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pending Template  Policy Activity

Template 2.16.840.1.113883.10.20.22.4.61 - PolicyActivity
Id 2.16.840.1.113883.10.20.22.4.61
Version valid from 2013‑01‑31 status pending Under pre-publication review
Classification CDA Entry Level Template
Context Parent nodes of template element with id 2.16.840.1.113883.10.20.22.4.61
Open/Closed Open (other than defined elements are allowed)
Description A policy activity represents the policy or program providing the coverage. The person for whom payment is being provided (i.e., the patient) is the covered party. The subscriber of the policy or program is represented as a participant that is the holder the coverage. The payer is represented as the performer of the policy activity.
Used by / Uses
Used by / Uses 3 templates
Used by Template id as Name Version
2.16.840.1.113883.10.20.22.4.60 Containment CoverageActivity Coverage Activity 2013‑01‑31
2.16.840.1.113883.10.20.22.2.18 link PayersSection Payers Section 2013‑01‑31
2.16.840.1.113883.10.20.22.1.2 link ContinuityofCareDocumentCCD Continuity of Care Document (CCD) 2013‑01‑31
Item DT Card Conf Description Label
cda:act
(PolicyActivity)
treetree @classCode
1 .. 1 F ACT
treetree @moodCode
1 .. 1 F EVN
treetree cda:templateId
1 .. 1 M SHALL contain exactly one [1..1] templateId (CONF:8900) such that it conf‑8900
treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.10.20.22.4.61
treetree cda:id
1 .. * M SHALL contain at least one [1..*] id (CONF:8901). conf‑8901
treetree cda:code
1 .. 1 M SHALL contain exactly one [1..1] code (CONF:8903). conf‑8903
treetree cda:statusCode
1 .. 1 M SHALL contain exactly one [1..1] statusCode (CONF:8902). conf‑8902
treeblank treetree @code
1 .. 1 F completed
treetree cda:performer
1 .. 1 M SHALL contain exactly one [1..1] performer (CONF:8906) such that it conf‑8906
treeblank treetree @typeCode
1 .. 1 F PRF
treeblank treetree cda:templateId
1 .. 1 M SHALL contain exactly one [1..1] templateId (CONF:16808). conf‑16808
treeblank treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.10.20.22.4.87
treeblank treetree cda:assignedEntity
1 .. 1 M SHALL contain exactly one [1..1] assignedEntity (CONF:8908). conf‑8908
treeblank treeblank treetree cda:id
1 .. * M This assignedEntity SHALL contain at least one [1..*] id (CONF:8909). conf‑8909
treeblank treeblank treetree cda:code
0 .. 1 R This assignedEntity SHOULD contain zero or one [0..1] code (CONF:8914). conf‑8914
  Schematron assert role red error
  test cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.87']]/cda:assignedEntity[count(cda:code) < 2]
  Message This assignedEntity SHOULD contain zero or one [0..1] code (CONF:8914).
treeblank treeblank treetree cda:addr
0 .. 1 This assignedEntity MAY contain zero or one [0..1] addr (CONF:8910).

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‑8910
  Schematron assert role red error
  test cda:performer[@typeCode][cda:templateId[@root='2.16.840.1.113883.10.20.22.4.87']]/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
0 .. 1 This assignedEntity MAY contain zero or one [0..1] telecom (CONF:8911). conf‑8911
treeblank treeblank treetree cda:representedOrganization
0 .. 1 R This assignedEntity SHOULD contain zero or one [0..1] representedOrganization (CONF:8912). conf‑8912
  Schematron assert role red error
  test cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.87']]/cda:assignedEntity[count(cda:representedOrganization) < 2]
  Message This assignedEntity SHOULD contain zero or one [0..1] representedOrganization (CONF:8912).
treeblank treeblank treeblank treetree cda:name
0 .. 1 R The representedOrganization, if present, SHOULD contain zero or one [0..1] name (CONF:8913). conf‑8913
  Schematron assert role red error
  test not(cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.87']]/cda:assignedEntity/cda:representedOrganization) or cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.87']]/cda:assignedEntity/cda:representedOrganization[count(cda:name) < 2]
  Message The representedOrganization, if present, SHOULD contain zero or one [0..1] name (CONF:8913).
treetree cda:performer
0 .. 1 R SHOULD contain zero or one [0..1] performer="PRF" Performer (CodeSystem: HL7ParticipationType 2.16.840.1.113883.5.90 STATIC) (CONF:8961) such that it conf‑8961
treeblank treetree cda:templateId
1 .. 1 M SHALL contain exactly one [1..1] templateId (CONF:16810). conf‑16810
treeblank treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.10.20.22.4.88
treeblank treetree cda:time
0 .. 1 R SHOULD contain zero or one [0..1] time (CONF:8963). conf‑8963
  Schematron assert role red error
  test count(cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']][count(cda:time) < 2][count(cda:assignedEntity)=1]) < 2
  Message SHOULD contain zero or one [0..1] time (CONF:8963).
treeblank treetree cda:assignedEntity
1 .. 1 M SHALL contain exactly one [1..1] assignedEntity (CONF:8962).

SHOULD include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name
conf‑8962
treeblank treeblank treetree cda:code
1 .. 1 M This assignedEntity SHALL contain exactly one [1..1] code (CONF:8968). conf‑8968
treeblank treeblank treeblank treetree @code
1 .. 1 F GUAR
treeblank treeblank treeblank treetree @codeSystem
1 .. 1 F 2.16.840.1.113883.5.110 (RoleClass)
treeblank treeblank treetree cda:addr
0 .. 1 R This assignedEntity SHOULD contain zero or one [0..1] addr (CONF:8964).

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‑8964
  Schematron assert role red error
  test not(cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']]/cda:assignedEntity) or cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']]/cda:assignedEntity[count(cda:addr) < 2]
  Message This assignedEntity SHOULD contain zero or one [0..1] addr (CONF:8964).
  Schematron assert role red error
  test not (cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']]/cda:assignedEntity/cda:addr) or cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']]/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
0 .. 1 R This assignedEntity SHOULD contain zero or one [0..1] telecom (CONF:8965). conf‑8965
  Schematron assert role red error
  test not(cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']]/cda:assignedEntity) or cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']]/cda:assignedEntity[count(cda:telecom) < 2]
  Message This assignedEntity SHOULD contain zero or one [0..1] telecom (CONF:8965).
  Schematron assert role red error
  test cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']]/cda:assignedEntity/cda:assignedPerson/cda:name or cda:performer[cda:templateId[@root='2.16.840.1.113883.10.20.22.4.88']]/cda:assignedEntity/cda:representedOrganization/cda:name
  Message SHOULD include assignedEntity/assignedPerson/name AND/OR assignedEntity/representedOrganization/name
treetree cda:participant
1 .. 1 M SHALL contain exactly one [1..1] participant (CONF:8916) such that it conf‑8916
treeblank treetree @typeCode
1 .. 1 F COV
treeblank treetree cda:templateId
1 .. 1 M SHALL contain exactly one [1..1] templateId (CONF:16812). conf‑16812
treeblank treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.10.20.22.4.89
treeblank treetree cda:time
0 .. 1 R SHOULD contain zero or one [0..1] time (CONF:8918). conf‑8918
treeblank treeblank treetree cda:low
0 .. 1 R The time, if present, SHOULD contain zero or one [0..1] low (CONF:8919). conf‑8919
treeblank treeblank treetree cda:high
0 .. 1 R The time, if present, SHOULD contain zero or one [0..1] high (CONF:8920). conf‑8920
treeblank treetree cda:participantRole
1 .. 1 M SHALL contain exactly one [1..1] participantRole (CONF:8921). conf‑8921
treeblank treeblank treetree cda:id
1 .. * M This participantRole SHALL contain at least one [1..*] id (CONF:8922).

This id is a unique identifier for the covered party member. Implementers SHOULD use the same GUID for each instance of a member identifier from the same health plan
conf‑8922
treeblank treeblank treetree cda:code
1 .. 1 M This participantRole SHALL contain exactly one [1..1] code (CONF:8923). conf‑8923
treeblank treeblank treetree cda:addr
0 .. 1 R This participantRole SHOULD contain zero or one [0..1] addr (CONF:8956).

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‑8956
  Schematron assert role red error
  test cda:participant[@typeCode='COV'][cda:templateId[@root='2.16.840.1.113883.10.20.22.4.89']]/cda:participantRole[count(cda:addr) < 2]
  Message This participantRole SHOULD contain zero or one [0..1] addr (CONF:8956).
  Schematron assert role red error
  test cda:participant[@typeCode='COV']/cda:participantRole/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:playingEntity
0 .. 1 R This participantRole SHOULD contain zero or one [0..1] playingEntity (CONF:8932).

If the member date of birth as recorded by the health plan differs from the patient date of birth as recorded in the registration/medication summary, then the member date of birth SHALL be recorded in sdtc:birthTime. 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 birthTime element.
conf‑8932
  Schematron assert role red error
  test cda:participant[@typeCode='COV'][cda:templateId[@root='2.16.840.1.113883.10.20.22.4.89']]/cda:participantRole[count(cda:playingEntity) < 2]
  Message This participantRole SHOULD contain zero or one [0..1] playingEntity (CONF:8932).
treeblank treeblank treeblank treetree cda:name
1 .. 1 M The playingEntity, if present, SHALL contain exactly one [1..1] name (CONF:8930). conf‑8930
treetree cda:participant
0 .. 1 R SHOULD contain zero or one [0..1] participant (CONF:8934) such that it

When the Subscriber is the patient, the participant element describing the subscriber SHALL NOT be present. This information will be recorded instead in the data elements used to record member information
conf‑8934
treeblank treetree @typeCode
1 .. 1 F HLD
treeblank treetree cda:templateId
1 .. 1 M SHALL contain exactly one [1..1] templateId (CONF:16813). conf‑16813
treeblank treeblank treetree @root
1 .. 1 F 2.16.840.1.113883.10.20.22.4.90
treeblank treetree cda:time
0 .. 1 MAY contain zero or one [0..1] time (CONF:8938). conf‑8938
treeblank treetree cda:participantRole
1 .. 1 M SHALL contain exactly one [1..1] participantRole (CONF:8936). conf‑8936
treeblank treeblank treetree cda:id
1 .. * M This participantRole SHALL contain at least one [1..*] id (CONF:8937).

This id is a unique identifier for the subscriber of the coverage
conf‑8937
treeblank treeblank treetree cda:addr
0 .. 1 R This participantRole SHOULD contain zero or one [0..1] addr (CONF:8925).

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‑8925
  Schematron assert role red error
  test not(cda:participant[@typeCode='HLD'][cda:templateId[@root='2.16.840.1.113883.10.20.22.4.90']]/cda:participantRole/cda:addr) or cda:participant[@typeCode='HLD'][cda:templateId[@root='2.16.840.1.113883.10.20.22.4.90']]/cda:participantRole/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:entryRelationship
1 .. * M SHALL contain at least one [1..*] entryRelationship (CONF:8939) such that it

The target of a policy activity with act/entryRelationship/@typeCode="REFR" SHALL be an authorization activity (templateId 2.16.840.1.113883.10.20.1.19) OR an act, with act[@classCode="ACT"] and act[@moodCode="DEF"], representing a description of the coverage plan

A description of the coverage plan SHALL contain one or more act/id, to represent the plan identifier, and an act/text with the name of the plan
conf‑8939
treeblank treetree @typeCode
1 .. 1 F REFR