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pending Template  Results Section (entries optional)

Template 2.16.840.1.113883.10.20.22.2.3 - ResultsSectionentriesoptional
Id 2.16.840.1.113883.10.20.22.2.3
Version valid from 2013‑01‑31 status pending Under pre-publication review
Classification CDA Section Level Template
Context Parent nodes of template element with id 2.16.840.1.113883.10.20.22.2.3
Open/Closed Open (other than defined elements are allowed)
Description The Results section contains the results of observations generated by laboratories, imaging procedures, and other procedures. The scope includes observations such as hematology, chemistry, serology, virology, toxicology, microbiology, plain x-ray, ultrasound, CT, MRI, angiography, echocardiography, nuclear medicine, pathology, and procedure observations. The section often includes notable results such as abnormal values or relevant trends, and could contain all results for the period of time being documented. Laboratory results are typically generated by laboratories providing analytic services in areas such as chemistry, hematology, serology, histology, cytology, anatomic pathology, microbiology, and/or virology. These observations are based on analysis of specimens obtained from the patient and submitted to the laboratory. Imaging results are typically generated by a clinician reviewing the output of an imaging procedure, such as where a cardiologist reports the left ventricular ejection fraction based on the review of a cardiac echocardiogram. Procedure results are typically generated by a clinician to provide more granular information about component observations made during a procedure, such as where a gastroenterologist reports the size of a polyp observed during a colonoscopy.
Used by / Uses
Used by / Uses 4 templates
Used by Template id as Name Version
2.16.840.1.113883.10.20.22.1.3 Containment HistoryandPhysical History and Physical 2013‑01‑31
2.16.840.1.113883.10.20.22.1.4 Containment ConsultationNote Consultation Note 2013‑01‑31
2.16.840.1.113883.10.20.22.1.9 Containment ProgressNote Progress Note 2013‑01‑31
Uses Template id as Name Version
2.16.840.1.113883.10.20.22.4.1 Containment ResultOrganizer DYNAMIC
Item DT Card Conf Description Label
cda:section
(ResultsSectionentriesoptional)
treetree cda:templateId
1 .. 1 M SHALL contain exactly one [1..1] templateId (CONF:7116) such that it conf‑7116
treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.10.20.22.2.3
treetree cda:code
1 .. 1 M SHALL contain exactly one [1..1] code (CONF:15431). conf‑15431
treeblank treetree @code
1 .. 1 F 30954-2
treeblank treetree @codeSystem
1 .. 1 F 2.16.840.1.113883.6.1 (LOINC)
treetree cda:title
1 .. 1 M SHALL contain exactly one [1..1] title (CONF:8891). conf‑8891
treetree cda:text
1 .. 1 M SHALL contain exactly one [1..1] text (CONF:7118). conf‑7118
treetree cda:entry
where
[cda:organizer [cda:templateId/@root='2.16.840.1.113883.10.20.22.4.1']]
0 .. * R conf‑7119
  Contains 2.16.840.1.113883.10.20.22.4.1 Result Organizer (DYNAMIC)