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To accurately process the Header and Encounters sections of a C-CDA CCD, in the Clinical:EncountersCcda Data Space, certain elements are required and must contain valid information. There are also certain elements that are optional but, if present, must also contain valid information. 

In the Header section, there are eight elements that are required and three elements that are optional. For more information see CCDA Header: Data Preparation Checklist.

In the Encounters section, there are five elements that are required and thirteen elements that are optional

This checklist provides a description of the Encounters elements and how they should be validated prior to processing in CDS.  

The encounters section of a CCD will typically have several sub-sections to represent different aspects of a particular encounter:

  • Encounter Activity
  • Service Delivery Location
  • Encounter Diagnosis
  • Problem Observation
  • Priority Preference

Each sub-section is uniquely identified by its templateId. When elements occur in multiple sub-sections (for example, value, code, effectiveTime), the templateId helps differentiate validation requirements.

 Section or Sub-SectionElementXPath
Required Elements



Encounters SectiontemplateIdsection/templateId
codesection/code
Encounter Activity templateIdsection/entry/encounter/templateId
codesection/entry/encounter/code
Service Delivery Location templateIdsection/entry/encounter/participant/participantRole/templateId
Optional (but validated
if present) Elements
Encounter Activity effectiveTimesection/entry/encounter/effectiveTime
sdtc:dischargeDispositionCodesection/entry/encounter/dischargeDispositionCode
performersection/entry/encounter/performer/id
Service Delivery Location codesection/entry/encounter/participant/participantRole/code
playingEntitysection/entry/encounter/participant/participantRole/playingEntity/name
telecomsection/entry/encounter/participant/participantRole/playingEntity/telecom
Encounter DiagnosistemplateIdsection/entry/encounter/entryRelationship/act/templateId
codesection/entry/encounter/entryRelationship/act/code
Problem Observation  templateIdsection/entry/encounter/entryRelationship/act/entryRelationship/observation/templateId
effectiveTimesection/entry/encounter/entryRelationship/act/entryRelationship/observation/effectiveTime
valuesection/entry/encounter/entryRelationship/act/entryRelationship/observation/value
Priority Preference templateIdsection/entry/encounter/entryRelationship/act/entryRelationship/observation/entryRelationship/observation/templateId
valuesection/entry/encounter/entryRelationship/act/entryRelationship/observation/entryRelationship/observation/value


A full copy of the sample Continuity of Care Document (CCD) used in this section is attached.

 


Required Elements

This section details the elements that are required for processing in Clinical Data Spaces, that is, they must be present, contain certain information, and be correct.

Encounter Section templateId

XPath:section/templateID
Purpose:Specifies which CCDA R2.1 template is being used to structure the encounter section. R2.1 templates define the requirements, format, and structure of a CCD section. This section lists and describes any healthcare encounters relevant to the patient's current health status or historical health history. Encounters are interactions between a patient and a practitioner who is responsible for diagnosing, evaluating or treating the patient. Encounters can occur in any location and may include visits, appointments, or phone or email interactions.

The templateID element must:

  • be present

  • contain a root attribute

    AttributeValuePurpose
    rootMust have a value of:
    2.16.840.1.113883.10.20.22.2.22 OR
    2.16.840.1.113883.10.20.22.2.22.1
    Uniquely identifies the encounters section template
Code Example for Encounter Section templateId
<section> 
	<templateID root=”2.16.840.1.113883.10.20.22.2.22.1”/> 
</section>

The entire encounters section is ignored if the templateId element is not provided with a root attribute containing a value of 2.16.840.1.113883.10.20.22.2.22 OR 2.16.840.1.113883.10.20.22.2.22.1. The information provided in this section will not be processed and you will not receive any notification that this section was ignored.

 

 

Encounter Section code

XPath:section/templateID
Purpose:Identifies that this section is detailing encounter information.

The code element must:

  • be present

  • contain code and codeSystem attributes

    AttributeValuePurpose

    code

    Must have a value of 46240-8

    Identifies that this section is detailing encounter information

    codeSystem

    Must have a value of 2.16.840.1.113883.6.1

    Identifies the LOINC coding system used to translate the identifier provided in the code attribute

    displayName and codeSystemName are not required for processing.

Code Example of Encounter Section code
<section> 
	<templateID root=”2.16.840.1.113883.10.20.22.2.22.1”/> 
	<code code=”46240-8” codeSystem=”2.16.840.1.113883.6.1” codeSystemName=”LOINC” displayName=”HISTORY OF ENCOUNTERS”/> 
</section>

Processing of the code element will fail if it does not contain correctly populated code AND codeSystem attributes.

 

 

 

Encounter Activity templateId

XPath:section/templateID
Purpose:Specifies which CCDA R2.1 template is being used to structure the encounter activity sub-section. R2.1 templates define the requirements, format, and structure of a CCD section. This sub-section describes an interaction between a patient and clinician. Interactions may include in-person encounters, telephone conversations, and email exchanges.

The templateID element must:

  • be present

  • contain a root attribute 

    AttributeValuePurpose
    rootMust have a value of 2.16.840.1.113883.10.20.22.4.49Uniquely identifies the encounter activity sub-section template.
Code Example of Encounter Activity templateId
<section> 
	<templateID root="2.16.840.1.113883.10.20.22.2.22.1"/> 
	<code code="46240-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="HISTORY OF ENCOUNTERS"/> 
	<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
		</encounter> 
	</entry> 
</section> 

The entire encounters activity sub-section is ignored if the templateId element is not provided with a root attribute of 2.16.840.1.113883.10.20.22.4.49. The information provided in this section will not be processed and you will not receive any notification that this section was ignored.

 

 

Encounter Activity code

XPath:section/entry/encounter/code
Purpose:Indicates the specific type of encounter (e.g in-person visit, telephone or email conversation)

The code element must:

  • be present

  • contain code and codeSystem attributes

    AttributeValuePurpose

    code

    Must be an alphanumerical string of any length. Could be one of the following:

    • 99201 - Office or other outpatient visit (problem focused)
    • 99203 - Office or other outpatient visit (detailed)
    • 19681004 - Nursing evaluation of patient and report (procedure)
    • 225929007 - Joint home visit (procedure)

    Identifies the specific type of encounter

    codeSystem

    Must include a numeric string of any length in the following format: 2.16.840.1.1113883.X.XX

    Typically, encounter type is determined by one of the following code systems:

    • 2.16.840.1.113883.6.12 (CPT)
    • 2.16.840.1.113883.6.96 (SNOMED)


    Identifies the coding system used to translate the identifier provided in the code attribute

    displayName or codeSystemName are not required for processing in Clinical Data Spaces

    For accurate processing, we except to see code with code and codeSystem attributes, as documented above. However <code nullFlavor="UNK"/> or <code nullFlavor="OTH"/> is acceptable.

    If code is populated with nullFlavor="OTH", a child element of translation must be present and contain code and codeSystem attributes. Clinical Data Spaces will process the information provided here instead.

Code Example of Encounter Activity code
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<code code="99241" displayName="Office consultation - 15 minutes" codeSystemName="CPT" codeSystem="2.16.840.1.113883.6.12" 	
			codeSystemVersion="4"/>
		</encounter> 
</entry>  
 

Processing of the code element will fail if it does not contain correctly populated code AND codeSystem attributes.

 

 

Service Delivery Location templateId

XPath:section/entry/encounter/participant/participantRole/templateId
Purpose:Specifies which CCDA R2.1 template is being used to structure the service delivery location sub-section. R2.1 templates define the requirements, format, and structure of a CCD section. This sub-section represents the location of where the encounter took place.

The templateId element must:

  • be present

  • contain a root attribute

    AttributeValuePurpose
    root
    2.16.840.1.113883.10.20.22.4.32
    Uniquely identifies the service delivery location sub-section template.
Code Example of Service Delivery Location templateId
<entry typeCode="DRIV">
	<encounter classCode="ENC" moodCode="EVN">
		<participant typeCode="LOC">
				<participantRole classCode="SDLOC">
					<templateId root="2.16.840.1.113883.10.20.22.4.32"/>		
				</participantRole>
		</participant>
	</encounter>
</entry>

The entire service delivery location sub-section is ignored if the templateId element is not provided with a root attribute of 2.16.840.1.113883.10.20.22.4.32. The information provided in this section will not be processed and you will not receive any notification that this section was ignored.



Optional Elements

This section details elements that are not required but if present, must contact certain information and be correct for accurate processing in Clinical Data Spaces (CDS). 

Encounter Activity effectiveTime

XPath:section/entry/encounter/effectiveTime
Purpose:

Indicates when the encounter (that is, an interaction between a clinician and patient) took place.

If present, the effectiveTime element must:

contain a value OR nullFlavor attribute

AttributeValuePurpose

value

Must be populated with a date in the format YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][+/-ZZZZ]

Specifies when the specific interaction took place

nullFlavor

Must be one of the following:

  • ASKU - asked but unknown
  • MSK - masked (sensitivity/confidentiality reasons)
  • NA - not available, system down
  • NASK - not asked
  • NAV - not available
  • NI - no information
  • OTH - other
  • UNK - unknown
Indicates that an attribute was needed, but was not provided, and gives a reason for why the information is not present. In this case, it suggests the encounter took place, but it was not recorded when.
Code Example of Encounter Activity effectiveTime
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<effectiveTime value="20000407"/>
		</encounter> 
</entry>  

Processing of the effectiveTime element will fail if it does not contain a correctly populated value or nullFlavor attribute.

 

 

Encounter Activity sdtc:dischargeDispositionCode

XPath:section/entry/encounter/effectiveTime
Purpose:

Indicates the current patient discharge status as it relates to this encounter

If present, the dischargeDispositionCode element must:

contain code AND codeSystem attributes

AttributeValuePurpose
code

Must include an alphanumeric string of any length.

Identifies the discharge status of the patient
codeSystem

Must be one of the following: 2.16.840.1.113883.6.301.5 OR
2.16.840.1.113883.12.112 

Identifies the coding system used to translate the identifier provided in the code attribute
Code Example of Encounter Activity sdtc:dischargeDispositionCode
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<sdtc:dischargeDispositionCode code="01" codeSystem"2.16.840.1.113883.3.88.12.80.33"/>
		</encounter> 
</entry>

Processing of the sdtc:dischargeDispositionCode element will fail if it does not contain correctly populated code and codeSystem attributes.

 

 

Encounter Activity performer

XPath:section/entry/encounter/performer
Purpose:

Indicates the unique identifier of the clinician interacting with a patient in this specific encounter (for example, the site-specific alphanumerical ID for a community nurse visiting a patient at home)

If present, the performer element must:
  • have a child element of assignedEntity, which must
  • have a child element of id, which must
  • contain a root attribute and optionally contain an extension attribute

    AttributeValuePurpose
    root

    Must include an alphanumeric string in an OID (object identifier) or UUID (universally unique identifier) format. 

    For example, OID: 2.16.840.1.113883.x.xx.x  or  UUID: 53459040-b1b4-49ed-ae1f-a52c8c502df4

    Uniquely identifies the performer of the current encounter

    extension

    Is optional and can include an alphanumeric string of any length

    Uniquely identifies the performer of the current encounter

Code Example of Encounter Activity performer
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<performer>
				<assignedEntity>
					<id extension="12345" root="2.16.840.1.113883.19.5"/>
				</assignedEntity>
			</performer>
		</encounter> 
</entry> 

The performer element and its contents will be ignored if the id element does not contain a correctly populated root attribute. Information provided within the performer element in the document header will be processed instead.

 

 

Service Delivery Location code

XPath:section/entry/encounter/participant/participantRole/code
Purpose:

Indicates the type of healthcare service location where the encounter took place

If present, the code element must:
  • be contained within participant
  • have a parent element of participantRole
  • contain code and codeSystem attributes:

    AttributeValuePurpose
    code

    Must include an alphanumeric string of any length.

    Identifies the type of healthcare service location where the encounter took place for example, emergency ward, GP practice, outpatient clinic
    codeSystemMust include an alphanumeric string of any length, but typically in the following format: 2.16.840.1.113883.X.XX.X.XIdentifies the coding system used to translate the identifier provided in the code attribute

    displayName or codeSystemName are not required for processing in Clinical Data Spaces.

    For accurate processing, we except to see code with code and codeSystem attributes, as documented above. However <code nullFlavor="UNK"/> or <code nullFlavor="OTH"/> is acceptable.

    If value is populated with nullFlavor="OTH", a child element of translation must be present and contain code and codeSystem attributes. Clinical Data Spaces will process the information provided here instead.

Code Example of Service Delivery code
<entry typeCode="DRIVE">
	<encounter classCode="ENC" moodCode="EVN">
		<participant typeCode="LOC">
			<participantRole classCode="SDLOC">
				<templateId root="2.16.840.1.113883.10.20.22.4.32"/>	
				<code code="GACH" codeSystem="2.16.840.1.113883.5.111" codeSystemName="HL7 RoleCode" displayName="General Acute Care Hospital"/>	
			</participantRole>
		</participant>
	</encounter>
</entry>

Processing of the code element will fail if it does not contain correctly populated code AND codeSystem attributes.

 

 

Service Delivery Location playingEntity

XPath:section/entry/encounter/participant/participantRole/playingEntity/name
Purpose:

Provides the name of the healthcare service location where the encounter took place

If present, the playingEntity element must:
  • be contained within participant
  • have a parent element of participantRole
  • contain a child element of name populated with alphanumeric text of any length
Code Example of Service Delivery Location playingEntity
<entry>
	<encounter>
		<participant typeCode="LOC">
			<participantRole classCode="SDLOC">
				<templateId root="2.16.840.1.113883.10.20.22.4.32"/>	
				<playingEntity>
					<name>Good Health Clinic</name>
				</playingEntity>		
			</participantRole>
		</participant>
	</encounter>
</entry>

Processing of the playingEntity element will fail if it does not contain a correctly populated child element of name.

 

 

Service Delivery Location telecom

XPath:section/entry/encounter/participant/participantRole/playingEntity/telecom
Purpose:

Provides the phone number of the healthcare service location where the encounter took place

If present, the playingEntity element must:
  • be contained within participant
  • have a parent element of participantRole
  • contain value and use attributes
AttributeValuePurpose
value

Must include an alphanumeric string of any length.

Identifies the phone number of the healthcare service location
use

Must include one of the following:

  • HP
  • HV
  • WP
  • MC
Identifies the type of phone number provided (for example, primary, vacation, work, mobile)
Code Example of Service Delivery Location telecom
<section>
	<entry>
		<encounter>
			<participant typeCode="LOC">
				<participantRole classCode="SDLOC">
					<templateId root="2.16.840.1.113883.10.20.22.4.32"/>	
					<telecom nullFlavor="UNK"/>		
				</participantRole>
			</participant>
		</encounter>
	</entry>
</section>

Processing of the telecom element will fail if it does not contain correctly populated value AND use attributes.

 

 

Encounter Diagnosis templateId

XPath:

section/entry/encounter/entryRelationship/act/templateId

Purpose:

Specifies which CCDA R2.1 template is being used to structure the encounter diagnosis sub-section. R2.1 templates define the requirements, format, and structure of a CCD section. This sub-section identifies relevant problems or diagnoses at the close of the encounter.

If present, the templateId element must:
  • be contained within an entryRelationship element with a typeCode attribute of "REFR"
  • have a parent element of act
  • contain a root attribute

    AttributeValuePurpose

    root

    2.16.840.1.113883.10.20.22.4.80

    Uniquely identifies the encounter diagnosis sub-section template

Code Example of Encounter Diagnosis templateId
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<entryRelationship typeCode="REFR">
					<act classCode="ACT" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.80" />
					</act>
			</entryRelationship>	
		</encounter> 
</entry> 

The entire encounter diagnosis sub-section is ignored if the templateId element is not provided with a root attribute of 2.16.840.1.113883.10.20.22.4.80.The information provided in this sub-section will not be processed and you will not receive any notification that this sub-section was ignored.

 

 

Encounter Diagnosis code

XPath:

section/entry/encounter/entryRelationship/act/code

Purpose:

Identifies the particular type of problem or diagnosis made at the encounter.

If present, the code element must:
  • be contained within an entryRelationship element with a typeCode attribute of "REFR", which has a templateId of 2.16.840.1.113883.10.20.22.4.80
  • have a parent element of act
  • contain code AND codeSystem attributes
AttributeValuePurpose

code

Must include an alphanumeric string of any length

Identifies the specific diagnosis in the coding system

codeSystem

Must include an alphanumeric string of any length, but typically in the following format: 2.16.840.1.113883.X.XX.X.X

Identifies the coding system used to translate the identifier provided in the code attribute

displayName or codeSystemName are not required for processing in Clinical Data Spaces.

Code Example of Encounter Diagnosis code
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<entryRelationship typeCode="REFR">
					<act classCode="ACT" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.80" />
							<code code="29308-4" displayName="Encounter Diagnosis" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" />
					</act>
			</entryRelationship>	
		</encounter> 
</entry> 

Processing of the code element will fail if it does not contain correctly populated code AND codeSystem attributes.

 

 

Problem Observation templateId

XPath:section/entry/encounter/entryRelationship/act/entryRelationship/observation/templateId
Purpose:

Specifies which CCDA R2.1 template is being used to structure the problem observation sub-section. R2.1 templates define the requirements, format, and structure of a CCD section. This sub-section represents a discrete observation about a patient's problem.

If present, the templateId element must:
  • be contained within an entryRelationship element with a typeCode attribute of "SUBJ"
  • have a parent element of observation
  • contain a root attribute

    AttributeValuePurpose

    root

    2.16.840.1.113883.10.20.22.4.4

    Uniquely identifies the problem observation sub-section template

Code Example of Problem Observation templateId
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<entryRelationship typeCode="REFR">
					<act classCode="ACT" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.80" />
							<entryRelationship typeCode="SUBJ">
									<observation classCode="OBS" moodCode="EVN">
										<templateId root="2.16.840.1.113883.10.20.22.4.4" />
									</observation>
							</entryRelationship>
					</act>
			</entryRelationship>			
		</encounter> 
</entry> 

The entire problem observation sub-section is ignored if the templateId element is not provided with a root attribute of 2.16.840.1.113883.10.20.22.4.80.The information provided in this sub-section will not be processed and you will not receive any notification that this sub-section was ignored.

 

 

Problem Observation effectiveTime

XPath:section/entry/encounter/entryRelationship/act/entryRelationship/observation/effectiveTime
Purpose:

Specifies the onset date, duration, and resolution date (if known) of the problem, as observed at a specific encounter.

If present, the effectiveTime element must:
  • be contained within an entryRelationship element with a typeCode attribute of "SUBJ", which has a templateId of 2.16.840.1.113883.10.20.22.4.4
  • have a parent element of observation
  • contain an attribute of xsi:type, value or nullFlavor

    AttributeValuePurpose
    xsi:type

    Must be populated with IVL_TS and effectiveTime must:

    1. have a low child element, which can be:
      • empty
      • have a nullFlavor attribute
      • have a value attribute indicating a specific date and time
    2. optionally have a high child element which can be:
      • empty
      • have a nullFlavor attribute
      • have a value attribute indicating a specific date and time
    Indicates the period over which the problem occurred. Low indicates the onset date (when the problem first occurred) and high specifies when the problem was known to be resolved. If high is not present, the problem is still active.
    valueMust be populated with a date in the format YYYY[MM[DD[HHMM[SS[.S[S[S[S]]]]]]]][+/-ZZZZ] where +/-ZZZZspecifies the offset from Coordinated Universal Time. Indicates the specific time a problem occurred
    nullFlavor

    Must be one of the following:

    • ASKU - asked but unknown
    • MSK - masked (for sensitivity or confidentiality reasons)
    • NA - not available, system down
    • NASK - not asked
    • NAV - not available
    • NI - no information
    • OTH - other
    • UNK - unknown 
    Indicates that an attribute was required, but was not provided, and gives a reason for why the information is not present. In this case, it suggests the problem occurred, but it was not recorded when.
Code Example of Problem Observation effectiveTime
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<entryRelationship typeCode="REFR">
					<act classCode="ACT" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.80" />
							<entryRelationship typeCode="SUBJ">
									<observation classCode="OBS" moodCode="EVN">
										<templateId root="2.16.840.1.113883.10.20.22.4.4" />
										<effectiveTime>
												<low nullFlavor="UNK"/>
										</effectiveTime>
									</observation>
							</entryRelationship>
					</act>
			</entryRelationship>			
		</encounter> 
</entry> 

Processing of the effectiveTime element will fail if it does not contain correctly populated xsi:type, value OR nullFlavor attributes.

 

 

Problem Observation value

XPath:section/entry/encounter/entryRelationship/act/entryRelationship/observation/value
Purpose:

Specifies the type of problem observed at the encounter

If present, the value element must:
  • be contained within an entryRelationship element with a typeCode attribute of "SUBJ", which has a templateId of 2.16.840.1.113883.10.20.22.4.4
  • have a parent element of observation
  • contain xsi:type, code and codeSystem attributes

    AttributeValuePurpose
    xsi:typeCDIndicates that the value element is providing code and codeSystem information

    code

    Must be an alphanumerical string of any length.

    Identifies the specific problem observed at the encounter

    codeSystemMust include an alphanumeric string of any length, but typically in the following format: 2.16.840.1.113883.X.XX.X.XIdentifies the coding system used to translate the identifier provided in the code attribute

    displayName and codeSystemName are not required for processing

    For accurate processing, we except to see code with code and codeSystem attributes, as documented above. However <value nullFlavor="UNK"/> or <value nullFlavor="OTH"/> is acceptable.

    If value is populated with nullFlavor="OTH", a child element of translation must be present and contain code and codeSystem attributes. Clinical Data Spaces will process the information provided here instead.

Code Example of Problem Observation value
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<entryRelationship typeCode="REFR">
					<act classCode="ACT" moodCode="EVN">
							<templateId root="2.16.840.1.113883.10.20.22.4.80" />
							<entryRelationship typeCode="SUBJ">
									<observation classCode="OBS" moodCode="EVN">
										<templateId root="2.16.840.1.113883.10.20.22.4.4" />
										<value xsi:type="CD" nullFlavor="UNK"/>
									</observation>
							</entryRelationship>
					</act>
			</entryRelationship>			
		</encounter> 
</entry> 

Processing of the value element will fail if it does not contain correctly populated xsi:type, code, and codeSystem attributes.

 

 

Priority Preference templateId

XPath:section/entry/encounter/entryRelationship/act/entryRelationship/observation/entryRelationship/observation/templateId
Purpose:

Specifies which CCDA R2.1 template is being used to structure the priority preference sub-section. R2.1 templates define the requirements, format, and structure of a CCD section. This sub-section represents priority preference chosen by a patient or a care provider, relative to options for care or treatment, or the prioritization of concerns or problems.

If present, the templateId element must:
  • be contained within an entryRelationship element with a typeCode attribute of "REFR"
  • have a parent element of observation
  • contain a root attribute

    AttributeValuePurpose

    root

    2.16.840.1.113883.10.20.22.4.143

    Uniquely identifies the priority preference sub-section

Code Example of Priority Preference templateId
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<code code="99241" displayName="Office consultation - 15 minutes" codeSystemName="CPT" codeSystem="2.16.840.1.113883.6.12" 	
			codeSystemVersion="4"/>
			<effectiveTime value="20010429"/>
			<entryRelationship typeCode="REFR">
					<act classCode="ACT" moodCode="EVN">
							<entryRelationship typeCode="SUBJ">
									<observation classCode="OBS" moodCode="EVN">
										<entryRelationship typeCode="REFR">
											<observation>
												<templateId root="2.16.840.1.113883.10.20.22.4.143"/>
											</observation>
										</entryRelationship>
									</observation>
							</entryRelationship>
					</act>
			</entryRelationship>			
		</encounter> 
</entry> 

The entire priority preference sub-section is ignored if the templateId element is not provided with a root attribute of 2.16.840.1.113883.10.20.22.4.143.The information provided in this sub-section will not be processed and you will not receive any notification that this sub-section was ignored.

 

 

Priority Preference value

XPath:section/entry/encounter/entryRelationship/act/entryRelationship/observation/value
Purpose:

Specifies the priority placed on the problem observed within this encounter

If present, the value element must:
  • be contained within an entryRelationship element with a typeCode attribute of "REFR", which has a templateId of 2.16.840.1.113883.10.20.22.4.143
  • have a parent element of observation
  • contain xsi:type, code and codeSystem attributes

    AttributeValuePurpose
    xsi:typeCDIndicates that the value element is providing code and codeSystem information

    code

    Must be an alphanumerical string of any length. Could be one of the following:

    • 394849002 - High priority
    • 394848005 - Normal priority
    • 441808003 - Delayed priority

    Identifies the specific priority placed on the problem observed within this encounter

    codeSystemMust have a value of: 2.16.840.1.113883.6.96Identifies the SNOMED CT coding system used to translate the identifier provided in the code attribute

displayName and codeSystemName are not required for processing

For accurate processing, we except to see code with code and codeSystem attributes, as documented above. However <value nullFlavor="UNK"/> or <value nullFlavor="OTH"/> is acceptable.

If value is populated with nullFlavor="OTH", a child element of translation must be present and contain code and codeSystem attributes. Clinical Data Spaces will process the information provided here instead.

Code Example of Priority Preference value
<entry typeCode="DRIV"> 
		<encounter classCode="ENC" moodCode="EVN"> 
			<templateId root="2.16.840.1.113883.10.20.22.4.49"/>
			<code code="99241" displayName="Office consultation - 15 minutes" codeSystemName="CPT" codeSystem="2.16.840.1.113883.6.12" 	
			codeSystemVersion="4"/>
			<effectiveTime value="20010429"/>
			<entryRelationship typeCode="REFR">
					<act classCode="ACT" moodCode="EVN">
							<entryRelationship typeCode="SUBJ">
									<observation classCode="OBS" moodCode="EVN">
										<entryRelationship typeCode="REFR">
											<observation>
												<templateId root="2.16.840.1.113883.10.20.22.4.143"/>
												<value xsi:type="CD" code="394848005" codeSystem="2.16.840.1.113883.6.96"/>
											</observation>
										</entryRelationship>
									</observation>
							</entryRelationship>
					</act>
			</entryRelationship>			
		</encounter> 
</entry>

Processing of the value element will fail if it does not contain correctly populated xsi:type,code, and codeSystem attributes.

 


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