1198- 5624). d.v.1. This assignedPerson SHALL contain at least one [1..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-5625).

Advance Directives - Template Revisions March 29 Page 19 participant The participant element identifies supporting entities, including parents, relatives, caregivers, insurance policyholders, guarantors, and others related in some way to the patient. A supporting person or organization is an individual or an organization with a relationship to the patient. A supporting person who is playing multiple roles would be recorded in multiple participants (e.g., emergency contact and next-of-kin).

21. MAY contain zero or more [0..*] participant (CONF:1198-10003) such that it a. MAY contain zero or one [0..1] time (CONF:1198-10004). b. SHALL contain associatedEntity/associatedPerson AND/OR associatedEntity/scopingOrganization (CONF:1198-10006). c. When participant/@typeCode is IND, associatedEntity/@classCode SHOULD be selected from ValueSet 2.16.840.1.113883.11.20.9.33 INDRoleclassCodes STATIC 2011-09-30 (CONF:1198- 10007). inFulfillmentOf The inFulfillmentOf element represents orders that are fulfilled by this document such as a radiologists’ report of an x-ray.

22. MAY contain zero or more [0..*] inFulfillmentOf (CONF:1198-9952). a. The inFulfillmentOf, if present, SHALL contain exactly one [1..1] order (CONF:1198-9953). a.i. This order SHALL contain at least one [1..*] id (CONF:1198-9954). documentationOf 23. MAY contain zero or more [0..*] documentationOf (CONF:1198-14835). A serviceEvent represents the main act being documented, such as a colonoscopy or a cardiac stress study. In a provision of healthcare serviceEvent, the care providers, PCP, or other longitudinal providers, are recorded within the serviceEvent. If the document is about a single encounter, the providers associated can be recorded in the componentOf/encompassingEncounter template.

a. The documentationOf, if present, SHALL contain exactly one [1..1] serviceEvent (CONF:1198- 14836). a.i. This serviceEvent SHALL contain exactly one [1..1] effectiveTime (CONF:1198-14837). a.i.1. This effectiveTime SHALL contain exactly one [1..1] low (CONF:1198-14838).

performer The performer participant represents clinicians who actually and principally carry out the serviceEvent. In a transfer of care this represents the healthcare providers involved in the current or pertinent historical care of the patient. Preferably, the patient’s key healthcare care team members would be listed, particularly their primary physician and any active consulting physicians, therapists, and counselors.

a.ii. This serviceEvent SHOULD contain zero or more [0..*] performer (CONF:1198-14839).

Advance Directives - Template Revisions March 29 Page 20 a.ii.1. The performer, if present, SHALL contain exactly one [1..1] @typeCode, which SHALL be selected from ValueSet x_ServiceEventPerformer urn:oid:2.16.840.1.113883.1.11.19601 STATIC (CONF:1198-14840). a.ii.2. The performer, if present, MAY contain zero or one [0..1] functionCode (CONF:1198-16818). a.ii.2.a. The functionCode, if present, SHOULD contain zero or one [0..1] @code, which SHOULD be selected from ValueSet ParticipationFunction urn:oid:2.16.840.1.113883.1.11.10267 STATIC (CONF:1198-32889). a.ii.3. The performer, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:1198-14841). a.ii.3.a. This assignedEntity SHALL contain at least one [1..*] id (CONF:1198- 14846). a.ii.3.a.i. Such ids SHOULD contain zero or one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier (CONF:1198-14847). a.ii.3.b. This assignedEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-14842). authorization The authorization element represents information about the patient’s consent. The type of consent is conveyed in consent/code. Consents in the header have been finalized (consent/statusCode must equal Completed) and should be on file. This specification does not address how 'Privacy Consent' is represented, but does not preclude the inclusion of ‘Privacy Consent’. The authorization consent is used for referring to consents that are documented elsewhere in the EHR or medical record for a health condition and/or treatment that is described in the CDA document.

24. MAY contain zero or more [0..*] authorization (CONF:1198-16792) such that it a. SHALL contain exactly one [1..1] consent (CONF:1198-16793). a.i. This consent MAY contain zero or more [0..*] id (CONF:1198-16794). a.ii. This consent MAY contain zero or one [0..1] code (CONF:1198-16795). Note: The type of consent (e.g., a consent to perform the related serviceEvent) is conveyed in consent/code. a.iii.This consent SHALL contain exactly one [1..1] statusCode (CONF:1198-16797). a.iii.1. This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:1198-16798). componentOf The encompassing encounter represents the setting of the clinical encounter during which the document act(s) or ServiceEvent(s) occurred. In order to represent providers associated with a specific encounter, they are recorded within the encompassingEncounter as participants. In a CCD, the encompassingEncounter may be used when

Advance Directives - Template Revisions March 29 Page 21 documenting a specific encounter and its participants. All relevant encounters in a CCD may be listed in the encounters section.

25. MAY contain zero or one [0..1] componentOf (CONF:1198-9955). a. The componentOf, if present, SHALL contain exactly one [1..1] encompassingEncounter (CONF:1198-9956). a.i. This encompassingEncounter SHALL contain at least one [1..*] id (CONF:1198-9959). a.ii. This encompassingEncounter SHALL contain exactly one [1..1] effectiveTime (CONF:1198-9958).

Figure 1: US Realm Header (V3) Example

Patient Chart Summary . . .

Advance Directives - Template Revisions March 29 Page 22 Figure 2: recordTarget Example

2222 Home Street Beaverton OR 97867 US Eve Betterhalf Eve Everywoman

Advance Directives - Template Revisions March 29 Page 23 2222 Home Street Beaverton OR 97867 US Boris Bo Betterhalf 4444 Home Street Beaverton OR 97867 US

Advance Directives - Template Revisions March 29 Page 24 The DoctorsTogether Physician Group 1007 Health Drive Portland OR 99123 US

Advance Directives - Template Revisions March 29 Page 25 Figure 3: author Example

1004 Healthcare Drive Portland OR 99123 US Patricia Patty Primary M.D.

Advance Directives - Template Revisions March 29 Page 26 Figure 4: dateEnterer Example

1007 Healthcare Drive Portland OR 99123 US Ellen Enter

Advance Directives - Template Revisions March 29 Page 27 Figure 5: Assigned Health Care Provider informant Example

1007 Healthcare Drive Portland OR 99123 US Harold Hippocrates M.D. The DoctorsApart Physician Group

Advance Directives - Template Revisions March 29 Page 28 Figure 6: Personal Relation informant Example

Boris Bo Betterhalf

Figure 7: custodian Example

Good Health HIE 1009 Healthcare Drive Portland OR 99123 US

Advance Directives - Template Revisions March 29 Page 29 Figure 8: informationRecipient Example

Sara Specialize M.D. The DoctorsApart Physician Group

Figure 9: Digital signature Example

omSJUEdmde9j44zmMiromSJUEdmde9j44zmMirdMDSsWdIJdksIJR3373jeu83 6edjzMMIjdMDSsWdIJdksIJR3373jeu83MNYD83jmMdomSJUEdmde9j44zmMir ... MNYD83jmMdomSJUEdmde9j44zmMir6edjzMMIjdMDSsWdIJdksIJR3373jeu83 4zmMir6edjzMMIjdMDSsWdIJdksIJR3373jeu83==

Advance Directives - Template Revisions March 29 Page 30 Figure 10: legalAuthenticator Example

Advance Directives - Template Revisions March 29 Page 31 Figure 11: authenticator Example

Advance Directives - Template Revisions March 29 Page 32 Figure 12: Supporting Person participant Example

2222 Home Street Beaverton OR 97867 US Boris Bo Betterhalf 2222 Home Street Beaverton OR 97867 US Boris

Advance Directives - Template Revisions March 29 Page 33 Bo Betterhalf

Figure 13: inFulfillmentOf Example

Advance Directives - Template Revisions March 29 Page 34 Figure 14: performer Example

Primary Care Provider 1004 Healthcare Drive Portland OR 99123 US Patricia Patty Primary M.D. The DoctorsTogether Physician Group 1004 Health Drive Portland OR 99123

Advance Directives - Template Revisions March 29 Page 35 US

Advance Directives - Template Revisions March 29 Page 36 Figure 15: documentationOf Example

Primary Care Provider 1004 Healthcare Drive Portland OR 99123 US Patricia Patty Primary

Advance Directives - Template Revisions March 29 Page 37 M.D. The DoctorsTogether Physician Group 1004 Health Drive Portland OR 99123 US

Figure 16: authorization Example

US Realm Header for Patient Generated Document [ClinicalDocument: identifier urn:hl7ii:2.16.840.1.113883.10.20.29.1:2017-05- 01 (open)] Draft as part of Advance Directives - Template Revisions This template is designed to be used in conjunction with the US Realm Header (V2). It includes additional conformances which further constrain the US Realm Header (V2).

Advance Directives - Template Revisions March 29 Page 38 The Patient Generated Document Header template is not a separate document type. The document body may contain any structured or unstructured content from C-CDA.

Table 3: US Realm Header for Patient Generated Document Constraints Overview

XPath Card. Verb Data CONF# Value Type ClinicalDocument (identifier: urn:hl7ii:2.16.840.1.113883.10.20.29.1:2017-05-01) templateId 1..1 SHALL 3332- 28458 @root 1..1 SHALL 3332- 2.16.840.1.113883.10.20.29.1 28459 @extension 1..1 SHALL 3332- 2015-08-01 32917 recordTarget 1..1 SHALL 3332- 28460 patientRole 1..1 SHALL 3332- 28461 id 1..* SHALL 3332- 28462 patient 1..1 SHALL 3332- 28465 guardian 0..* MAY 3332- 28469 id 0..* SHOULD 3332- 28470 code 0..1 SHOULD 3332- urn:oid:2.16.840.1.113883.11.20.12.1 28473 (Personal And Legal Relationship Role Type) languageCommunication 0..* SHOULD 3332- 28474 preferenceInd 0..1 MAY 3332- 28475 providerOrganization 0..1 MAY 3332- 28476 author 1..* SHALL 3332- 28477 assignedAuthor 1..1 SHALL 3332- 28478 id 1..* SHALL 3332- 28479 code 0..1 SHOULD 3332- 28481 @code 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.11.20.12.1 28676 (Personal And Legal Relationship Role Type) dataEnterer 0..1 MAY 3332- 28678

Advance Directives - Template Revisions March 29 Page 39 assignedEntity 1..1 SHALL 3332- 28679 code 0..1 MAY 3332- urn:oid:2.16.840.1.113883.11.20.12.1 28680 (Personal And Legal Relationship Role Type) informant 0..* MAY 3332- 28681 relatedEntity 1..1 SHALL 3332- 28682 code 0..1 MAY 3332- 28683 @code 0..1 SHOULD 3332- urn:oid:2.16.840.1.113883.11.20.12.1 28684 (Personal And Legal Relationship Role Type) custodian 1..1 SHALL 3332- 28685 assignedCustodian 1..1 SHALL 3332- 28686 representedCustodianOrganization 1..1 SHALL 3332- 28687 id 1..* SHALL 3332- 28688 informationRecipient 0..* MAY 3332- 28690 intendedRecipient 1..1 SHALL 3332- 28691 id 0..* SHOULD 3332- 28692 @root 0..1 SHOULD 3332- 28693 legalAuthenticator 0..1 MAY 3332- 28694 assignedEntity 1..1 SHALL 3332- 28695 id 1..* SHALL 3332- 28696 code 0..1 MAY 3332- 28697 @code 0..1 MAY 3332- urn:oid:2.16.840.1.113883.11.20.12.1 28698 (Personal And Legal Relationship Role Type) authenticator 0..* MAY 3332- 28699 assignedEntity 1..1 SHALL 3332- 28700 id 1..* SHALL 3332- 28701 code 0..1 SHOULD 3332- urn:oid:2.16.840.1.113883.11.20.12.1

Advance Directives - Template Revisions March 29 Page 40 28702 (Personal And Legal Relationship Role Type) participant 0..* MAY 3332- 28703 @typeCode 1..1 SHALL 3332- 28704 associatedEntity 1..1 SHALL 3332- 28705 code 0..1 SHOULD 3332- urn:oid:2.16.840.1.113883.11.20.12.1 28706 (Personal And Legal Relationship Role Type) inFulfillmentOf 0..* MAY 3332- 28707 order 1..1 SHALL 3332- 28708 id 1..* SHALL 3332- 28709 documentationOf 0..* MAY 3332- 28710 serviceEvent 1..1 SHALL 3332- 28711 code 0..1 SHOULD 3332- 28712 performer 0..* SHOULD 3332- 28713 functionCode 0..1 MAY 3332- 28714 assignedEntity 1..1 SHALL 3332- 28715 id 1..* SHALL 3332- 28716 code 0..1 MAY 3332- urn:oid:2.16.840.1.113883.11.20.12.1 28718 (Personal And Legal Relationship Role Type)

1. Conforms to US Realm Header (V3) template (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.1.1:2015-08-01). 2. SHALL contain exactly one [1..1] templateId (CONF:3332-28458) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.29.1" (CONF:3332- 28459). b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:3332-32917). c. When asserting this templateId, all C-CDA 2.1 section and entry templates that had a previous version in C-CDA R1.1 SHALL include both the C-CDA 2.1 templateId and the C-CDA R1.1 templateId root without an extension. See C-CDA R2.1 Volume 1 - Design Considerations for additional detail (CONF:3332-32945).

Advance Directives - Template Revisions March 29 Page 41 The recordTarget records the patient whose health information is described by the clinical document; each recordTarget must contain at least one patientRole element. If the document receiver is interested in setting up a translator for the encounter with the patient, the receiver of the document will have to infer the need for a translator, based upon the language skills identified for the patient, the patient’s language of preference and the predominant language used by the organization receiving the CDA. HL7 Vocabulary simply describes guardian as a relationship to a ward. This need not be a formal legal relationship. When a guardian relationship exists for the patient, it can be represented, regardless of who is present at the time the document is generated. This need not be a formal legal relationship. A child’s parent can be represented in the guardian role. In this case, the guardian/code element would encode the personal relationship of "mother" for the child’s mom or "father" for the child’s dad. An elderly person's child can be represented in the guardian role. In this case, the guardian/code element would encode the personal relationship of "daughter" or "son", or if a legal relationship existed, the relationship of "legal guardian" could be encoded.

3. SHALL contain exactly one [1..1] recordTarget (CONF:3332-28460). a. This recordTarget SHALL contain exactly one [1..1] patientRole (CONF:3332-28461). a.i. This patientRole SHALL contain at least one [1..*] id (CONF:3332-28462). a.ii. This patientRole SHALL contain exactly one [1..1] patient (CONF:3332-28465). a.ii.1. This patient MAY contain zero or more [0..*] guardian (CONF:3332-28469). a.ii.1.a. The guardian, if present, SHOULD contain zero or more [0..*] id (CONF:3332-28470). a.ii.1.b. The guardian, if present, SHOULD contain zero or one [0..1] code, which SHALL be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332-28473). a.ii.2. This patient SHOULD contain zero or more [0..*] languageCommunication (CONF:3332-28474). a.ii.2.a. The languageCommunication, if present, MAY contain zero or one [0..1] preferenceInd (CONF:3332-28475). Note: Indicates a preference for information about care delivery and treatments be communicated (or translated if needed) into this language.

If more than one languageCommunication is present, only one languageCommunication element SHALL have a preferenceInd with a value of 1.

If present, this organization represents the provider organization where the person is claiming to be a patient.

a.iii.This patientRole MAY contain zero or one [0..1] providerOrganization (CONF:3332- 28476). Note: If present, this organization represents the provider organization where the person is claiming to be a patient. The author element represents the creator of the clinical document. The author may be a device, or a person. The person is the patient or the patient’s advocate.

4. SHALL contain at least one [1..*] author (CONF:3332-28477). a. Such authors SHALL contain exactly one [1..1] assignedAuthor (CONF:3332-28478).

Advance Directives - Template Revisions March 29 Page 42 a.i. This assignedAuthor SHALL contain at least one [1..*] id (CONF:3332-28479). When the author is a person who is not acting in the role of a clinician, this code encodes the personal or legal relationship between author and the patient.

a.ii. This assignedAuthor SHOULD contain zero or one [0..1] code (CONF:3332-28481). a.ii.1. The code, if present, SHALL contain exactly one [1..1] @code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332- 28676). The dataEnterer element represents the person who transferred the content, written or dictated by someone else, into the clinical document. The guiding rule of thumb is that an author provides the content found within the header or body of the document, subject to their own interpretation, and the dataEnterer adds that information to the electronic system. In other words, a dataEnterer transfers information from one source to another (e.g., transcription from paper form to electronic system). If the dataEnterer is missing, this role is assumed to be played by the author.

5. MAY contain zero or one [0..1] dataEnterer (CONF:3332-28678). a. The dataEnterer, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:3332- 28679). a.i. This assignedEntity MAY contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332-28680). The informant element describes the source of the information in a medical document. Assigned health care providers may be a source of information when a document is created. (e.g., a nurse's aide who provides information about a recent significant health care event that occurred within an acute care facility.) In these cases, the assignedEntity element is used. When the informant is a personal relation, that informant is represented in the relatedEntity element, even if the personal relation is a medical professional. The code element of the relatedEntity describes the relationship between the informant and the patient. The relationship between the informant and the patient needs to be described to help the receiver of the clinical document understand the information in the document. Each informant can be either an assignedEntity (a clinician serving the patient) OR a relatedEntity (a person with a personal or legal relationship with the patient). The constraints here apply to relatedEntity.

6. MAY contain zero or more [0..*] informant (CONF:3332-28681) such that it a. SHALL contain exactly one [1..1] relatedEntity (CONF:3332-28682). a.i. This relatedEntity MAY contain zero or one [0..1] code (CONF:3332-28683). a.i.1. The code, if present, SHOULD contain zero or one [0..1] @code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332- 28684). The custodian element represents the organization or person that is in charge of maintaining the document. The custodian is the steward that is entrusted with the care of the document. Every CDA document has exactly one custodian. The custodian participation satisfies the CDA definition of Stewardship. Because CDA is an exchange standard and may not represent the original form of the authenticated document (e.g., CDA could include scanned copy of original), the custodian represents the steward of the original source document. The custodian may be the document originator, a health information exchange, or other responsible party. Also, the custodian may be the patient or an organization acting on behalf of the patient, such as a PHR organization.

Advance Directives - Template Revisions March 29 Page 43 7. SHALL contain exactly one [1..1] custodian (CONF:3332-28685). a. This custodian SHALL contain exactly one [1..1] assignedCustodian (CONF:3332-28686). The representedCustodianOrganization may be the person when the document is not maintained by an organization.

a.i. This assignedCustodian SHALL contain exactly one [1..1] representedCustodianOrganization (CONF:3332-28687). The combined @root and @extension attributes record the custodian organization’s identity in a secure, trusted, and unique way.

a.i.1. This representedCustodianOrganization SHALL contain at least one [1..*] id (CONF:3332-28688). The informationRecipient element records the intended recipient of the information at the time the document is created. For example, in cases where the intended recipient of the document is the patient's health chart, set the receivedOrganization to be the scoping organization for that chart.

8. MAY contain zero or more [0..*] informationRecipient (CONF:3332-28690). a. The informationRecipient, if present, SHALL contain exactly one [1..1] intendedRecipient (CONF:3332-28691). The combined @root and @extension attributes to record the information recipient’s identity in a secure, trusted, and unique way.

a.i. This intendedRecipient SHOULD contain zero or more [0..*] id (CONF:3332-28692). For a provider, the id/@root ="2.16.840.1.113883.4.6" indicates the National Provider Identifier where id/@extension is the NPI number for the provider. The ids MAY reference the id of a person or organization entity specified elsewhere in the document.

a.i.1. The id, if present, SHOULD contain zero or one [0..1] @root (CONF:3332- 28693). In a patient authored document, the legalAuthenticator identifies the single person legally responsible for the document and must be present if the document has been legally authenticated. (Note that per the following section, there may also be one or more document authenticators.) Based on local practice, patient authored documents may be provided without legal authentication. This implies that a patient authored document that does not contain this element has not been legally authenticated. The act of legal authentication requires a certain privilege be granted to the legal authenticator depending upon local policy. All patient documents have the potential for legal authentication, given the appropriate legal authority. Local policies MAY choose to delegate the function of legal authentication to a device or system that generates the document. In these cases, the legal authenticator is the person accepting responsibility for the document, not the generating device or system. Note that the legal authenticator, if present, must be a person.

9. MAY contain zero or one [0..1] legalAuthenticator (CONF:3332-28694). a. The legalAuthenticator, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:3332-28695). The combined @root and @extension attributes to record the information recipient’s identity in a secure, trusted, and unique way.

Advance Directives - Template Revisions March 29 Page 44 a.i. This assignedEntity SHALL contain at least one [1..*] id (CONF:3332-28696). a.ii. This assignedEntity MAY contain zero or one [0..1] code (CONF:3332-28697). a.ii.1. The code, if present, MAY contain zero or one [0..1] @code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332- 28698). 10. MAY contain zero or more [0..*] authenticator (CONF:3332-28699). a. The authenticator, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:3332- 28700). The combined @root and @extension attributes to record the authenticator’s identity in a secure, trusted, and unique way.

a.i. This assignedEntity SHALL contain at least one [1..*] id (CONF:3332-28701). a.ii. This assignedEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332-28702). The participant element identifies other supporting participants, including parents, relatives, caregivers, insurance policyholders, guarantors, and other participants related in some way to the patient. A supporting person or organization is an individual or an organization with a relationship to the patient. A supporting person who is playing multiple roles would be recorded in multiple participants (e.g., emergency contact and next-of-kin)

11. MAY contain zero or more [0..*] participant (CONF:3332-28703). Unless otherwise specified by the document specific header constraints, when participant/@typeCode is IND, associatedEntity/@classCode SHALL be selected from ValueSet 2.16.840.1.113883.11.20.9.33 INDRoleclassCodes STATIC 2011-09-30

a. The participant, if present, SHALL contain exactly one [1..1] @typeCode (CONF:3332-28704). b. The participant, if present, SHALL contain exactly one [1..1] associatedEntity (CONF:3332- 28705). b.i. This associatedEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332-28706). 12. MAY contain zero or more [0..*] inFulfillmentOf (CONF:3332-28707). a. The inFulfillmentOf, if present, SHALL contain exactly one [1..1] order (CONF:3332-28708). A scheduled appointment or service event in a practice management system may be represented using this id element.

a.i. This order SHALL contain at least one [1..*] id (CONF:3332-28709). 13. MAY contain zero or more [0..*] documentationOf (CONF:3332-28710). a. The documentationOf, if present, SHALL contain exactly one [1..1] serviceEvent (CONF:3332- 28711). The code should be selected from a value set established by the document-level template for a specific type of Patient Generated Document.

a.i. This serviceEvent SHOULD contain zero or one [0..1] code (CONF:3332-28712).

Advance Directives - Template Revisions March 29 Page 45 a.ii. This serviceEvent SHOULD contain zero or more [0..*] performer (CONF:3332-28713). The functionCode SHALL be selected from value set ParticipationType 2.16.840.1.113883.1.11.10901 When indicating the performer was the primary care physician the functionCode shall be =”PCP”

a.ii.1. The performer, if present, MAY contain zero or one [0..1] functionCode (CONF:3332-28714). a.ii.2. The performer, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:3332-28715). The combined @root and @extension attributes record the performer’s identity in a secure, trusted, and unique way.

a.ii.2.a. This assignedEntity SHALL contain at least one [1..*] id (CONF:3332- 28716). If the assignedEntity is an individual, the code SHOULD be selected from value set PersonalandLegalRelationshipRoleType value set

a.ii.2.b. This assignedEntity MAY contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332-28718).

Advance Directives - Template Revisions March 29 Page 46 Figure 17: Patient Generated Document recordTarget Example

2222 Home Street Beaverton OR 97867 US Eve Betterhalf Eve Everywoman

Advance Directives - Template Revisions March 29 Page 47 2222 Home Street Beaverton OR 97867 US Boris Bo Betterhalf 4444 Home Street Beaverton OR 97867

Advance Directives - Template Revisions March 29 Page 48 US The DoctorsTogether Physician Group 1007 Health Drive Portland OR 99123 US

Advance Directives - Template Revisions March 29 Page 49 Figure 18: Patient Generated Document author Example

2222 Home Street Boston MA 02368 US Adam Everyman

Advance Directives - Template Revisions March 29 Page 50 Figure 19: Patient Generated Document author device Example

ACME PHR MyPHR v1.0 ACME PHR Solutions, Inc. 4 Future Way Provenance RI 02919

Advance Directives - Template Revisions March 29 Page 51 Figure 20: Patient Generated Document dataEnterer Example

Advance Directives - Template Revisions March 29 Page 52 Figure 21: Patient Generated Document informant Example

Advance Directives - Template Revisions March 29 Page 53 Figure 22: Patient Generated Document informant RelEnt Example

2222 Home Street Boston MA 02368 US Alice Everyman

Advance Directives - Template Revisions March 29 Page 54 Figure 23: Patient Generated Document custodian Example

MyPersonalHealthRecord.Com 123 Boylston Street Blue Hill MA 02368 USA

Advance Directives - Template Revisions March 29 Page 55 Figure 24: Patient Generated Document informationRecipient

Adam Everyman MyPersonalHealthRecord.Com

Advance Directives - Template Revisions March 29 Page 56 Dr. Patricia Primary Good Health Internal Medicine 100 Health Drive Boston MA 02368 USA

Advance Directives - Template Revisions March 29 Page 57 Figure 25: Patient Generated Document legalAuthenticator Example

Advance Directives - Template Revisions March 29 Page 58 Figure 26: Patient Generated Document authenticator Example

Advance Directives - Template Revisions March 29 Page 59 Figure 27: Patient Generated Document participant Example

17 Daws Rd. Blue Bell MA 02368 US Mrs. Martha Mum

Figure 28: Patient Generated Document inFulfillmentOf Example

Advance Directives - Template Revisions March 29 Page 60 2 S E C T I O N

Advance Directives Section (entries optional) [section: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.2.21:2017-05-01 (open)] Draft as part of Advance Directives - Template Revisions

Table 4: Advance Directives Section (entries optional) Contexts

Contained By: Contains: Advance Directive Observation (V3) Advance Directive Organizer (V2)

This section contains data defining the patient’s advance directives and any reference to supporting documentation, including living wills, healthcare proxies, and CPR and resuscitation status. If the referenced documents are available, they can be included in the exchange package. The most recent directives are required, if known, and should be listed in as much detail as possible. This section differentiates between "advance directives" and "advance directive documents". The former is the directions to be followed whereas the latter refers to a legal document containing those directions.

Table 5: Advance Directives Section (entries optional) Constraints Overview

XPath Card. Verb Data CONF# Value Type section (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.2.21:2017-05-01) templateId 1..1 SHALL 3332- 7928 @root 1..1 SHALL 3332- 2.16.840.1.113883.10.20.22.2.21 10376 @extension 1..1 SHALL 3332- 2015-08-01 32497 code 1..1 SHALL 3332- 15340 @code 1..1 SHALL 3332- 42348-3 15342 @codeSystem 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.6.1 (LOINC) 30812 = 2.16.840.1.113883.6.1 title 1..1 SHALL 3332- 7930 text 1..1 SHALL 3332- 7931 entry 0..* MAY 3332- 7957 observation 1..1 SHALL 3332- Advance Directive Observation

Advance Directives - Template Revisions March 29 Page 61 15443 (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.2 2.4.48:2015-08-01 entry 0..* MAY 3332- 32891 organizer 1..1 SHALL 3332- Advance Directive Organizer (V2) 32892 (identifier: urn:hl7ii:2.16.840.1.113883.10.20.2 2.4.108:2015-08-01

1. SHALL contain exactly one [1..1] templateId (CONF:3332-7928) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.2.21" (CONF:3332-10376). b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:3332-32497). 2. SHALL contain exactly one [1..1] code (CONF:3332-15340). a. This code SHALL contain exactly one [1..1] @code="42348-3" Advance Directives (CONF:3332- 15342). b. This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3332-30812). 3. SHALL contain exactly one [1..1] title (CONF:3332-7930). 4. SHALL contain exactly one [1..1] text (CONF:3332-7931). 5. MAY contain zero or more [0..*] entry (CONF:3332-7957) such that it a. SHALL contain exactly one [1..1] Advance Directive Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) (CONF:3332-15443). 6. MAY contain zero or more [0..*] entry (CONF:3332-32891) such that it a. SHALL contain exactly one [1..1] Advance Directive Organizer (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2015-08-01) (CONF:3332-32892).

Advance Directives Section (entries optional) (V3) [section: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.2.21:2015-08-01 (open)] Published as part of Consolidated CDA Templates for Clinical Notes (US Realm) DSTU R2.1

Table 6: Advance Directives Section (entries optional) (V3) Contexts

This section contains data defining the patient’s advance directives and any reference to supporting documentation, including living wills, healthcare proxies, and CPR and resuscitation status. If the referenced documents are available, they can be included in the exchange package. The most recent directives are required, if known, and should be listed in as much detail as possible.

Advance Directives - Template Revisions March 29 Page 62 This section differentiates between "advance directives" and "advance directive documents". The former is the directions to be followed whereas the latter refers to a legal document containing those directions.

Table 7: Advance Directives Section (entries optional) (V3) Constraints Overview

XPath Card. Verb Data CONF# Value Type section (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.2.21:2015-08-01) templateId 1..1 SHALL 1198- 7928 @root 1..1 SHALL 1198- 2.16.840.1.113883.10.20.22.2.21 10376 @extension 1..1 SHALL 1198- 2015-08-01 32497 code 1..1 SHALL 1198- 15340 @code 1..1 SHALL 1198- 42348-3 15342 @codeSystem 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.6.1 (LOINC) 30812 = 2.16.840.1.113883.6.1 title 1..1 SHALL 1198- 7930 text 1..1 SHALL 1198- 7931 entry 0..* MAY 1198- 7957 observation 1..1 SHALL 1198- Advance Directive Observation 15443 (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.2 2.4.48:2015-08-01 entry 0..* MAY 1198- 32891 organizer 1..1 SHALL 1198- Advance Directive Organizer (V2) 32892 (identifier: urn:hl7ii:2.16.840.1.113883.10.20.2 2.4.108:2015-08-01

1. SHALL contain exactly one [1..1] templateId (CONF:1198-7928) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.2.21" (CONF:1198-10376). b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32497). 2. SHALL contain exactly one [1..1] code (CONF:1198-15340). a. This code SHALL contain exactly one [1..1] @code="42348-3" Advance Directives (CONF:1198- 15342). b. This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:1198-30812). 3. SHALL contain exactly one [1..1] title (CONF:1198-7930).

Advance Directives - Template Revisions March 29 Page 63 4. SHALL contain exactly one [1..1] text (CONF:1198-7931). 5. MAY contain zero or more [0..*] entry (CONF:1198-7957) such that it a. SHALL contain exactly one [1..1] Advance Directive Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) (CONF:1198-15443). 6. MAY contain zero or more [0..*] entry (CONF:1198-32891) such that it a. SHALL contain exactly one [1..1] Advance Directive Organizer (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2015-08-01) (CONF:1198-32892).

Advance Directives Section (entries required) [section: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.2.21.1:2017-05-01 (open)] Draft as part of Advance Directives - Template Revisions

Table 8: Advance Directives Section (entries required) Contexts

This section contains data defining the patient’s advance directives and any reference to supporting documentation, including living wills, healthcare proxies, and CPR and resuscitation status. If the referenced documents are available, they can be included in the exchange package. The most recent directives are required, if known, and should be listed in as much detail as possible. This section differentiates between "advance directives" and "advance directive documents". The former is the directions to be followed whereas the latter refers to a legal document containing those directions.

Table 9: Advance Directives Section (entries required) Constraints Overview

XPath Card. Verb Data CONF# Value Type section (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.2.21.1:2017-05-01) @nullFlavor 0..1 MAY 3332- urn:oid:2.16.840.1.113883.5.1008 32800 (HL7NullFlavor) = NI templateId 1..1 SHALL 3332- 30227 @root 1..1 SHALL 3332- 2.16.840.1.113883.10.20.22.2.21.1 30228 @extension 1..1 SHALL 3332- 2015-08-01 32512 code 1..1 SHALL 3332- 32929 @code 1..1 SHALL 3332- 42348-3 32930 @codeSystem 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.6.1 (LOINC) 32931 = 2.16.840.1.113883.6.1

Advance Directives - Template Revisions March 29 Page 64 title 1..1 SHALL 3332- 32932 text 1..1 SHALL 3332- 32933 entry 1..* SHALL 3332- 30235 observation 0..1 MAY 3332- Advance Directive Observation 30236 (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.2 2.4.48:2015-08-01 organizer 0..1 MAY 3332- Advance Directive Organizer (V2) 32420 (identifier: urn:hl7ii:2.16.840.1.113883.10.20.2 2.4.108:2015-08-01

1. Conforms to Advance Directives Section (entries optional) (V3) template (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.2.21:2015-08-01). 2. MAY contain zero or one [0..1] @nullFlavor="NI" No information (CodeSystem: HL7NullFlavor urn:oid:2.16.840.1.113883.5.1008) (CONF:3332-32800). 3. SHALL contain exactly one [1..1] templateId (CONF:3332-30227) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.2.21.1" (CONF:3332-30228). b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:3332-32512). 4. SHALL contain exactly one [1..1] code (CONF:3332-32929). a. This code SHALL contain exactly one [1..1] @code="42348-3" Advance Directives (CONF:3332- 32930). b. This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3332-32931). 5. SHALL contain exactly one [1..1] title (CONF:3332-32932). 6. SHALL contain exactly one [1..1] text (CONF:3332-32933). If section/@nullFlavor is not present SHALL contain an Advance Directive Observation (V2) OR an Advance Directive Organizer (NEW):

7. SHALL contain at least one [1..*] entry (CONF:3332-30235) such that it a. MAY contain zero or one [0..1] Advance Directive Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) (CONF:3332-30236). b. MAY contain zero or one [0..1] Advance Directive Organizer (V2) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2015-08-01) (CONF:3332-32420). c. This entry SHALL contain EITHER an Advance Directive Observation (V2) OR an Advance Directive Organizer (CONF:3332-32881).

Advance Directives - Template Revisions March 29 Page 65 Figure 29: Advance Directives Section (V3) Example

Advance Directives - Template Revisions March 29 Page 66 3 E N T RY

Advance Directive Observation [observation: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2017-05-01 (open)] Draft as part of Advance Directives - Template Revisions

Table 10: Advance Directive Observation Contexts

Contained By: Contains: Author Participation US Realm Address (AD.US.FIELDED) US Realm Person Name (PN.US.FIELDED)

This clinical statement represents Advance Directive Observation findings (e.g., “resuscitation status is Full Code”) rather than orders. It should not be considered a legal document or a substitute for the actual Advance Directive document. The related legal documents are referenced using the reference/externalReference element. The Advance Directive Observation describes the patient’s directives, including but not limited to: • Medications • Transfer of Care to Hospital • Treatment • Procedures • Intubation and Ventilation • Diagnostic Tests • Tests The observation/value element contains the detailed patient directive which may be coded or text. For example, a category directive may be antibiotics, and the details would be intravenous antibiotics only.

Table 11: Advance Directive Observation Constraints Overview

XPath Card. Verb Data CONF# Value Type observation (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2017-05-01) @classCode 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.6 8648 (HL7ActClass) = OBS @moodCode 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.1001 8649 (HL7ActMood) = EVN templateId 1..1 SHALL 3332- 8655 @root 1..1 SHALL 3332- 2.16.840.1.113883.10.20.22.4.48 10485

Advance Directives - Template Revisions March 29 Page 67 @extension 1..1 SHALL 3332- 2015-08-01 32496 id 1..* SHALL 3332- 8654 code 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.1.11.20.2 8651 (AdvanceDirectiveTypeCode) translation 1..1 SHALL 3332- 32842 @code 1..1 SHALL 3332- 75320-2 32843 @codeSystem 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.6.1 (LOINC) 32844 = 2.16.840.1.113883.6.1 statusCode 1..1 SHALL 3332- 8652 @code 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.14 19082 (HL7ActStatus) = completed effectiveTime 1..1 SHALL 3332- 8656 low 1..1 SHALL 3332- 28719 high 1..1 SHALL 3332- 15521 value 1..1 SHALL 3332- 30804 author 0..* SHOULD 3332- Author Participation (identifier: 32406 urn:oid:2.16.840.1.113883.10.20.22 .4.119 participant 0..* SHOULD 3332- 8662 @typeCode 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.90 8663 (HL7ParticipationType) = VRF templateId 1..1 SHALL 3332- 8664 @root 1..1 SHALL 3332- 2.16.840.1.113883.10.20.1.58 10486 time 0..1 SHOULD 3332- 8665 participantRole 1..1 SHALL 3332- 8825 code 0..1 SHOULD 3332- urn:oid:2.16.840.1.114222.4.11.1066 28446 (Healthcare Provider Taxonomy (HIPAA)) addr 0..* MAY 3332- US Realm Address 28451 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 playingEntity 0..1 MAY 3332- 28428

Advance Directives - Template Revisions March 29 Page 68 code 0..1 SHOULD 3332- urn:oid:2.16.840.1.113883.11.20.9.51 28429 (Healthcare Agent Qualifier) name 0..* MAY 3332- US Realm Person Name 28454 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 participant 0..* SHOULD 3332- 8667 @typeCode 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.90 8668 (HL7ParticipationType) = CST participantRole 1..1 SHALL 3332- 8669 @classCode 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.110 8670 (HL7RoleClass) = AGNT code 0..1 SHOULD 3332- urn:oid:2.16.840.1.113883.11.20.12.1 28440 (Personal And Legal Relationship Role Type) addr 0..1 SHOULD 3332- US Realm Address 8671 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 telecom 0..* SHOULD 3332- 8672 playingEntity 1..1 SHALL 3332- 8824 code 0..1 SHOULD 3332- urn:oid:2.16.840.1.113883.11.20.9.51 28444 (Healthcare Agent Qualifier) name 1..1 SHALL 3332- 8673 reference 1..* SHOULD 3332- 8692 @typeCode 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.1002 8694 (HL7ActRelationshipType) = REFR externalDocument 1..1 SHALL 3332- 8693 id 1..* SHALL 3332- 8695 text 0..1 MAY 3332- 8696 reference 0..1 MAY 3332- 8697

1. SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:3332-8648). 2. SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3332-8649). 3. SHALL contain exactly one [1..1] templateId (CONF:3332-8655) such that it

Advance Directives - Template Revisions March 29 Page 69 a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.48" (CONF:3332-10485). b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:3332-32496). 4. SHALL contain at least one [1..*] id (CONF:3332-8654). 5. SHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet AdvanceDirectiveTypeCode urn:oid:2.16.840.1.113883.1.11.20.2 STATIC 2006-10-17 (CONF:3332-8651). a. This code SHALL contain exactly one [1..1] translation (CONF:3332-32842) such that it a.i. SHALL contain exactly one [1..1] @code="75320-2" Advance directive (CONF:3332- 32843). a.ii. SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:3332-32844). 6. SHALL contain exactly one [1..1] statusCode (CONF:3332-8652). a. This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:3332-19082). 7. SHALL contain exactly one [1..1] effectiveTime (CONF:3332-8656). a. This effectiveTime SHALL contain exactly one [1..1] low (CONF:3332-28719). b. This effectiveTime SHALL contain exactly one [1..1] high (CONF:3332-15521). b.i. If the Advance Directive does not have a specified ending time, the element SHALL have the nullFlavor attribute set to NA (CONF:3332-32449).

8. SHALL contain exactly one [1..1] value (CONF:3332-30804) such that it a. If type CD, then value will be SNOMED-CT 2.16.840.1.113883.6.96 (CONF:3332-32493).

9. SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:3332-32406). The participant "VRF" represents the clinician(s) who verified the patient advance directive observation.

10. SHOULD contain zero or more [0..*] participant (CONF:3332-8662) such that it a. SHALL contain exactly one [1..1] @typeCode="VRF" Verifier (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:3332- 8663). b. SHALL contain exactly one [1..1] templateId (CONF:3332-8664) such that it b.i. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.1.58" (CONF:3332-10486). c. SHOULD contain zero or one [0..1] time (CONF:3332-8665). c.i. The data type of Observation/participant/time in a verification SHALL be TS (time stamp) (CONF:3332-8666).

d. SHALL contain exactly one [1..1] participantRole (CONF:3332-8825). d.i. This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:3332-28446). d.ii. This participantRole MAY contain zero or more [0..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:3332-28451).

Advance Directives - Template Revisions March 29 Page 70 d.iii. This participantRole MAY contain zero or one [0..1] playingEntity (CONF:3332- 28428). d.iii.1.The playingEntity, if present, SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Agent Qualifier urn:oid:2.16.840.1.113883.11.20.9.51 DYNAMIC (CONF:3332- 28429). d.iii.2.The playingEntity, if present, MAY contain zero or more [0..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:3332-28454). This custodian (CST) participant identifies a legal representative for the patient's advance directive. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. If there is more than one legal representative, a qualifier may be used to designate the legal representative as primary or secondary.

11. SHOULD contain zero or more [0..*] participant (CONF:3332-8667) such that it a. SHALL contain exactly one [1..1] @typeCode="CST" Custodian (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:3332- 8668). b. SHALL contain exactly one [1..1] participantRole (CONF:3332-8669). b.i. This participantRole SHALL contain exactly one [1..1] @classCode="AGNT" Agent (CodeSystem: HL7RoleClass urn:oid:2.16.840.1.113883.5.110 STATIC) (CONF:3332-8670). b.ii. This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:3332-28440). b.iii. This participantRole SHOULD contain zero or one [0..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:3332-8671). b.iv.This participantRole SHOULD contain zero or more [0..*] telecom (CONF:3332-8672). b.v. This participantRole SHALL contain exactly one [1..1] playingEntity (CONF:3332- 8824). b.v.1. This playingEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Agent Qualifier urn:oid:2.16.840.1.113883.11.20.9.51 DYNAMIC (CONF:3332- 28444). Record the name of the agent who can provide a copy of the Advance Directive in the name element.

b.v.2. This playingEntity SHALL contain exactly one [1..1] name (CONF:3332-8673). 12. SHOULD contain at least one [1..*] reference (CONF:3332-8692) such that it a. SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:3332-8694). b. SHALL contain exactly one [1..1] externalDocument (CONF:3332-8693). b.i. This externalDocument SHALL contain at least one [1..*] id (CONF:3332-8695). b.ii. This externalDocument MAY contain zero or one [0..1] text (CONF:3332-8696).

Advance Directives - Template Revisions March 29 Page 71 b.ii.1. The text, if present, MAY contain zero or one [0..1] reference (CONF:3332- 8697). b.ii.1.a. The URL of a referenced advance directive document MAY be present, and SHALL be represented in Observation/reference/ExternalDocument/text/reference (CONF:3332- 8698). b.ii.1.b. If a URL is referenced, then it SHOULD have a corresponding linkHTML element in narrative block (CONF:3332-8699).

Advance Directives - Template Revisions March 29 Page 72 Figure 30: Advance Directive Observation (V3) Example

Do not resuscitate

Advance Directives - Template Revisions March 29 Page 73 Nurse Nightingale RN Good Health Hospital ... Nurse Florence RN

Advance Directives - Template Revisions March 29 Page 74 ... Mrs. Martha Jones

Advance Directive Observation (V3) [observation: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01 (open)] Published as part of Consolidated CDA Templates for Clinical Notes (US Realm) DSTU R2.1

Table 12: Advance Directive Observation (V3) Contexts

Contained By: Contains: Advance Directive Organizer (V2) (required) Author Participation Advance Directives Section (entries optional) (V3)

Advance Directives - Template Revisions March 29 Page 75 Contained By: Contains: (optional) US Realm Address (AD.US.FIELDED) Advance Directives Section (entries optional) (optional) US Realm Person Name (PN.US.FIELDED) Advance Directives Section (entries required) (optional) Advance Directive Organizer (required)

This clinical statement represents Advance Directive Observation findings (e.g., “resuscitation status is Full Code”) rather than orders. It should not be considered a legal document or a substitute for the actual Advance Directive document. The related legal documents are referenced using the reference/externalReference element. The Advance Directive Observation describes the patient’s directives, including but not limited to: • Medications • Transfer of Care to Hospital • Treatment • Procedures • Intubation and Ventilation • Diagnostic Tests • Tests The observation/value element contains the detailed patient directive which may be coded or text. For example, a category directive may be antibiotics, and the details would be intravenous antibiotics only.

Table 13: Advance Directive Observation (V3) Constraints Overview

XPath Card. Verb Data CONF# Value Type observation (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) @classCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.6 8648 (HL7ActClass) = OBS @moodCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.1001 8649 (HL7ActMood) = EVN templateId 1..1 SHALL 1198- 8655 @root 1..1 SHALL 1198- 2.16.840.1.113883.10.20.22.4.48 10485 @extension 1..1 SHALL 1198- 2015-08-01 32496 id 1..* SHALL 1198- 8654 code 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.1.11.20.2 8651 (AdvanceDirectiveTypeCode) translation 1..1 SHALL 1198- 32842 @code 1..1 SHALL 1198- 75320-2 32843

Advance Directives - Template Revisions March 29 Page 76 @codeSystem 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.6.1 (LOINC) 32844 = 2.16.840.1.113883.6.1 statusCode 1..1 SHALL 1198- 8652 @code 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.14 19082 (HL7ActStatus) = completed effectiveTime 1..1 SHALL 1198- 8656 low 1..1 SHALL 1198- 28719 high 1..1 SHALL 1198- 15521 value 1..1 SHALL 1198- 30804 author 0..* SHOULD 1198- Author Participation (identifier: 32406 urn:oid:2.16.840.1.113883.10.20.22 .4.119 participant 0..* SHOULD 1198- 8662 @typeCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.90 8663 (HL7ParticipationType) = VRF templateId 1..1 SHALL 1198- 8664 @root 1..1 SHALL 1198- 2.16.840.1.113883.10.20.1.58 10486 time 0..1 SHOULD 1198- 8665 participantRole 1..1 SHALL 1198- 8825 code 0..1 SHOULD 1198- urn:oid:2.16.840.1.114222.4.11.1066 28446 (Healthcare Provider Taxonomy (HIPAA)) addr 0..* MAY 1198- US Realm Address 28451 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 playingEntity 0..1 MAY 1198- 28428 code 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.51 28429 (Healthcare Agent Qualifier) name 0..* MAY 1198- US Realm Person Name 28454 (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.1.1 participant 0..* SHOULD 1198- 8667 @typeCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.90 8668 (HL7ParticipationType) = CST

Advance Directives - Template Revisions March 29 Page 77 participantRole 1..1 SHALL 1198- 8669 @classCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.110 8670 (HL7RoleClass) = AGNT code 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.12.1 28440 (Personal And Legal Relationship Role Type) addr 0..1 SHOULD 1198- US Realm Address 8671 (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22 .5.2 telecom 0..* SHOULD 1198- 8672 playingEntity 1..1 SHALL 1198- 8824 code 0..1 SHOULD 1198- urn:oid:2.16.840.1.113883.11.20.9.51 28444 (Healthcare Agent Qualifier) name 1..1 SHALL 1198- 8673 reference 1..* SHOULD 1198- 8692 @typeCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.1002 8694 (HL7ActRelationshipType) = REFR externalDocument 1..1 SHALL 1198- 8693 id 1..* SHALL 1198- 8695 text 0..1 MAY 1198- 8696 reference 0..1 MAY 1198- 8697

1. SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6 STATIC) (CONF:1198-8648). 2. SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-8649). 3. SHALL contain exactly one [1..1] templateId (CONF:1198-8655) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.48" (CONF:1198-10485). b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32496). 4. SHALL contain at least one [1..*] id (CONF:1198-8654). 5. SHALL contain exactly one [1..1] code, which SHOULD be selected from ValueSet AdvanceDirectiveTypeCode urn:oid:2.16.840.1.113883.1.11.20.2 STATIC 2006-10-17 (CONF:1198-8651). a. This code SHALL contain exactly one [1..1] translation (CONF:1198-32842) such that it

Advance Directives - Template Revisions March 29 Page 78 a.i. SHALL contain exactly one [1..1] @code="75320-2" Advance directive (CONF:1198- 32843). a.ii. SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1) (CONF:1198-32844). 6. SHALL contain exactly one [1..1] statusCode (CONF:1198-8652). a. This statusCode SHALL contain exactly one [1..1] @code="completed" Completed (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14 STATIC) (CONF:1198-19082). 7. SHALL contain exactly one [1..1] effectiveTime (CONF:1198-8656). a. This effectiveTime SHALL contain exactly one [1..1] low (CONF:1198-28719). b. This effectiveTime SHALL contain exactly one [1..1] high (CONF:1198-15521). b.i. If the Advance Directive does not have a specified ending time, the element SHALL have the nullFlavor attribute set to NA (CONF:1198-32449).

8. SHALL contain exactly one [1..1] value (CONF:1198-30804) such that it a. If type CD, then value will be SNOMED-CT 2.16.840.1.113883.6.96 (CONF:1198-32493).

9. SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1198-32406). The participant "VRF" represents the clinician(s) who verified the patient advance directive observation.

10. SHOULD contain zero or more [0..*] participant (CONF:1198-8662) such that it a. SHALL contain exactly one [1..1] @typeCode="VRF" Verifier (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198- 8663). b. SHALL contain exactly one [1..1] templateId (CONF:1198-8664) such that it b.i. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.1.58" (CONF:1198-10486). c. SHOULD contain zero or one [0..1] time (CONF:1198-8665). c.i. The data type of Observation/participant/time in a verification SHALL be TS (time stamp) (CONF:1198-8666).

d. SHALL contain exactly one [1..1] participantRole (CONF:1198-8825). d.i. This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1198-28446). d.ii. This participantRole MAY contain zero or more [0..*] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-28451). d.iii. This participantRole MAY contain zero or one [0..1] playingEntity (CONF:1198- 28428). d.iii.1.The playingEntity, if present, SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Agent Qualifier urn:oid:2.16.840.1.113883.11.20.9.51 DYNAMIC (CONF:1198- 28429). d.iii.2.The playingEntity, if present, MAY contain zero or more [0..*] US Realm Person Name (PN.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) (CONF:1198-28454).

Advance Directives - Template Revisions March 29 Page 79 This custodian (CST) participant identifies a legal representative for the patient's advance directive. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. If there is more than one legal representative, a qualifier may be used to designate the legal representative as primary or secondary.

11. SHOULD contain zero or more [0..*] participant (CONF:1198-8667) such that it a. SHALL contain exactly one [1..1] @typeCode="CST" Custodian (CodeSystem: HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 STATIC) (CONF:1198- 8668). b. SHALL contain exactly one [1..1] participantRole (CONF:1198-8669). b.i. This participantRole SHALL contain exactly one [1..1] @classCode="AGNT" Agent (CodeSystem: HL7RoleClass urn:oid:2.16.840.1.113883.5.110 STATIC) (CONF:1198-8670). b.ii. This participantRole SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 DYNAMIC (CONF:1198-28440). b.iii. This participantRole SHOULD contain zero or one [0..1] US Realm Address (AD.US.FIELDED) (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) (CONF:1198-8671). b.iv.This participantRole SHOULD contain zero or more [0..*] telecom (CONF:1198-8672). b.v. This participantRole SHALL contain exactly one [1..1] playingEntity (CONF:1198- 8824). b.v.1. This playingEntity SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Agent Qualifier urn:oid:2.16.840.1.113883.11.20.9.51 DYNAMIC (CONF:1198- 28444). Record the name of the agent who can provide a copy of the Advance Directive in the name element.

b.v.2. This playingEntity SHALL contain exactly one [1..1] name (CONF:1198-8673). 12. SHOULD contain at least one [1..*] reference (CONF:1198-8692) such that it a. SHALL contain exactly one [1..1] @typeCode="REFR" Refers to (CodeSystem: HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 STATIC) (CONF:1198-8694). b. SHALL contain exactly one [1..1] externalDocument (CONF:1198-8693). b.i. This externalDocument SHALL contain at least one [1..*] id (CONF:1198-8695). b.ii. This externalDocument MAY contain zero or one [0..1] text (CONF:1198-8696). b.ii.1. The text, if present, MAY contain zero or one [0..1] reference (CONF:1198- 8697). b.ii.1.a. The URL of a referenced advance directive document MAY be present, and SHALL be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198- 8698). b.ii.1.b. If a URL is referenced, then it SHOULD have a corresponding linkHTML element in narrative block (CONF:1198-8699).

Advance Directives - Template Revisions March 29 Page 80 Figure 31: Advance Directive Observation (V3) Example

Do not resuscitate

Advance Directives - Template Revisions March 29 Page 81 Nurse Nightingale RN Good Health Hospital ... Nurse Florence RN

Advance Directives - Template Revisions March 29 Page 82 ... Mrs. Martha Jones

Advance Directive Organizer [organizer: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2017-05-01 (open)] Draft as part of Advance Directives - Template Revisions

Table 14: Advance Directive Organizer Contexts

Contained By: Contains: Advance Directive Observation (V3) Author Participation

Advance Directives - Template Revisions March 29 Page 83 This clinical statement groups a set of advance directive observations.

Table 15: Advance Directive Organizer Constraints Overview

XPath Card. Verb Data CONF# Value Type organizer (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2017-05-01) @classCode 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.6 28410 (HL7ActClass) = CLUSTER @moodCode 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.1001 28411 (HL7ActMood) = EVN templateId 1..1 SHALL 3332- 28412 @root 1..1 SHALL 3332- 2.16.840.1.113883.10.20.22.4.108 28413 @extension 1..1 SHALL 3332- 2015-08-01 32876 id 1..* SHALL 3332- 28414 code 1..1 SHALL 3332- 28415 @code 1..1 SHALL 3332- 45473-6 31230 @codeSystem 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.6.1 (LOINC) 31231 = 2.16.840.1.113883.6.1 statusCode 1..1 SHALL 3332- 28418 @code 1..1 SHALL 3332- urn:oid:2.16.840.1.113883.5.14 31346 (HL7ActStatus) = completed author 0..* SHOULD 3332- Author Participation (identifier: 32407 urn:oid:2.16.840.1.113883.10.20.22 .4.119 component 1..* SHALL 3332- 28420 observation 1..1 SHALL 3332- Advance Directive Observation 28421 (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.2 2.4.48:2015-08-01

1. SHALL contain exactly one [1..1] @classCode="CLUSTER" Cluster (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:3332-28410). 2. SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:3332-28411). 3. SHALL contain exactly one [1..1] templateId (CONF:3332-28412) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.108" (CONF:3332-28413).

Advance Directives - Template Revisions March 29 Page 84 b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:3332-32876). 4. SHALL contain at least one [1..*] id (CONF:3332-28414). 5. SHALL contain exactly one [1..1] code (CONF:3332-28415). a. This code SHALL contain exactly one [1..1] @code="45473-6" Advance directive - living will (CONF:3332-31230). b. This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1 STATIC) (CONF:3332-31231). 6. SHALL contain exactly one [1..1] statusCode (CONF:3332-28418). a. This statusCode SHALL contain exactly one [1..1] @code="completed" (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:3332-31346). 7. SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:3332-32407). 8. SHALL contain at least one [1..*] component (CONF:3332-28420) such that it a. SHALL contain exactly one [1..1] Advance Directive Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) (CONF:3332-28421).

Advance Directives - Template Revisions March 29 Page 85 Figure 32: Advance Directive Organizer Example

Nurse Nightingale RN Good Health Hospital ...

Advance Directives - Template Revisions March 29 Page 86 ...

Advance Directive Organizer (V2) [organizer: identifier urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2015-08-01 (open)] Published as part of Consolidated CDA Templates for Clinical Notes (US Realm) DSTU R2.1

Table 16: Advance Directive Organizer (V2) Contexts

Contained By: Contains: Advance Directives Section (entries optional) (V3) Advance Directive Observation (V3) (optional) Author Participation Advance Directives Section (entries optional) (optional) Advance Directives Section (entries required) (optional)

This clinical statement groups a set of advance directive observations.

Table 17: Advance Directive Organizer (V2) Constraints Overview

XPath Card. Verb Data CONF# Value Type organizer (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.108:2015-08-01)

Advance Directives - Template Revisions March 29 Page 87 @classCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.6 28410 (HL7ActClass) = CLUSTER @moodCode 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.1001 28411 (HL7ActMood) = EVN templateId 1..1 SHALL 1198- 28412 @root 1..1 SHALL 1198- 2.16.840.1.113883.10.20.22.4.108 28413 @extension 1..1 SHALL 1198- 2015-08-01 32876 id 1..* SHALL 1198- 28414 code 1..1 SHALL 1198- 28415 @code 1..1 SHALL 1198- 45473-6 31230 @codeSystem 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.6.1 (LOINC) 31231 = 2.16.840.1.113883.6.1 statusCode 1..1 SHALL 1198- 28418 @code 1..1 SHALL 1198- urn:oid:2.16.840.1.113883.5.14 31346 (HL7ActStatus) = completed author 0..* SHOULD 1198- Author Participation (identifier: 32407 urn:oid:2.16.840.1.113883.10.20.22 .4.119 component 1..* SHALL 1198- 28420 observation 1..1 SHALL 1198- Advance Directive Observation 28421 (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.2 2.4.48:2015-08-01

1. SHALL contain exactly one [1..1] @classCode="CLUSTER" Cluster (CodeSystem: HL7ActClass urn:oid:2.16.840.1.113883.5.6) (CONF:1198-28410). 2. SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: HL7ActMood urn:oid:2.16.840.1.113883.5.1001 STATIC) (CONF:1198-28411). 3. SHALL contain exactly one [1..1] templateId (CONF:1198-28412) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.108" (CONF:1198-28413). b. SHALL contain exactly one [1..1] @extension="2015-08-01" (CONF:1198-32876). 4. SHALL contain at least one [1..*] id (CONF:1198-28414). 5. SHALL contain exactly one [1..1] code (CONF:1198-28415). a. This code SHALL contain exactly one [1..1] @code="45473-6" Advance directive - living will (CONF:1198-31230).

Advance Directives - Template Revisions March 29 Page 88 b. This code SHALL contain exactly one [1..1] @codeSystem="2.16.840.1.113883.6.1" (CodeSystem: LOINC urn:oid:2.16.840.1.113883.6.1 STATIC) (CONF:1198-31231). 6. SHALL contain exactly one [1..1] statusCode (CONF:1198-28418). a. This statusCode SHALL contain exactly one [1..1] @code="completed" (CodeSystem: HL7ActStatus urn:oid:2.16.840.1.113883.5.14) (CONF:1198-31346). 7. SHOULD contain zero or more [0..*] Author Participation (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) (CONF:1198-32407). 8. SHALL contain at least one [1..*] component (CONF:1198-28420) such that it a. SHALL contain exactly one [1..1] Advance Directive Observation (V3) (identifier: urn:hl7ii:2.16.840.1.113883.10.20.22.4.48:2015-08-01) (CONF:1198-28421).

Advance Directives - Template Revisions March 29 Page 89 Figure 33: Advance Directive Organizer Example

Nurse Nightingale RN Good Health Hospital ...

Advance Directives - Template Revisions March 29 Page 90 ...

Advance Directives - Template Revisions March 29 Page 91 4 U N S P E C I F I E D

Author Participation [author: identifier urn:oid:2.16.840.1.113883.10.20.22.4.119 (open)] Published as part of Consolidated CDA Templates for Clinical Notes (US Realm) DSTU R2

Table 18: Author Participation Contexts

Contained By: Contains: Advance Directive Observation (V3) (optional) Advance Directive Organizer (V2) (optional) Advance Directive Observation (optional) Advance Directive Organizer (optional)

This template represents the Author Participation (including the author timestamp). CDA R2 requires that Author and Author timestamp be asserted in the document header. From there, authorship propagates to contained sections and contained entries, unless explicitly overridden. The Author Participation template was added to those templates in scope for analysis in R2. Although it is not explicitly stated in all templates the Author Participation template can be used in any template.

Table 19: Author Participation Constraints Overview

XPath Card. Verb Data CONF# Value Type author (identifier: urn:oid:2.16.840.1.113883.10.20.22.4.119) templateId 1..1 SHALL 1098- 32017 @root 1..1 SHALL 1098- 2.16.840.1.113883.10.20.22.4.119 32018 time 1..1 SHALL 1098- 31471 assignedAuthor 1..1 SHALL 1098- 31472 id 1..* SHALL 1098- 31473 code 0..1 SHOULD 1098- urn:oid:2.16.840.1.114222.4.11.1066 31671 (Healthcare Provider Taxonomy (HIPAA)) assignedPerson 0..1 MAY 1098- 31474 name 0..* MAY 1098- 31475 representedOrganization 0..1 MAY 1098- 31476

Advance Directives - Template Revisions March 29 Page 92 id 0..* MAY 1098- 31478 name 0..* MAY 1098- 31479 telecom 0..* MAY 1098- 31480 addr 0..* MAY 1098- 31481

1. SHALL contain exactly one [1..1] templateId (CONF:1098-32017) such that it a. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.119" (CONF:1098-32018). 2. SHALL contain exactly one [1..1] time (CONF:1098-31471). 3. SHALL contain exactly one [1..1] assignedAuthor (CONF:1098-31472). a. This assignedAuthor SHALL contain at least one [1..*] id (CONF:1098-31473). Note: This id may be set equal to (a pointer to) an id on a participant elsewhere in the document (header or entries) or a new author participant can be described here. If the id is pointing to a participant already described elsewhere in the document, assignedAuthor/id is sufficient to identify this participant and none of the remaining details of assignedAuthor are required to be set. Application Software must be responsible for resolving the identifier back to its original object and then rendering the information in the correct place in the containing section's narrative text. This id must be a pointer to another author participant. a.i. If the ID isn't referencing an author described elsewhere in the document, then the author components required in US Realm Header are required here as well (CONF:1098-32628).

b. This assignedAuthor SHOULD contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 DYNAMIC (CONF:1098-31671). b.i. If the content is patient authored the code SHOULD be selected from Personal And Legal Relationship Role Type (2.16.840.1.113883.11.20.12.1) (CONF:1098-32315).

c. This assignedAuthor MAY contain zero or one [0..1] assignedPerson (CONF:1098-31474). c.i. The assignedPerson, if present, MAY contain zero or more [0..*] name (CONF:1098-31475). d. This assignedAuthor MAY contain zero or one [0..1] representedOrganization (CONF:1098- 31476). d.i. The representedOrganization, if present, MAY contain zero or more [0..*] id (CONF:1098- 31478). d.ii. The representedOrganization, if present, MAY contain zero or more [0..*] name (CONF:1098- 31479). d.iii. The representedOrganization, if present, MAY contain zero or more [0..*] telecom (CONF:1098-31480). d.iv.The representedOrganization, if present, MAY contain zero or more [0..*] addr (CONF:1098- 31481).

Advance Directives - Template Revisions March 29 Page 93 Figure 34: New Author Participant Example

Nurse Nightingale RN Good Health Hospital

Figure 35: Existing Author Reference Example

Advance Directives - Template Revisions March 29 Page 94 US Realm Address (AD.US.FIELDED) [addr: identifier urn:oid:2.16.840.1.113883.10.20.22.5.2 (open)] Published as part of Consolidated CDA Templates for Clinical Notes (US Realm) DSTU R1.1

Table 20: US Realm Address (AD.US.FIELDED) Contexts

Contained By: Contains: Advance Directive Observation (V3) (optional) US Realm Header (V3) (required) Advance Directive Observation (optional)

Reusable address template, for use in US Realm CDA Header.

Table 21: US Realm Address (AD.US.FIELDED) Constraints Overview

XPath Card. Verb Data CONF# Value Type addr (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.2) @use 0..1 SHOULD 81- urn:oid:2.16.840.1.113883.1.11.10637 7290 (PostalAddressUse) country 0..1 SHOULD 81- urn:oid:2.16.840.1.113883.3.88.12.80.6 7295 3 (Country) state 0..1 SHOULD 81- urn:oid:2.16.840.1.113883.3.88.12.80.1 7293 (StateValueSet) city 1..1 SHALL 81- 7292 postalCode 0..1 SHOULD 81- urn:oid:2.16.840.1.113883.3.88.12.80.2 7294 (PostalCode) streetAddressLine 1..1 SHALL 81- 7291

1. SHOULD contain zero or one [0..1] @use, which SHALL be selected from ValueSet PostalAddressUse urn:oid:2.16.840.1.113883.1.11.10637 STATIC 2005-05-01 (CONF:81-7290). 2. SHOULD contain zero or one [0..1] country, which SHALL be selected from ValueSet Country urn:oid:2.16.840.1.113883.3.88.12.80.63 DYNAMIC (CONF:81-7295). 3. SHOULD contain zero or one [0..1] state (ValueSet: StateValueSet urn:oid:2.16.840.1.113883.3.88.12.80.1 DYNAMIC) (CONF:81-7293). a. State is required if the country is US. If country is not specified, it's assumed to be US. If country is something other than US, the state MAY be present but MAY be bound to different vocabularies (CONF:81-10024).

4. SHALL contain exactly one [1..1] city (CONF:81-7292). 5. SHOULD contain zero or one [0..1] postalCode, which SHOULD be selected from ValueSet PostalCode urn:oid:2.16.840.1.113883.3.88.12.80.2 DYNAMIC (CONF:81-7294).

Advance Directives - Template Revisions March 29 Page 95 a. PostalCode is required if the country is US. If country is not specified, it's assumed to be US. If country is something other than US, the postalCode MAY be present but MAY be bound to different vocabularies (CONF:81-10025).

6. SHALL contain exactly one [1..1] streetAddressLine (CONF:81-7291). 7. SHALL NOT have mixed content except for white space (CONF:81-7296).

Figure 36: US Realm Address Example

22 Sample Street Beaverton OR 97867 US

US Realm Date and Time (DTM.US.FIELDED) [effectiveTime: identifier urn:oid:2.16.840.1.113883.10.20.22.5.4 (open)] Published as part of Consolidated CDA Templates for Clinical Notes (US Realm) DSTU R1.1

Table 22: US Realm Date and Time (DTM.US.FIELDED) Contexts

Contained By: Contains: US Realm Header (V3) (required)

The US Realm Clinical Document Date and Time datatype flavor records date and time information. If no time zone offset is provided, you can make no assumption about time, unless you have made a local exchange agreement. This data type uses the same rules as US Realm Date and Time (DT.US.FIELDED), but is used with elements having a datatype of TS.

Table 23: US Realm Date and Time (DTM.US.FIELDED) Constraints Overview

X Card. Verb Data CONF# Value P Type a t h effectiveTime (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.4)

1. SHALL be precise to the day (CONF:81-10127). 2. SHOULD be precise to the minute (CONF:81-10128). 3. MAY be precise to the second (CONF:81-10129).

Advance Directives - Template Revisions March 29 Page 96 4. If more precise than day, SHOULD include time-zone offset (CONF:81-10130).

Figure 37: US Realm Date and Time Example

US Realm Person Name (PN.US.FIELDED) [name: identifier urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (open)] Published as part of Consolidated CDA Templates for Clinical Notes (US Realm) DSTU R1.1

Table 24: US Realm Person Name (PN.US.FIELDED) Contexts

Contained By: Contains: Advance Directive Observation (V3) (optional) US Realm Header (V3) (required) Advance Directive Observation (optional)

The US Realm Clinical Document Person Name datatype flavor is a set of reusable constraints that can be used for Persons.

Table 25: US Realm Person Name (PN.US.FIELDED) Constraints Overview

XPath Card. Verb Data CONF# Value Type name (identifier: urn:oid:2.16.840.1.113883.10.20.22.5.1.1) name 1..1 SHALL 81- 9368

1. SHALL contain exactly one [1..1] name (CONF:81-9368). a. The content of name SHALL be either a conformant Patient Name (PTN.US.FIELDED), or a string (CONF:81-9371). b. The string SHALL NOT contain name parts (CONF:81-9372).

Advance Directives - Template Revisions March 29 Page 97 5 T E M P L AT E I D S I N T H I S G U I D E

Table 26: Template List

Template Title Template Type templateId US Realm Header (V3) document urn:hl7ii:2.16.840.1.113883.10.20.22.1.1:2 015-08-01 US Realm Header for Patient document urn:hl7ii:2.16.840.1.113883.10.20.29.1:20 Generated Document 17-05-01 Advance Directives Section (entries section urn:hl7ii:2.16.840.1.113883.10.20.22.2.21: optional) 2017-05-01 Advance Directives Section (entries section urn:hl7ii:2.16.840.1.113883.10.20.22.2.21: optional) (V3) 2015-08-01 Advance Directives Section (entries section urn:hl7ii:2.16.840.1.113883.10.20.22.2.21. required) 1:2017-05-01 Advance Directive Observation entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.48: 2017-05-01 Advance Directive Observation (V3) entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.48: 2015-08-01 Advance Directive Organizer entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.10 8:2017-05-01 Advance Directive Organizer (V2) entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.10 8:2015-08-01 Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 US Realm Address unspecified urn:oid:2.16.840.1.113883.10.20.22.5.2 (AD.US.FIELDED) US Realm Date and Time unspecified urn:oid:2.16.840.1.113883.10.20.22.5.4 (DTM.US.FIELDED) US Realm Person Name unspecified urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (PN.US.FIELDED)

Table 27: Template Containments

Template Title Template Type templateId US Realm Header (V3) document urn:hl7ii:2.16.840.1.113883.10.20.22.1.1:2 015-08-01 US Realm Address unspecified urn:oid:2.16.840.1.113883.10.20.22.5.2 (AD.US.FIELDED) US Realm Date and Time unspecified urn:oid:2.16.840.1.113883.10.20.22.5.4 (DTM.US.FIELDED) US Realm Person Name unspecified urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (PN.US.FIELDED) US Realm Header for Patient document urn:hl7ii:2.16.840.1.113883.10.20.29.1:20 Generated Document 17-05-01 Advance Directives Section (entries section urn:hl7ii:2.16.840.1.113883.10.20.22.2.21:

Advance Directives - Template Revisions March 29 Page 98 Template Title Template Type templateId optional) 2017-05-01 Advance Directive Observation (V3) entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.48: 2015-08-01 Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 US Realm Address unspecified urn:oid:2.16.840.1.113883.10.20.22.5.2 (AD.US.FIELDED) US Realm Person Name unspecified urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (PN.US.FIELDED) Advance Directive Organizer (V2) entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.10 8:2015-08-01 Advance Directive Observation entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.48: (V3) 2015-08-01 Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 US Realm Address unspecified urn:oid:2.16.840.1.113883.10.20.22.5.2 (AD.US.FIELDED) US Realm Person Name unspecified urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (PN.US.FIELDED) Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 Advance Directives Section (entries section urn:hl7ii:2.16.840.1.113883.10.20.22.2.21. required) 1:2017-05-01 Advance Directive Observation (V3) entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.48: 2015-08-01 Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 US Realm Address unspecified urn:oid:2.16.840.1.113883.10.20.22.5.2 (AD.US.FIELDED) US Realm Person Name unspecified urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (PN.US.FIELDED) Advance Directive Organizer (V2) entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.10 8:2015-08-01 Advance Directive Observation entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.48: (V3) 2015-08-01 Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 US Realm Address unspecified urn:oid:2.16.840.1.113883.10.20.22.5.2 (AD.US.FIELDED) US Realm Person Name unspecified urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (PN.US.FIELDED) Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 Advance Directive Observation entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.48: 2017-05-01 Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 US Realm Address unspecified urn:oid:2.16.840.1.113883.10.20.22.5.2 (AD.US.FIELDED) US Realm Person Name unspecified urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (PN.US.FIELDED) Advance Directive Organizer entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.10

Advance Directives - Template Revisions March 29 Page 99 Template Title Template Type templateId 8:2017-05-01 Advance Directive Observation (V3) entry urn:hl7ii:2.16.840.1.113883.10.20.22.4.48: 2015-08-01 Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119 US Realm Address unspecified urn:oid:2.16.840.1.113883.10.20.22.5.2 (AD.US.FIELDED) US Realm Person Name unspecified urn:oid:2.16.840.1.113883.10.20.22.5.1.1 (PN.US.FIELDED) Author Participation unspecified urn:oid:2.16.840.1.113883.10.20.22.4.119

Advance Directives - Template Revisions March 29 Page 100 6 VAL U E S E T S I N T H I S G U I D E

Table 28: Race

Value Set: Race urn:oid:2.16.840.1.113883.1.11.14914 Concepts in the race value set include the 5 minimum categories for race specified by OMB along with a more detailed set of race categories used by the Bureau of Census. Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name 1002-5 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 American Indian or Alaska 8 Native 2028-9 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Asian 8 2054-5 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Black or African American 8 2076-8 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Native Hawaiian or Other 8 Pacific Islander 2106-3 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 White 8 1006-6 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Abenaki 8 1579-2 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Absentee Shawnee 8 1490-2 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Acoma 8 2126-1 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Afghanistani 8 1740-0 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Ahtna 8 ...

Table 29: HL7 BasicConfidentialityKind

Value Set: HL7 BasicConfidentialityKind urn:oid:2.16.840.1.113883.1.11.16926 A value set of HL7 Code indication the level of confidentiality an act. Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name N HL7Confidentiality urn:oid:2.16.840.1.113883.5.25 normal R HL7Confidentiality urn:oid:2.16.840.1.113883.5.25 restricted V HL7Confidentiality urn:oid:2.16.840.1.113883.5.25 very restricted

Advance Directives - Template Revisions March 29 Page 101 Table 30: Language

Value Set: Language urn:oid:2.16.840.1.113883.1.11.11526 A value set of codes defined by Internet RFC 4646 (replacing RFC 3066). Please see ISO 639 language code set maintained by Library of Congress for enumeration of language codes. Value Set Source: http://www.loc.gov/standards/iso639-2/php/code_list.php Code Code System Code System OID Print Name aa Language urn:oid:2.16.840.1.113883.6.12 Afar 1 ab Language urn:oid:2.16.840.1.113883.6.12 Abkhazian 1 ace Language urn:oid:2.16.840.1.113883.6.12 Achinese 1 ach Language urn:oid:2.16.840.1.113883.6.12 Acoli 1 ada Language urn:oid:2.16.840.1.113883.6.12 Adangme 1 ady Language urn:oid:2.16.840.1.113883.6.12 Adyghe; Adygei 1 ae Language urn:oid:2.16.840.1.113883.6.12 Avestan 1 af Language urn:oid:2.16.840.1.113883.6.12 Afrikaans 1 afa Language urn:oid:2.16.840.1.113883.6.12 Afro-Asiatic (Other) 1 afh Language urn:oid:2.16.840.1.113883.6.12 Afrihili 1 ...

Table 31: Telecom Use (US Realm Header)

Value Set: Telecom Use (US Realm Header) urn:oid:2.16.840.1.113883.11.20.9.20 Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name HP HL7AddressUse urn:oid:2.16.840.1.113883.5.11 Primary home 19 HV HL7AddressUse urn:oid:2.16.840.1.113883.5.11 Vacation home 19 WP HL7AddressUse urn:oid:2.16.840.1.113883.5.11 Work place 19 MC HL7AddressUse urn:oid:2.16.840.1.113883.5.11 Mobile contact 19

Advance Directives - Template Revisions March 29 Page 102 Table 32: Administrative Gender (HL7 V3)

Value Set: Administrative Gender (HL7 V3) urn:oid:2.16.840.1.113883.1.11.1 Administrative Gender based upon HL7 V3 vocabulary. This value set contains only male, female and undifferentiated concepts. Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name F HL7AdministrativeGender urn:oid:2.16.840.1.113883.5.1 Female M HL7AdministrativeGender urn:oid:2.16.840.1.113883.5.1 Male UN HL7AdministrativeGender urn:oid:2.16.840.1.113883.5.1 Undifferentiated

Table 33: Marital Status

Value Set: Marital Status urn:oid:2.16.840.1.113883.1.11.12212 Marital Status is the domestic partnership status of a person. Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name A HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Annulled D HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Divorced T HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Domestic partner I HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Interlocutory L HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Legally Separated M HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Married S HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Never Married P HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Polygamous W HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 Widowed

Table 34: Religious Affiliation

Value Set: Religious Affiliation urn:oid:2.16.840.1.113883.1.11.19185 A value set of codes that reflect spiritual faith affiliation. Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name 1001 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Adventist 76 1002 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 African Religions 76 1003 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Afro-Caribbean Religions 76 1004 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Agnosticism 76 1005 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Anglican 76 1006 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Animism 76

Advance Directives - Template Revisions March 29 Page 103 Value Set: Religious Affiliation urn:oid:2.16.840.1.113883.1.11.19185 A value set of codes that reflect spiritual faith affiliation. Value Set Source: https://vsac.nlm.nih.gov/ 1007 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Atheism 76 1008 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Babi & Baha'I faiths 76 1009 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Baptist 76 1010 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.10 Bon 76 ...

Table 35: Race Category Excluding Nulls

Value Set: Race Category Excluding Nulls urn:oid:2.16.840.1.113883.3.2074.1.1.3 Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name 1002-5 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 American Indian or Alaska 8 Native 2028-9 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Asian 8 2054-5 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Black or African American 8 2076-8 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Native Hawaiian or Other 8 Pacific Islander 2106-3 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 White 8

Table 36: Ethnicity

Value Set: Ethnicity urn:oid:2.16.840.1.114222.4.11.837 Code System: Race & Ethnicity - CDC 2.16.840.1.113883.6.238 Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name 2135-2 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Hispanic or Latino 8 2186-5 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Not Hispanic or Latino 8

Table 37: Personal And Legal Relationship Role Type

Value Set: Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 A personal or legal relationship records the role of a person in relation to another person, or a person to himself or herself. This value set is to be used when recording relationships based on personal or family ties or through legal assignment of responsibility. Value Set Source: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.11.20.12.1

Advance Directives - Template Revisions March 29 Page 104 Value Set: Personal And Legal Relationship Role Type urn:oid:2.16.840.1.113883.11.20.12.1 A personal or legal relationship records the role of a person in relation to another person, or a person to himself or herself. This value set is to be used when recording relationships based on personal or family ties or through legal assignment of responsibility. Value Set Source: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.113883.11.20.12.1 SELF HL7RoleCode urn:oid:2.16.840.1.113883.5.11 self 1 MTH HL7RoleCode urn:oid:2.16.840.1.113883.5.11 mother 1 FTH HL7RoleCode urn:oid:2.16.840.1.113883.5.11 father 1 DAU HL7RoleCode urn:oid:2.16.840.1.113883.5.11 natural daughter 1 SON HL7RoleCode urn:oid:2.16.840.1.113883.5.11 natural son 1 DAUINLAW HL7RoleCode urn:oid:2.16.840.1.113883.5.11 daughter in-law 1 SONINLAW HL7RoleCode urn:oid:2.16.840.1.113883.5.11 son in-law 1 GUARD HL7RoleCode urn:oid:2.16.840.1.113883.5.11 guardian 1 HPOWATT HL7RoleCode urn:oid:2.16.840.1.113883.5.11 healthcare power of attorney 1 ...

Table 38: Country

Value Set: Country urn:oid:2.16.840.1.113883.3.88.12.80.63 This identifies the codes for the representation of names of countries, territories and areas of geographical interest. Value Set Source: http://www.iso.org/iso/country_codes/iso_3166_code_lists.htm Code Code System Code System OID Print Name AW Country urn:oid:2.16.840.1.113883.3.88 Aruba .12.80.63 IL Country urn:oid:2.16.840.1.113883.3.88 Israel .12.80.63 ...

Table 39: PostalCode

Value Set: PostalCode urn:oid:2.16.840.1.113883.3.88.12.80.2 A value set of postal (ZIP) Code of an address in the United States Value Set Source: http://ushik.ahrq.gov/ViewItemDetails?system=mdr&itemKey=86671000 Code Code System Code System OID Print Name 19009 USPostalCodes urn:oid:2.16.840.1.113883.6.23 Bryn Athyn 1 92869-1736 USPostalCodes urn:oid:2.16.840.1.113883.6.23 Orange, CA 1

Advance Directives - Template Revisions March 29 Page 105 Value Set: PostalCode urn:oid:2.16.840.1.113883.3.88.12.80.2 A value set of postal (ZIP) Code of an address in the United States Value Set Source: http://ushik.ahrq.gov/ViewItemDetails?system=mdr&itemKey=86671000 32830-8413 USPostalCodes urn:oid:2.16.840.1.113883.6.23 Lake Buena Vista, FL 1 ...

Table 40: LanguageAbilityMode

Value Set: LanguageAbilityMode urn:oid:2.16.840.1.113883.1.11.12249 This identifies the language ability of the individual. A value representing the method of expression of the language. Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name ESGN HL7LanguageAbilityMode urn:oid:2.16.840.1.113883.5.60 Expressed signed ESP HL7LanguageAbilityMode urn:oid:2.16.840.1.113883.5.60 Expressed spoken EWR HL7LanguageAbilityMode urn:oid:2.16.840.1.113883.5.60 Expressed written RSGN HL7LanguageAbilityMode urn:oid:2.16.840.1.113883.5.60 Received signed RSP HL7LanguageAbilityMode urn:oid:2.16.840.1.113883.5.60 Received spoken RWR HL7LanguageAbilityMode urn:oid:2.16.840.1.113883.5.60 Received written

Table 41: LanguageAbilityProficiency

Value Set: LanguageAbilityProficiency urn:oid:2.16.840.1.113883.1.11.12199 Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name E HL7LanguageAbilityProficienc urn:oid:2.16.840.1.113883.5.61 Excellent y F HL7LanguageAbilityProficienc urn:oid:2.16.840.1.113883.5.61 Fair y G HL7LanguageAbilityProficienc urn:oid:2.16.840.1.113883.5.61 Good y P HL7LanguageAbilityProficienc urn:oid:2.16.840.1.113883.5.61 Poor y

Table 42: Detailed Ethnicity

Value Set: Detailed Ethnicity urn:oid:2.16.840.1.114222.4.11.877 List of detailed ethnicity codes reported on a limited basis Value Set Source: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.877 Code Code System Code System OID Print Name 2138-6 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Andalusian 8 2166-7 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Argentinean 8

Advance Directives - Template Revisions March 29 Page 106 Value Set: Detailed Ethnicity urn:oid:2.16.840.1.114222.4.11.877 List of detailed ethnicity codes reported on a limited basis Value Set Source: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.877 2139-4 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Asturian 8 2142-8 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Belearic Islander 8 2167-5 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Bolivian 8 2163-4 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Canal Zone 8 2145-1 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Canarian 8 2140-2 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Castillian 8 2141-0 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Catalonian 8 2155-0 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.23 Central American 8 ...

Table 43: Healthcare Provider Taxonomy (HIPAA)

Value Set: Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 The Health Care Provider Taxonomy value set is a collection of unique alphanumeric codes, ten characters in length. The code set is structured into three distinct Levels including Provider Type, Classification, and Area of Specialization. The Health Care Provider Taxonomy code set allows a single provider (individual, group, or institution) to identify their specialty category. Providers may have one or more than one value associated to them. When determining what value or values to associate with a provider, the user needs to review the requirements of the trading partner with which the value(s) are being used. Value Set Source: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.1066 Code Code System Code System OID Print Name 171100000X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Acupuncturist (HIPAA) 1 363LA2100X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Nurse Practitioner - Acute Care (HIPAA) 1 364SA2100X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Clinical Nurse Specialist - (HIPAA) 1 Acute Care 101YA0400X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Counselor - Addiction (HIPAA) 1 (Substance Use Disorder) 103TA0400X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Psychologist - Addiction (HIPAA) 1 (Substance Use Disorder) 163WA0400X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Registered Nurse - Addiction (HIPAA) 1 (Substance Use Disorder) 207LA0401X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Anesthesiology - Addiction (HIPAA) 1 Medicine 207QA0401X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Family Medicine - Addiction (HIPAA) 1 Medicine

Advance Directives - Template Revisions March 29 Page 107 Value Set: Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.114222.4.11.1066 The Health Care Provider Taxonomy value set is a collection of unique alphanumeric codes, ten characters in length. The code set is structured into three distinct Levels including Provider Type, Classification, and Area of Specialization. The Health Care Provider Taxonomy code set allows a single provider (individual, group, or institution) to identify their specialty category. Providers may have one or more than one value associated to them. When determining what value or values to associate with a provider, the user needs to review the requirements of the trading partner with which the value(s) are being used. Value Set Source: https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.1066 207RA0401X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Internal Medicine - Addiction (HIPAA) 1 Medicine 2084A0401X Healthcare Provider Taxonomy urn:oid:2.16.840.1.113883.6.10 Psychiatry & Neurology - (HIPAA) 1 Addiction Medicine ...

Table 44: INDRoleclassCodes

Value Set: INDRoleclassCodes urn:oid:2.16.840.1.113883.11.20.9.33 Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name PRS HL7RoleClass urn:oid:2.16.840.1.113883.5.11 personal relationship 0 NOK HL7RoleClass urn:oid:2.16.840.1.113883.5.11 next of kin 0 CAREGIVER HL7RoleClass urn:oid:2.16.840.1.113883.5.11 caregiver 0 AGNT HL7RoleClass urn:oid:2.16.840.1.113883.5.11 agent 0 GUAR HL7RoleClass urn:oid:2.16.840.1.113883.5.11 guarantor 0 ECON HL7RoleClass urn:oid:2.16.840.1.113883.5.11 emergency contact 0

Table 45: x_ServiceEventPerformer

Value Set: x_ServiceEventPerformer urn:oid:2.16.840.1.113883.1.11.19601 Value Set Source: http://www.hl7.org/documentcenter/public/standards/vocabulary/vocabulary_tables/infrastructure/vocabulary/voc abulary.html Code Code System Code System OID Print Name PRF HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 performer SPRF HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 secondary performer PPRF HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 primary performer

Advance Directives - Template Revisions March 29 Page 108 Table 46: ParticipationFunction

Value Set: ParticipationFunction urn:oid:2.16.840.1.113883.1.11.10267 This HL7-defined value set can be used to specify the exact function an actor had in a service in all necessary detail. Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name SNRS HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 Scrub nurse SASST HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 Second assistant surgeon _AuthorizedParticipationFuncti HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 AuthorizedParticipationFunctio on n _AuthorizedReceiverParticipati HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 AuthorizedReceiverParticipatio onFunction nFunction AUCG HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 caregiver information receiver AULR HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 legitimate relationship information receiver AUTM HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 care team information receiver AUWA HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 work area information receiver _ConsenterParticipationFunctio HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 ConsenterParticipationFunction n GRDCON HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 legal guardian consent author ...

Table 47: Healthcare Agent Qualifier

Value Set: Healthcare Agent Qualifier urn:oid:2.16.840.1.113883.11.20.9.51 A value set SNOMED-CT qualifier codes for representing principal and secondary. Value Set Source: https://vsac.nlm.nih.gov Code Code System Code System OID Print Name 63161005 SNOMED CT urn:oid:2.16.840.1.113883.6.96 Principal 2603003 SNOMED CT urn:oid:2.16.840.1.113883.6.96 Secondary

Table 48: PostalAddressUse

Value Set: PostalAddressUse urn:oid:2.16.840.1.113883.1.11.10637 A value set of HL7 Codes for address use. Value Set Source: https://vsac.nlm.nih.gov/ Code Code System Code System OID Print Name BAD HL7AddressUse urn:oid:2.16.840.1.113883.5.11 bad address 19 CONF HL7AddressUse urn:oid:2.16.840.1.113883.5.11 confidential 19 DIR HL7AddressUse urn:oid:2.16.840.1.113883.5.11 direct 19 H HL7AddressUse urn:oid:2.16.840.1.113883.5.11 home address 19

Advance Directives - Template Revisions March 29 Page 109 Value Set: PostalAddressUse urn:oid:2.16.840.1.113883.1.11.10637 A value set of HL7 Codes for address use. Value Set Source: https://vsac.nlm.nih.gov/ HP HL7AddressUse urn:oid:2.16.840.1.113883.5.11 primary home 19 HV HL7AddressUse urn:oid:2.16.840.1.113883.5.11 vacation home 19 PHYS HL7AddressUse urn:oid:2.16.840.1.113883.5.11 physical visit address 19 PST HL7AddressUse urn:oid:2.16.840.1.113883.5.11 postal address 19 PUB HL7AddressUse urn:oid:2.16.840.1.113883.5.11 public 19 TMP HL7AddressUse urn:oid:2.16.840.1.113883.5.11 temporary 19 ...

Table 49: StateValueSet

Value Set: StateValueSet urn:oid:2.16.840.1.113883.3.88.12.80.1 Identifies addresses within the United States are recorded using the FIPS 5-2 two-letter alphabetic codes for the State, District of Columbia, or an outlying area of the United States or associated area Value Set Source: http://www.census.gov/geo/reference/ansi_statetables.html Code Code System Code System OID Print Name AL FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Alabama AK FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Alaska AZ FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Arizona AR FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Arkansas CA FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 California CO FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Colorado CT FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Connecticut DE FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Delaware DC FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 District of Columbia FL FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Florida ...

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Table 50: Code Systems

Name OID Country urn:oid:2.16.840.1.113883.3.88.12.80.63 FIPS 5-2 (State) urn:oid:2.16.840.1.113883.6.92 Healthcare Provider Taxonomy (HIPAA) urn:oid:2.16.840.1.113883.6.101 HL7ActClass urn:oid:2.16.840.1.113883.5.6 HL7ActMood urn:oid:2.16.840.1.113883.5.1001 HL7ActRelationshipType urn:oid:2.16.840.1.113883.5.1002 HL7ActStatus urn:oid:2.16.840.1.113883.5.14 HL7AddressUse urn:oid:2.16.840.1.113883.5.1119 HL7AdministrativeGender urn:oid:2.16.840.1.113883.5.1 HL7Confidentiality urn:oid:2.16.840.1.113883.5.25 HL7LanguageAbilityMode urn:oid:2.16.840.1.113883.5.60 HL7LanguageAbilityProficiency urn:oid:2.16.840.1.113883.5.61 HL7MaritalStatus urn:oid:2.16.840.1.113883.5.2 HL7NullFlavor urn:oid:2.16.840.1.113883.5.1008 HL7ParticipationFunction urn:oid:2.16.840.1.113883.5.88 HL7ParticipationSignature urn:oid:2.16.840.1.113883.5.89 HL7ParticipationType urn:oid:2.16.840.1.113883.5.90 HL7Race urn:oid:2.16.840.1.113883.5.104 HL7ReligiousAffiliation urn:oid:2.16.840.1.113883.5.1076 HL7RoleClass urn:oid:2.16.840.1.113883.5.110 HL7RoleCode urn:oid:2.16.840.1.113883.5.111 Language urn:oid:2.16.840.1.113883.6.121 LOINC urn:oid:2.16.840.1.113883.6.1 Race & Ethnicity - CDC urn:oid:2.16.840.1.113883.6.238 SNOMED CT urn:oid:2.16.840.1.113883.6.96 USPostalCodes urn:oid:2.16.840.1.113883.6.231

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