Back To Index  <<  Back To Templates

pending Template  US Realm Header

Template 2.16.840.1.113883.10.20.22.1.1 - USRealmHeader
Id 2.16.840.1.113883.10.20.22.1.1
Version valid from 2013‑01‑31 status pending Under pre-publication review
Classification CDA Document Level Template
Context Pathname //
Open/Closed Open (other than defined elements are allowed)
Description This section describes constraints that apply to the header for all documents within the scope of this implementation guide. Header constraints specific to each document type are described in the appropriate document-specific section below.
Item DT Card Conf Description Label
cda:ClinicalDocument
(USRealmHeader)
treetree cda:realmCode
1 .. 1 M SHALL contain exactly one [1..1] realmCode="US" (CONF:16791). conf‑16791
treetree cda:typeId
1 .. 1 M SHALL contain exactly one [1..1] typeId (CONF:5361). conf‑5361
treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.1.3
treeblank treetree @extension
1 .. 1 F POCD_HD000040
treetree cda:templateId
1 .. 1 M SHALL contain exactly one [1..1] templateId (CONF:5252) such that it conf‑5252
treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.10.20.22.1.1
treetree cda:id
1 .. 1 M SHALL contain exactly one [1..1] id (CONF:5363).

This id SHALL be a globally unique identifier for the document
conf‑5363
treetree cda:code
1 .. 1 M SHALL contain exactly one [1..1] code (CONF:5253). conf‑5253
treetree cda:title
1 .. 1 M SHALL contain exactly one [1..1] title (CONF:5254).

can either be a locally defined name or the display name corresponding to clinicalDocument/code
conf‑5254
treetree cda:effectiveTime
1 .. 1 M SHALL contain exactly one [1..1] effectiveTime (CONF:5256).

The content SHALL be a conformant US Realm Date and Time (DTM.US.FIELDED) (2.16.840.1.113883.10.20.22.5.4)
conf‑5256
  Schematron assert role red error
  test string-length(cda:effectiveTime//@value)>=8
  Message The content SHALL be a conformant US Realm Date and Time (DTM.US.FIELDED) (2.16.840.1.113883.10.20.22.5.4)
treetree cda:confidentialityCode
1 .. 1 M SHALL contain exactly one [1..1] confidentialityCode, which SHOULD be selected from ValueSet HL7 BasicConfidentialityKind 2.16.840.1.113883.1.11.16926 STATIC 2010-04-21 (CONF:5259). conf‑5259
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.16926 HL7 BasicConfidentialityKind (DYNAMIC)
treetree cda:languageCode
1 .. 1 M SHALL contain exactly one [1..1] languageCode, which SHALL be selected from ValueSet Language 2.16.840.1.113883.1.11.11526 DYNAMIC (CONF:5372). conf‑5372
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.11526 Language (DYNAMIC)
treetree cda:setId
0 .. 1 MAY contain zero or one [0..1] setId (CONF:5261).

If setId is present versionNumber SHALL be present
conf‑5261
  Schematron assert role red error
  test count(../cda:versionNumber |../cda:setId)=2 or count(../cda:versionNumber | ../cda:setId)=0
  Message If setId is present versionNumber SHALL be present
treetree cda:versionNumber
0 .. 1 MAY contain zero or one [0..1] versionNumber (CONF:5264).

If versionNumber is present setId SHALL be present
conf‑5264
  Schematron assert role red error
  test count(//cda:versionNumber | //cda:setId)=2 or count(//cda:versionNumber | //cda:setId)=0
  Message If versionNumber is present setId SHALL be present
treetree cda:recordTarget
1 .. * M SHALL contain at least one [1..*] recordTarget (CONF:5266). conf‑5266
treeblank treetree cda:patientRole
1 .. 1 M Such recordTargets SHALL contain exactly one [1..1] patientRole (CONF:5267). conf‑5267
treeblank treeblank treetree cda:id
1 .. * M This patientRole SHALL contain at least one [1..*] id (CONF:5268). conf‑5268
treeblank treeblank treetree cda:addr
1 .. * M This patientRole SHALL contain at least one [1..*] addr (CONF:5271).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑5271
  Schematron assert role red error
  test cda:recordTarget/cda:patientRole/cda:addr[cda:streetAddressLine and cda:city and (cda:country!='US' or ((not(cda:country) or cda:country='US') and cda:state and cda:postalCode))]
  Message The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:telecom
1 .. * M This patientRole SHALL contain at least one [1..*] telecom (CONF:5280). conf‑5280
treeblank treeblank treeblank treetree @use
0 .. 1  
  CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.11.20.9.20 Telecom Use (US Realm Header) (DYNAMIC)
treeblank treeblank treetree cda:patient
1 .. 1 M This patientRole SHALL contain exactly one [1..1] patient (CONF:5283). conf‑5283
treeblank treeblank treeblank treetree cda:name
1 .. * M This patient SHALL contain at least one [1..*] name (CONF:5284).

The content of name SHALL be a conformant US Realm Patient Name (PTN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1)
conf‑5284
  Schematron assert role red error
  test (count(cda:recordTarget/cda:patientRole/cda:patient/cda:name/cda:given) > 0 and cda:recordTarget/cda:patientRole/cda:patient/cda:name/cda:family)
  Message The content of name SHALL be a conformant US Realm Patient Name (PTN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1)
treeblank treeblank treeblank treetree cda:administrativeGenderCode
1 .. 1 M This patient SHALL contain exactly one [1..1] administrativeGenderCode, which SHALL be selected from ValueSet Administrative Gender (HL7 V3) 2.16.840.1.113883.1.11.1 DYNAMIC (CONF:6394). conf‑6394
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.1 Administrative Gender (HL7 V3) (DYNAMIC)
treeblank treeblank treeblank treetree cda:birthTime
1 .. 1 M This patient SHALL contain exactly one [1..1] birthTime (CONF:5298).

SHALL be precise to year

SHOULD be precise to day
conf‑5298
  Schematron assert role red error
  test string-length(cda:recordTarget/cda:patientRole/cda:patient/cda:birthTime/@value) >= 4
  Message SHALL be precise to year
  Schematron assert role red error
  test string-length(cda:recordTarget/cda:patientRole/cda:patient/cda:birthTime/@value) >= 8
  Message SHOULD be precise to day
treeblank treeblank treeblank treetree cda:maritalStatusCode
0 .. 1 R This patient SHOULD contain zero or one [0..1] maritalStatusCode, which SHALL be selected from ValueSet Marital Status 2.16.840.1.113883.1.11.12212 DYNAMIC (CONF:5303). conf‑5303
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.12212 Marital Status (DYNAMIC)
treeblank treeblank treeblank treetree cda:religiousAffiliationCode
0 .. 1 This patient MAY contain zero or one [0..1] religiousAffiliationCode, which SHALL be selected from ValueSet Religious Affiliation 2.16.840.1.113883.1.11.19185 DYNAMIC (CONF:5317). conf‑5317
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.19185 Religious Affiliation (DYNAMIC)
treeblank treeblank treeblank treetree cda:raceCode
0 .. 1 This patient MAY contain zero or one [0..1] raceCode, which SHALL be selected from ValueSet Race 2.16.840.1.113883.1.11.14914 DYNAMIC (CONF:5322). conf‑5322
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.14914 Race (DYNAMIC)
treeblank treeblank treeblank treetree sdtc:raceCode
0 .. * This patient MAY contain zero or more [0..*] sdtc:raceCode, which SHALL be selected from ValueSet Race 2.16.840.1.113883.1.11.14914 DYNAMIC (CONF:7263). conf‑7263
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.14914 Race (DYNAMIC)
treeblank treeblank treeblank treetree cda:ethnicGroupCode
0 .. 1 This patient MAY contain zero or one [0..1] ethnicGroupCode, which SHALL be selected from ValueSet EthnicityGroup 2.16.840.1.114222.4.11.837 DYNAMIC (CONF:5323). conf‑5323
  CONF
The value of @code shall be drawn from value set 2.16.840.1.114222.4.11.837 EthnicityGroup (DYNAMIC)
treeblank treeblank treeblank treetree cda:guardian
0 .. * This patient MAY contain zero or more [0..*] guardian (CONF:5325). conf‑5325
treeblank treeblank treeblank treeblank treetree cda:code
0 .. 1 R The guardian, if present, SHOULD contain zero or one [0..1] code, which SHALL be selected from ValueSet ResponsibleParty 2.16.840.1.113883.1.11.19830 DYNAMIC (CONF:5326). conf‑5326
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.19830 ResponsibleParty (DYNAMIC)
treeblank treeblank treeblank treeblank treetree cda:addr
0 .. * R The guardian, if present, SHOULD contain zero or more [0..*] addr (CONF:5359).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑5359
  Schematron assert role red error
  test not(cda:recordTarget/cda:patientRole/cda:patient/cda:guardian/cda:addr) or (cda:recordTarget/cda:patientRole/cda:patient/cda:guardian/cda:addr[cda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode))])
  Message The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treeblank treeblank treetree cda:telecom
0 .. * The guardian, if present, MAY contain zero or more [0..*] telecom (CONF:5382). conf‑5382
treeblank treeblank treeblank treeblank treeblank treetree @use
0 .. 1  
  CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.11.20.9.20 Telecom Use (US Realm Header) (DYNAMIC)
treeblank treeblank treeblank treeblank treetree cda:guardianPerson
1 .. 1 M The guardian, if present, SHALL contain exactly one [1..1] guardianPerson (CONF:5385). conf‑5385
treeblank treeblank treeblank treeblank treeblank treetree cda:name
1 .. * M This guardianPerson SHALL contain at least one [1..*] name (CONF:5386).

The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
conf‑5386
  Schematron assert role red error
  test not(cda:recordTarget/cda:patientRole/cda:patient/cda:guardian) or (count(cda:recordTarget/cda:patientRole/cda:patient/cda:guardian/cda:guardianPerson/cda:name/cda:given) > 0 and cda:recordTarget/cda:patientRole/cda:patient/cda:guardian/cda:guardianPerson/cda:name/cda:family) or (count(cda:recordTarget/cda:patientRole/cda:patient/cda:guardian/cda:guardianPerson/cda:name[*])=0 and string-length(cda:recordTarget/cda:patientRole/cda:patient/cda:guardian/cda:guardianPerson/cda:name)!=0)
  Message The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
treeblank treeblank treeblank treetree cda:birthplace
0 .. 1 This patient MAY contain zero or one [0..1] birthplace (CONF:5395). conf‑5395
treeblank treeblank treeblank treeblank treetree cda:place
1 .. 1 M The birthplace, if present, SHALL contain exactly one [1..1] place (CONF:5396). conf‑5396
treeblank treeblank treeblank treeblank treeblank treetree cda:addr
1 .. 1 M This place SHALL contain exactly one [1..1] addr (CONF:5397).

If country is US, this addr SHALL contain exactly one [1..1] state, which SHALL be selected from ValueSet 2.16.840.1.113883.3.88.12.80.1 StateValueSet DYNAMIC
conf‑5397
treeblank treeblank treeblank treeblank treeblank treeblank treetree cda:country
0 .. 1 R This addr SHOULD contain zero or one [0..1] country, which SHALL be selected from ValueSet Country 2.16.840.1.113883.3.88.12.80.63 DYNAMIC (CONF:5404). conf‑5404
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.80.63 Country (DYNAMIC)
treeblank treeblank treeblank treeblank treeblank treeblank treetree cda:postalCode
0 .. 1 This addr MAY contain zero or one [0..1] postalCode, which SHALL be selected from ValueSet PostalCode 2.16.840.1.113883.3.88.12.80.2 DYNAMIC (CONF:5403). conf‑5403
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.3.88.12.80.2 PostalCode (DYNAMIC)
  Schematron assert role red error
  test (cda:recordTarget/cda:patientRole/cda:addr[cda:country='US' or cda:country='USA']) and cda:recordTarget/cda:patientRole/cda:addr/cda:state
  Message If country is US, this addr SHALL contain exactly one [1..1] state, which SHALL be selected from ValueSet 2.16.840.1.113883.3.88.12.80.1 StateValueSet DYNAMIC
treeblank treeblank treeblank treetree cda:languageCommunication
0 .. * R This patient SHOULD contain zero or more [0..*] languageCommunication (CONF:5406). conf‑5406
treeblank treeblank treeblank treeblank treetree cda:languageCode
1 .. 1 M The languageCommunication, if present, SHALL contain exactly one [1..1] languageCode, which SHALL be selected from ValueSet Language 2.16.840.1.113883.1.11.11526 DYNAMIC (CONF:5407). conf‑5407
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.11526 Language (DYNAMIC)
treeblank treeblank treeblank treeblank treetree cda:modeCode
0 .. 1 The languageCommunication, if present, MAY contain zero or one [0..1] modeCode, which SHALL be selected from ValueSet LanguageAbilityMode 2.16.840.1.113883.1.11.12249 DYNAMIC (CONF:5409). conf‑5409
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.12249 LanguageAbilityMode (DYNAMIC)
treeblank treeblank treeblank treeblank treetree cda:proficiencyLevelCode
0 .. 1 R The languageCommunication, if present, SHOULD contain zero or one [0..1] proficiencyLevelCode, which SHALL be selected from ValueSet LanguageAbilityProficiency 2.16.840.1.113883.1.11.12199 DYNAMIC (CONF:9965). conf‑9965
  CONF
The value of @code shall be drawn from value set 2.16.840.1.113883.1.11.12199 LanguageAbilityProficiency (DYNAMIC)
treeblank treeblank treeblank treeblank treetree cda:preferenceInd
0 .. 1 The languageCommunication, if present, MAY contain zero or one [0..1] preferenceInd (CONF:5414). conf‑5414
treeblank treeblank treetree cda:providerOrganization
0 .. 1 This patientRole MAY contain zero or one [0..1] providerOrganization (CONF:5416). conf‑5416
treeblank treeblank treeblank treetree cda:id
1 .. * M The providerOrganization, if present, SHALL contain at least one [1..*] id (CONF:5417). conf‑5417
treeblank treeblank treeblank treeblank treetree @root
0 .. 1 F 2.16.840.1.113883.4.6
treeblank treeblank treeblank treetree cda:name
1 .. * M The providerOrganization, if present, SHALL contain at least one [1..*] name (CONF:5419). conf‑5419
treeblank treeblank treeblank treetree cda:telecom
1 .. * M The providerOrganization, if present, SHALL contain at least one [1..*] telecom (CONF:5420). conf‑5420
treeblank treeblank treeblank treeblank treetree @use
0 .. 1  
  CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.11.20.9.20 Telecom Use (US Realm Header) (DYNAMIC)
treeblank treeblank treeblank treetree cda:addr
1 .. * M The providerOrganization, if present, SHALL contain at least one [1..*] addr (CONF:5422).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑5422
  Schematron assert role red error
  test not(cda:recordTarget/cda:patientRole/cda:providerOrganization) or cda:recordTarget/cda:patientRole/cda:providerOrganization/cda:addr[cda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode))]
  Message The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treetree cda:author
1 .. * M SHALL contain at least one [1..*] author (CONF:5444). conf‑5444
treeblank treetree cda:time
1 .. 1 M Such authors SHALL contain exactly one [1..1] time (CONF:5445).

The content SHALL be a conformant US Realm Date and Time (DTM.US.FIELDED) (2.16.840.1.113883.10.20.22.5.4)
conf‑5445
  Schematron assert role red error
  test string-length(cda:author/cda:time//@value)>=8
  Message The content SHALL be a conformant US Realm Date and Time (DTM.US.FIELDED) (2.16.840.1.113883.10.20.22.5.4)
treeblank treetree cda:assignedAuthor
1 .. 1 M Such authors SHALL contain exactly one [1..1] assignedAuthor (CONF:5448).

There SHALL be exactly one assignedAuthor/assignedPerson or exactly one assignedAuthor/assignedAuthoringDevice
conf‑5448
treeblank treeblank treetree cda:id
1 .. * M This assignedAuthor SHALL contain at least one [1..*] id (CONF:5449).

If this assignedAuthor is an assignedPerson, the id SHOULD contain zero to one [0..1] @root="2.16.840.1.113883.4.6" National Provider Identifier.
conf‑5449
treeblank treeblank treetree cda:code
0 .. 1 R This assignedAuthor SHOULD contain zero or one [0..1] code (CONF:16787). conf‑16787
treeblank treeblank treetree cda:addr
1 .. * M This assignedAuthor SHALL contain at least one [1..*] addr (CONF:5452).

The content SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑5452
  Schematron assert role red error
  test cda:author/cda:assignedAuthor/cda:addr[cda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode))]
  Message The content SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:telecom
1 .. * M This assignedAuthor SHALL contain at least one [1..*] telecom (CONF:5428). conf‑5428
treeblank treeblank treeblank treetree @use
0 .. 1  
  CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.11.20.9.20 Telecom Use (US Realm Header) (DYNAMIC)
treeblank treeblank treetree cda:assignedPerson
0 .. 1 R This assignedAuthor SHOULD contain zero or one [0..1] assignedPerson (CONF:5430). conf‑5430
treeblank treeblank treeblank treetree cda:name
1 .. * M The assignedPerson, if present, SHALL contain at least one [1..*] name (CONF:16789).

The content SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
conf‑16789
  Schematron assert role red error
  test not(cda:author/cda:assignedAuthor/cda:assignedPerson) or (count(cda:author/cda:assignedAuthor/cda:assignedPerson/cda:name/cda:given) > 0 and cda:author/cda:assignedAuthor/cda:assignedPerson/cda:name/cda:family) or (count(cda:author/cda:assignedAuthor/cda:assignedPerson/cda:name[*])=0 and string-length(cda:author/cda:assignedAuthor/cda:assignedPerson/cda:name)!=0)
  Message The content SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
treeblank treeblank treetree cda:assignedAuthoringDevice
0 .. 1 R This assignedAuthor SHOULD contain zero or one [0..1] assignedAuthoringDevice (CONF:16783). conf‑16783
treeblank treeblank treeblank treetree cda:manufacturerModelName
1 .. 1 M The assignedAuthoringDevice, if present, SHALL contain exactly one [1..1] manufacturerModelName (CONF:16784). conf‑16784
treeblank treeblank treeblank treetree cda:softwareName
1 .. 1 M The assignedAuthoringDevice, if present, SHALL contain exactly one [1..1] softwareName (CONF:16785). conf‑16785
  Schematron assert role red error
  test count(cda:author/cda:assignedAuthor/cda:assignedPerson)=1 or count(cda:author/cda:assignedAuthor/cda:assignedAuthoringDevice)=1
  Message There SHALL be exactly one assignedAuthor/assignedPerson or exactly one assignedAuthor/assignedAuthoringDevice
treetree cda:dataEnterer
0 .. 1 MAY contain zero or one [0..1] dataEnterer (CONF:5441). conf‑5441
treeblank treetree cda:assignedEntity
1 .. 1 M The dataEnterer, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:5442).

This assignedEntity MAY contain zero or one [0..1] code which SHOULD be selected from coding system NUCC Health Care Provider Taxonomy 2.16.840.1.113883.6.101
conf‑5442
treeblank treeblank treetree cda:id
1 .. * M This assignedEntity SHALL contain at least one [1..*] id (CONF:5443). conf‑5443
treeblank treeblank treeblank treetree @root
0 .. 1 F 2.16.840.1.113883.4.6
treeblank treeblank treetree cda:addr
1 .. * M This assignedEntity SHALL contain at least one [1..*] addr (CONF:5460).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑5460
  Schematron assert role red error
  test not(cda:dataEnterer) or cda:dataEnterer/cda:assignedEntity/cda:addr[cda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode))]
  Message The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:telecom
1 .. * M This assignedEntity SHALL contain at least one [1..*] telecom (CONF:5466). conf‑5466
treeblank treeblank treeblank treetree @use
0 .. 1  
  CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.11.20.9.20 Telecom Use (US Realm Header) (DYNAMIC)
treeblank treeblank treetree cda:assignedPerson
1 .. 1 M This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:5469). conf‑5469
treeblank treeblank treeblank treetree cda:name
1 .. * M This assignedPerson SHALL contain at least one [1..*] name (CONF:5470).

The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
conf‑5470
  Schematron assert role red error
  test not(cda:dataEnterer) or (count(cda:dataEnterer/cda:assignedEntity/cda:assignedPerson/cda:name/cda:given) > 0 and cda:dataEnterer/cda:assignedEntity/cda:assignedPerson/cda:name/cda:family) or (count(cda:dataEnterer/cda:assignedEntity/cda:assignedPerson/cda:name[*])=0 and string-length(cda:dataEnterer/cda:assignedEntity/cda:assignedPerson/cda:name)!=0)
  Message The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
treetree cda:informant
0 .. * MAY contain zero or more [0..*] informant (CONF:8001) such that it conf‑8001
treeblank treetree cda:assignedEntity
1 .. 1 M SHALL contain exactly one [1..1] assignedEntity (CONF:8002).

This assignedEntity MAY contain zero or one [0..1] code which SHOULD be selected from coding system NUCC Health Care Provider Taxonomy 2.16.840.1.113883.6.101
conf‑8002
  Schematron assert role red error
  test not(cda:informant) or cda:informant[cda:assignedEntity or cda:relatedEntity]
  Message SHALL contain exactly one [1..1] assignedEntity (CONF:8002).
treeblank treeblank treetree cda:id
1 .. * M This assignedEntity SHALL contain at least one [1..*] id (CONF:9945).

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‑9945
treeblank treeblank treetree cda:addr
1 .. * M This assignedEntity SHALL contain at least one [1..*] addr (CONF:8220).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑8220
  Schematron assert role red error
  test not(informant) or informant/cda:*/addr
  Message This assignedEntity SHALL contain at least one [1..*] addr (CONF:8220).
  Schematron assert role red error
  test not(cda:informant) or cda:informant/cda:*/cda:addr[cda:streetAddressLine and cda:city and (cda:country!='US' or ((not(cda:country) or cda:country='US') and cda:state and cda:postalCode))]
  Message The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:assignedPerson
1 .. 1 M This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:8221). conf‑8221
  Schematron assert role red error
  test not(cda:informant) or cda:informant[cda:assignedEntity/cda:assignedPerson or cda:relatedEntity/cda:relatedPerson]
  Message This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:8221).
treeblank treeblank treeblank treetree cda:name
1 .. * M This assignedPerson SHALL contain at least one [1..*] name (CONF:8222).

The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
conf‑8222
  Schematron assert role red error
  test not(cda:informant) or cda:informant/cda:assignedEntity/cda:assignedPerson/cda:name or cda:informant/cda:relatedEntity/cda:relatedPerson/cda:name
  Message This assignedPerson SHALL contain at least one [1..*] name (CONF:8222).
  Schematron assert role red error
  test not(cda:informant) or (count(cda:informant/cda:assignedEntity/cda:assignedPerson/cda:name/cda:given) > 0 and cda:informant/cda:assignedEntity/cda:assignedPerson/cda:name/cda:family) or (count(cda:informant/cda:assignedEntity/cda:assignedPerson/cda:name[*])=0 and string-length(cda:informant/cda:assignedEntity/cda:assignedPerson/cda:name)!=0)
  Message The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
  Schematron assert role red error
  test not(cda:informant/cda:assignedEntity/cda:code) or cda:informant/cda:assignedEntity/cda:code[@code=document('voc.xml')/voc:systems/voc:system[@valueSetOid='2.16.840.1.113883.6.101']/voc:code/@value]
  Message This assignedEntity MAY contain zero or one [0..1] code which SHOULD be selected from coding system NUCC Health Care Provider Taxonomy 2.16.840.1.113883.6.101
treetree cda:informant
0 .. * MAY contain zero or more [0..*] informant (CONF:26467) such that it conf‑34681
treeblank treetree cda:relatedEntity
1 .. 1 M SHALL contain exactly one [1..1] relatedEntity (CONF:26468). conf‑34682
treetree cda:custodian
1 .. 1 M SHALL contain exactly one [1..1] custodian (CONF:5519). conf‑5519
treeblank treetree cda:assignedCustodian
1 .. 1 M This custodian SHALL contain exactly one [1..1] assignedCustodian (CONF:5520). conf‑5520
treeblank treeblank treetree cda:representedCustodianOrganization
1 .. 1 M This assignedCustodian SHALL contain exactly one [1..1] representedCustodianOrganization (CONF:5521). conf‑5521
treeblank treeblank treeblank treetree cda:id
1 .. * M This representedCustodianOrganization SHALL contain at least one [1..*] id (CONF:5522). conf‑5522
treeblank treeblank treeblank treeblank treetree @root
0 .. 1 F 2.16.840.1.113883.4.6
treeblank treeblank treeblank treetree cda:name
1 .. 1 M This representedCustodianOrganization SHALL contain exactly one [1..1] name (CONF:5524). conf‑5524
treeblank treeblank treeblank treetree cda:telecom
1 .. 1 M This representedCustodianOrganization SHALL contain exactly one [1..1] telecom (CONF:5525). conf‑5525
treeblank treeblank treeblank treeblank treetree @use
0 .. 1  
  CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.11.20.9.20 Telecom Use (US Realm Header) (DYNAMIC)
treeblank treeblank treeblank treetree cda:addr
1 .. 1 M This representedCustodianOrganization SHALL contain exactly one [1..1] addr (CONF:5559).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑5559
  Schematron assert role red error
  test cda:custodian/cda:assignedCustodian/cda:representedCustodianOrganization/cda:addr[cda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode))]
  Message The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treetree cda:informationRecipient
0 .. * MAY contain zero or more [0..*] informationRecipient (CONF:5565). conf‑5565
treeblank treetree cda:intendedRecipient
1 .. 1 M The informationRecipient, if present, SHALL contain exactly one [1..1] intendedRecipient (CONF:5566). conf‑5566
treeblank treeblank treetree cda:informationRecipient
0 .. 1 This intendedRecipient MAY contain zero or one [0..1] informationRecipient (CONF:5567). conf‑5567
treeblank treeblank treeblank treetree cda:name
1 .. * M The informationRecipient, if present, SHALL contain at least one [1..*] name (CONF:5568).

The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
conf‑5568
  Schematron assert role red error
  test not(cda:informationRecipient/cda:intendedRecipient/cda:informationRecipient) or (count(cda:informationRecipient/cda:intendedRecipient/cda:informationRecipient/cda:name/cda:given) > 0 and cda:informationRecipient/cda:intendedRecipient/cda:informationRecipient/cda:name/cda:family) or (count(cda:informationRecipient/cda:intendedRecipient/cda:informationRecipient/cda:name/cda:given) > 0 and cda:informationRecipient/cda:intendedRecipient/cda:informationRecipient/cda:name/cda:family) or (count(cda:informationRecipient/cda:intendedRecipient/cda:informationRecipient/cda:name[*])=0 and string-length(cda:informationRecipient/cda:intendedRecipient/cda:informationRecipient/cda:name)!=0)
  Message The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
treeblank treeblank treetree cda:receivedOrganization
0 .. 1 This intendedRecipient MAY contain zero or one [0..1] receivedOrganization (CONF:5577). conf‑5577
treeblank treeblank treeblank treetree cda:name
1 .. 1 M The receivedOrganization, if present, SHALL contain exactly one [1..1] name (CONF:5578). conf‑5578
treetree cda:legalAuthenticator
0 .. 1 R SHOULD contain zero or one [0..1] legalAuthenticator (CONF:5579). conf‑5579
treeblank treetree cda:time
1 .. 1 M The legalAuthenticator, if present, SHALL contain exactly one [1..1] time (CONF:5580).

The content SHALL be a conformant US Realm Date and Time (DTM.US.FIELDED) (2.16.840.1.113883.10.20.22.5.4)
conf‑5580
  Schematron assert role red error
  test not(cda:legalAuthenticator) or (string-length(cda:legalAuthenticator/cda:time//@value)>=8)
  Message The content SHALL be a conformant US Realm Date and Time (DTM.US.FIELDED) (2.16.840.1.113883.10.20.22.5.4)
treeblank treetree cda:signatureCode
1 .. 1 M The legalAuthenticator, if present, SHALL contain exactly one [1..1] signatureCode (CONF:5583). conf‑5583
treeblank treeblank treetree @code
1 .. 1 F S
treeblank treeblank treetree @code
1 .. 1 F S
treeblank treeblank treetree @codeSystem
1 .. 1 F 2.16.840.1.113883.5.89 (Participation Signature)
treeblank treetree cda:assignedEntity
1 .. 1 M The legalAuthenticator, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:5585). conf‑5585
treeblank treeblank treetree cda:id
1 .. * M This assignedEntity SHALL contain at least one [1..*] id (CONF:5586). conf‑5586
treeblank treeblank treeblank treetree @root
0 .. 1 F 2.16.840.1.113883.4.6
treeblank treeblank treetree cda:code
0 .. 1 This assignedEntity MAY contain zero or one [0..1] code, which SHOULD be selected from ValueSet Healthcare Provider Taxonomy (HIPAA) 2.16.840.1.114222.4.11.1066 STATIC (CONF:17000). conf‑17000
  CONF
The value of @code shall be drawn from value set 2.16.840.1.114222.4.11.1066 Healthcare Provider Taxonomy (HIPAA) (DYNAMIC)
treeblank treeblank treetree cda:addr
1 .. * M This assignedEntity SHALL contain at least one [1..*] addr (CONF:5589).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑5589
  Schematron assert role red error
  test not(cda:legalAuthenticator) or cda:legalAuthenticator/cda:assignedEntity/cda:addr[cda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode))]
  Message The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:telecom
1 .. * M This assignedEntity SHALL contain at least one [1..*] telecom (CONF:5595). conf‑5595
treeblank treeblank treeblank treetree @use
0 .. 1  
  CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.11.20.9.20 Telecom Use (US Realm Header) (DYNAMIC)
treeblank treeblank treetree cda:assignedPerson
1 .. 1 M This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:5597). conf‑5597
treeblank treeblank treeblank treetree cda:name
1 .. * M This assignedPerson SHALL contain at least one [1..*] name (CONF:5598).

The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
conf‑5598
  Schematron assert role red error
  test not(cda:legalAuthenticator) or (count(cda:legalAuthenticator/cda:assignedEntity/cda:assignedPerson/cda:name/cda:given) > 0 and cda:legalAuthenticator/cda:assignedEntity/cda:assignedPerson/cda:name/cda:family) or (count(cda:legalAuthenticator/cda:assignedEntity/cda:assignedPerson/cda:name/cda:given) > 0 and cda:legalAuthenticator/cda:assignedEntity/cda:assignedPerson/cda:name/cda:family) or (count(cda:legalAuthenticator/cda:assignedEntity/cda:assignedPerson/cda:name[*])=0 and string-length(cda:legalAuthenticator/cda:assignedEntity/cda:assignedPerson/cda:name)!=0)
  Message The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
treetree cda:authenticator
0 .. * MAY contain zero or more [0..*] authenticator (CONF:5607). conf‑5607
treeblank treetree cda:time
1 .. 1 M The authenticator, if present, SHALL contain exactly one [1..1] time (CONF:5608).

The content SHALL be a conformant US Realm Date and Time (DTM.US.FIELDED) (2.16.840.1.113883.10.20.22.5.4)
conf‑5608
  Schematron assert role red error
  test not(cda:authenticator) or string-length(cda:authenticator/cda:time//@value)>=8
  Message The content SHALL be a conformant US Realm Date and Time (DTM.US.FIELDED) (2.16.840.1.113883.10.20.22.5.4)
treeblank treetree cda:signatureCode
1 .. 1 M The authenticator, if present, SHALL contain exactly one [1..1] signatureCode (CONF:5610). conf‑5610
treeblank treeblank treetree @code
1 .. 1 F S
treeblank treeblank treetree @code
1 .. 1 F S
treeblank treeblank treetree @codeSystem
1 .. 1 F 2.16.840.1.113883.5.89 (Participation Signature)
treeblank treetree cda:assignedEntity
1 .. 1 M The authenticator, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:5612). conf‑5612
treeblank treeblank treetree cda:id
1 .. * M This assignedEntity SHALL contain at least one [1..*] id (CONF:5613). conf‑5613
treeblank treeblank treeblank treetree @root
0 .. 1 F 2.16.840.1.113883.4.6
treeblank treeblank treetree cda:code
0 .. 1 This assignedEntity MAY contain zero or one [0..1] code (CONF:16825). conf‑16825
treeblank treeblank treetree cda:addr
1 .. * M This assignedEntity SHALL contain at least one [1..*] addr (CONF:5616).

The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
conf‑5616
  Schematron assert role red error
  test not(cda:authenticator) or cda:authenticator/cda:assignedEntity/cda:addr[cda:streetAddressLine and cda:city and ((not(cda:country) or cda:country!='US') or (cda:country='US' and cda:state and cda:postalCode))]
  Message The content of addr SHALL be a conformant US Realm Address (AD.US.FIELDED) (2.16.840.1.113883.10.20.22.5.2)
treeblank treeblank treetree cda:telecom
1 .. * M This assignedEntity SHALL contain at least one [1..*] telecom (CONF:5622). conf‑5622
treeblank treeblank treeblank treetree @use
0 .. 1  
  CONF
The value of @use shall be drawn from value set 2.16.840.1.113883.11.20.9.20 Telecom Use (US Realm Header) (DYNAMIC)
treeblank treeblank treetree cda:assignedPerson
1 .. 1 M This assignedEntity SHALL contain exactly one [1..1] assignedPerson (CONF:5624). conf‑5624
treeblank treeblank treeblank treetree cda:name
1 .. * M This assignedPerson SHALL contain at least one [1..*] name (CONF:5625).

The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
conf‑5625
  Schematron assert role red error
  test not(cda:authenticator) or (count(cda:authenticator/cda:assignedEntity/cda:assignedPerson/cda:name/cda:given) > 0 and cda:authenticator/cda:assignedEntity/cda:assignedPerson/cda:name/cda:family) or (count(cda:authenticator/cda:assignedEntity/cda:assignedPerson/cda:name/cda:given) > 0 and cda:authenticator/cda:assignedEntity/cda:assignedPerson/cda:name/cda:family) or (count(cda:authenticator/cda:assignedEntity/cda:assignedPerson/cda:name[*])=0 and string-length(cda:authenticator/cda:assignedEntity/cda:assignedPerson/cda:name)!=0)
  Message The content of name SHALL be a conformant US Realm Person Name (PN.US.FIELDED) (2.16.840.1.113883.10.20.22.5.1.1)
treetree cda:participant
0 .. * MAY contain zero or more [0..*] participant (CONF:10003) such that it

Such participants, if present, SHALL contain associatedEntity/associatedPerson or associatedEntity/scopingOrganization.

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
conf‑10003
treeblank treetree cda:time
0 .. 1 MAY contain zero or one [0..1] time (CONF:10004). conf‑10004
  Schematron assert role red error
  test not(//cda:associatedEntity) or //cda:associatedEntity[cda:associatedPerson | cda:scopingOrganization]
  Message Such participants, if present, SHALL contain associatedEntity/associatedPerson or associatedEntity/scopingOrganization.
treetree cda:inFulfillmentOf
0 .. * MAY contain zero or more [0..*] inFulfillmentOf (CONF:9952). conf‑9952
treeblank treetree cda:order
1 .. 1 M The inFulfillmentOf, if present, SHALL contain exactly one [1..1] order (CONF:9953). conf‑9953
treeblank treeblank treetree cda:id
1 .. * M This order SHALL contain at least one [1..*] id (CONF:9954). conf‑9954
treetree cda:documentationOf
0 .. * MAY contain zero or more [0..*] documentationOf (CONF:14835). conf‑14835
treeblank treetree cda:serviceEvent
1 .. 1 M The documentationOf, if present, SHALL contain exactly one [1..1] serviceEvent (CONF:14836). conf‑14836
treeblank treeblank treetree cda:effectiveTime
1 .. 1 M This serviceEvent SHALL contain exactly one [1..1] effectiveTime (CONF:14837). conf‑14837
treeblank treeblank treeblank treetree cda:low
1 .. 1 M This effectiveTime SHALL contain exactly one [1..1] low (CONF:14838). conf‑14838
treeblank treeblank treetree cda:performer
0 .. * R This serviceEvent SHOULD contain zero or more [0..*] performer (CONF:14839).

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
conf‑14839
treeblank treeblank treeblank treetree @typeCode
1 .. 1 R
treeblank treeblank treeblank treetree cda:functionCode
0 .. 1 The performer, if present, MAY contain zero or one [0..1] functionCode (CONF:16818). conf‑16818
treeblank treeblank treeblank treeblank treetree @codeSystem
0 .. 1  
treeblank treeblank treeblank treetree cda:assignedEntity
1 .. 1 M The performer, if present, SHALL contain exactly one [1..1] assignedEntity (CONF:14841). conf‑14841
treeblank treeblank treeblank treeblank treetree cda:id
1 .. * M This assignedEntity SHALL contain at least one [1..*] id (CONF:14846). conf‑14846
treeblank treeblank treeblank treeblank treeblank treetree @root
0 .. 1 F 2.16.840.1.113883.4.6
treeblank treeblank treeblank treeblank treetree cda:code
0 .. 1 R This assignedEntity SHOULD contain zero or one [0..1] code (CONF:14842). conf‑14842
treetree cda:authorization
0 .. * MAY contain zero or more [0..*] authorization (CONF:16792) such that it conf‑16792
treeblank treetree cda:consent
1 .. 1 M SHALL contain exactly one [1..1] consent (CONF:16793). conf‑16793
treeblank treeblank treetree cda:id
0 .. * This consent MAY contain zero or more [0..*] id (CONF:16794). conf‑16794
treeblank treeblank treetree cda:code
0 .. 1 This consent MAY contain zero or one [0..1] code (CONF:16795). conf‑16795
treeblank treeblank treetree cda:statusCode
1 .. 1 M This consent SHALL contain exactly one [1..1] statusCode (CONF:16797). conf‑16797
treeblank treeblank treeblank treetree @code
1 .. 1 F completed
treetree cda:componentOf
0 .. 1 MAY contain zero or one [0..1] componentOf (CONF:9955). conf‑9955
treeblank treetree cda:encompassingEncounter
1 .. 1 M The componentOf, if present, SHALL contain exactly one [1..1] encompassingEncounter (CONF:9956). conf‑9956
treeblank treeblank treetree cda:id
1 .. * M This encompassingEncounter SHALL contain at least one [1..*] id (CONF:9959). conf‑9959
treeblank treeblank treetree cda:effectiveTime
1 .. 1 M This encompassingEncounter SHALL contain exactly one [1..1] effectiveTime (CONF:9958). conf‑9958