Thu Oct 18 13:09:29 BST 2007
| POCD_RM170001UK06 | ||||||||||
| ClinicalDocument |
The header of the clinical document.
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| Used by: | ||||||||||
| [1..1] [M] classCode (CS {CNE:ActClass } ) { Fixed="DOCCLIN" } |
Indicates this is a clinical document.
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| [1..1] [M] moodCode (CS {CNE:ActMood } ) { Fixed="EVN" } |
Indicates this is an event.
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| [1..1] [M] code (CV {CNE:CDADocumentTypeSnCT } ) { Default="163381000000105" } |
A code from the vocabulary shown indicating that this is a Outpatient report The Coded with Code System flavour of Coded Value (CV) datatype shall be used to carry this information as follows:
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| [1..1] [M] confidentialityCode (CV {CNE:x_BasicConfidentialityKind } ) { Fixed="V" } |
A code from the HL7 x_BasicConfidentialityKind vocabulary to denote the level of confidentially applied to the document.
When this attribute contains a value of "V" ("very restricted") then the relevant centralised ACF service must be consulted prior to rendering. The guidance documentation for this domain should be referred to for further information. |
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| [1..1] [M] effectiveTime (TS) |
The time at which the document was created. In the format yyyyMMddhhmmss |
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| [1..1] [M] id (II) |
his is the unique identifier of the clinical document. The Identifier Global datatype flavour is used to carry the identifier as follows:
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| [1..1] [M] messageType (II) { Fixed="POCD_MT170001UK06" } |
This attribute holds the message type. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] [M] setId (II) |
Represents an identifier that is common across all document revisions.
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| [1..1] [M] title (ST) |
This attribute carries the text associated with the SnomedCT code carried in act.code. |
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| [1..1] [M] typeId (II) { Fixed="POCD_HD000040" } |
The fixed value of this attribute indicates this is a CDA document. |
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| [1..1] [M] versionNumber (INT) |
An integer value used to version successive replacement documents. |
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| [0..1] authenticator |
The person who has overall responsibility for the document when the author does not.
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| [1..1] [M] typeCode (CS {CNE:ParticipationType } ) { Fixed="AUTHEN" } |
Indicates this is a authenticator. |
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| [1..1] [M] contentId (II) { "NPFIT-000024#Role" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] [R] signatureCode (CS {CNE:ParticipationSignature } ) |
This attribute is only present for CDA compliancy and MUST be set to a null flavor of "NA" |
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| [1..1] [R] time (TS) |
The time at which the document was authenticated. |
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| [1..1] participant (AuthenticatorChoice) |
A link to a choice of authenticators. |
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| [1..1] [M] author |
The author of the clinical document.
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| [1..1] [M] typeCode (CS {CNE:ParticipationType } ) { Fixed="AUT" } |
Indicates that this is an author. |
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| [1..1] [M] contextControlCode (CS {CNE:ContextControl } ) { Fixed="OP" } |
Specifies how the author contributes to the context of the Outpatient report and whether it may be propagated to descendent acts whose association allows such propagation. "O" (Overriding)- the association replaces any context of the same or more specific type that has been conducted from the parent act. "P" (Propagating)- the association is conducted to all child acts where the ActRelationship.contextConductionInd is set to "true." |
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| [1..1] [M] contentId (II) { "NPFIT-000007#Role" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] [M] functionCode (CV {CNE:AuthorFunctionType } ) { Fixed="OA" } |
A code from the vocabulary shown indicating the function of the document author The Coded Plain flavour of Coded Value (CV) datatype shall be used to carry this information as follows:
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| [1..1] [M] time (TS) |
The time which the author authored the clinical document. |
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| [1..1] [M] participant (AuthorChoice) |
An abstract placeholder for the templates of an author. |
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| [1..1] [M] component |
Refers to a component of the header of the CDA document. |
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| [1..1] [M] typeCode (CS {CNE:ActRelationshipType } ) { Fixed="COMP" } |
Indicates this is a component. |
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| [1..1] [M] contextConductionInd (BL) { Fixed="true" } |
If true, associations in the parent act are conducted across the ActRelationship to the child act. |
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| [1..1] [M] structuredBody (StructuredBody) |
A link to the structured body part of the CDA document.
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| [1..1] [M] componentOf |
Refers to the current document is a documentation of events that occurred during the EncompassingEncounter |
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| [1..1] [M] typeCode (CS {CNE:ActRelationshipType } ) { Fixed="COMP" } |
Indicates this is a component. |
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| [1..1] [M] contentId (II) { "NPFIT-000001#Act" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] [M] encompassingEncounter (EncompassingEncounter) |
A link to the Encompassing encounter. |
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| [1..1] [M] custodian |
The custodian of the CDA document.
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| [1..1] [M] typeCode (CS {CNE:ParticipationType } ) { Fixed="CST" } |
Indicates that this is a custodian. |
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| [1..1] [M] contentId (II) { "NPFIT-000014#Role" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] [M] participant (CustodianChoice) |
A link to the custodian templates. |
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| [0..1] dataEnterer |
Refers to the person who entered the information contained in the document.
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| [1..1] [M] typeCode (CS {CNE:ParticipationType } ) { Fixed="ENT" } |
Indicates this is a dataEnterer |
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| [1..1] [M] contextControlCode (CS {CNE:ContextControl } ) { Fixed="OP" } |
Specifies how the dataEnterer contributes to the context of the Outpatients report and whether it may be propagated to descendent acts whose association allows such propagation. "O" (Overriding)- the association replaces any context of the same or more specific type that has been conducted from the parent act. "P" (Propagating)- the association is conducted to all child acts where the ActRelationship.contextConductionInd is set to "true." |
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| [1..1] [M] contentId (II) { "NPFIT-000016#Role" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] participant (DataEntererChoice) |
A link to the choice of role templates. |
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| [1..*] [M] informationRecipient |
The primary information recipients of the clinical document.
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| [1..1] [M] typeCode (CS {CNE:ParticipationType } ) { Fixed="PRCP" } |
Indicates that this is a primary information recipient. |
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| [1..1] [M] contentId (II) { "NPFIT-000008#Role" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] [M] participant (RecipientChoice) |
A link to the choice of information recipients. |
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| [1..1] [M] recordTarget |
The patient who's record is the target for the information in the Document.
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| [1..1] [M] typeCode (CS {CNE:ParticipationType } ) { Fixed="RCT" } |
Indicates that this is the record target of the clinical document. |
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| [1..1] [M] contextControlCode (CS {CNE:ContextControl } ) { Fixed="OP" } |
Specifies how this participation contributes to the context of the current act and whether it may be
propagated to descendent acts whose association allows such propagation.
"O" (Overriding)- the association replaces any context of the same or more specific type that has been conducted from the parent act. "P" (Propagating)- the association is conducted to all child acts where the ActRelationship.contextConductionInd is set to "true." |
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| [1..1] [M] contentId (II) { "NPFIT-000019#Role" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] [M] participant (Patient) |
A link to the patient role. |
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| [0..1] relatedDocument |
Refers to the document that is being replaced.
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| [1..1] [M] typeCode (CS {CNE:ActRelationshipType } ) { Fixed="RPLC" } |
Indicates this is a replacement. |
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| [1..1] priorParentDocument (ParentDocument) |
A link to the Parent Document. |
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| [0..*] tracker |
A tracker i.e. a copy recipient.
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| [1..1] [M] typeCode (CS {CNE:ParticipationType } ) { Fixed="TRC" } |
Indicates that this is a tracker. |
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| [1..1] [M] contentId (II) { "NPFIT-000008#Role" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] participant (RecipientChoice) |
A link to the choice of information recipients. |
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| CustodianChoice |
An abstract placeholder for the templates of an custodian. |
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| Used by: ClinicalDocument | ||||||||||
| [1..1] either : Template4 |
A link to the custodian templates.
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| RecipientChoice |
An abstract placeholder for the templates of a recipient. |
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| Used by: ClinicalDocument | ||||||||||
| [1..1] either : Template2 |
A link to the recipient templates. |
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| AuthorChoice |
An abstract placeholder for the templates of an author.
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| Used by: ClinicalDocument | ||||||||||
| [1..1] either : Template3 |
A link to the author templates. |
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| Patient |
An abstract placeholder for the templates of a patient |
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| Used by: ClinicalDocument | ||||||||||
| [1..1] either : Template6 |
A link to the patient role templates. |
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| StructuredBody |
The StructuredBody represents a CDA document body that is comprised of one or more document sections. |
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| Used by: ClinicalDocument | ||||||||||
| [1..1] [M] classCode (CS {CNE:ActClass } ) { Fixed="DOCBODY" } |
Indicates this is the body of the CDA document.
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| [1..1] [M] moodCode (CS {CNE:ActMood } ) { Fixed="EVN" } |
Indicates this is an event.
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| [1..1] [M] component |
A link to the component(s) of the structured body.
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| [1..1] [M] typeCode (CS {CNE:ActRelationshipType } ) { Fixed="COMP" } |
Indicates that this is a component. |
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| [1..1] [M] contextConductionInd (BL) { Fixed="true" } |
If true, associations in the parent act are conducted across the ActRelationship to the child act. |
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| [1..1] [M] classificationSection (ClassificationSection) | ||||||||||
| ClassificationSection |
A section which is not rendered but is used to hold the coded entries and CRE classification in one place for ease of processing.
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| Used by: StructuredBody | ||||||||||
| [1..1] [M] classCode (CS {CNE:ActClass } ) { Fixed="DOCSECT" } |
Indicates this is a Document Section |
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| [1..1] [M] moodCode (CS {CNE:ActMood } ) { Fixed="EVN" } |
Indicates this is an event |
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| [1..1] [M] id (II) |
This is the unique identifier of the classification section. The Identifier Global datatype flavour is used to carry the identifier as follows:
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| [1..*] [M] component | ||||||||||
| [1..1] [M] typeCode (CS {CNE:ActRelationshipType } ) { Fixed="COMP" } |
Indicates that this is a component.
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| [1..1] [M] contextConductionInd (BL) { Fixed="true" } |
If true, associations in the parent act are conducted across the ActRelationship to the child act.
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| [1..1] [M] contentId (II) { "NPFIT-000001#Section" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] [M] sectionChoice (SectionChoice) |
A link to the CDA section choice.
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| [0..*] entry |
Refers to the CDA coded entries
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| [1..1] [M] typeCode (CS {CNE:ActRelationshipType } ) { Fixed="COMP" } |
Indicates that this is a component. |
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| [1..1] [M] contextConductionInd (BL) { Fixed="true" } |
If true, associations in the parent act are conducted across the ActRelationship to the child act. |
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| [1..1] [M] contentId (II) { "NPFIT-000027#Section" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] codedEntry (CodedEntry) |
A link to the coded entry templates. |
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| [0..*] entry1 |
Refers to the CRE type entry. |
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| [1..1] [M] typeCode (CS {CNE:ActRelationshipType } ) { Fixed="COMP" } |
Indicates that this is a component. |
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| [1..1] [M] contextConductionInd (BL) { Fixed="true" } |
If true, associations in the parent act are conducted across the ActRelationship to the child act. |
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| [1..1] [M] contentId (II) { "NPFIT-000032#Section" } |
This attribute, when valued in an instance, provides a unique forward pointing identifier for a template which constrains the classes and attributes which follow. The attribute is intended simply as a structural navigational aid and should not be relied upon as an indicator of semantic meaning. The IdentifierExternal datatype flavour is used to carry this information as follows:
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| [1..1] cRETypeListChoice (CRETypeListChoice) |
A link to the CRE type templates |
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| SectionChoice |
An abstract choice of allowable templates for the Section part of the CDA document.
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| Used by: ClassificationSection | ||||||||||
| [1..1] either : Template9 | ||||||||||
| CodedEntry |
The coded entries of the CDA document.
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| Used by: ClassificationSection | ||||||||||
| [1..1] either : Template |
A link to the coded entry templates. |
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| CRETypeListChoice |
An abstract placeholder for the templates of a CRE type list. |
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| Used by: ClassificationSection | ||||||||||
| [1..1] either : Template10 |
A link to the CRE type list templates |
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| EncompassingEncounter |
An abstract placeholder for the templates of an Encompassing encounter. |
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| Used by: ClinicalDocument | ||||||||||
| [1..1] either : Template8 |
A link to the Encompassing encounter templates. |
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| ParentDocument |
A related CDA document which is being referenced.
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| Used by: ClinicalDocument | ||||||||||
| [1..1] [M] classCode (CS {CNE:ActClass } ) { Fixed="DOCCLIN" } |
Indicates this is a clinical document.
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| [1..1] [M] moodCode (CS {CNE:ActMood } ) { Fixed="EVN" } |
Indicates this is an event.
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| [1..1] [M] code (CV {CNE:CDADocumentTypeSnCT } ) |
A code from the vocabulary shown indicating the type of document. The Coded with Code System flavour of Coded Value (CV) datatype shall be used to carry this information as follows:
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| [1..1] [M] id (II) |
The UUID of the CDA document being referenced when the document is being replaced. The Identifier Global datatype flavour is used to carry the identifier as follows:
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| [1..1] [M] setId (II) |
Represents an identifier that is common across all document revisions.
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| [1..1] [M] versionNumber (INT) |
The integer version number of the document being referenced. |
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| AuthenticatorChoice |
An abstract placeholder for the templates of a Authenticator. |
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| Used by: ClinicalDocument | ||||||||||
| [1..1] either : Template7 |
A link to the authenticator templates. |
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| DataEntererChoice |
An abstract placeholder for the templates of a role. |
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| Used by: ClinicalDocument | ||||||||||
| [1..1] either : Template5 |
A link to the role templates. |
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