Document Header
OID: N/A
LOINCs: #{}
Alias: header
Entries Required: N/A
Internal ID: Header
sample1
{
"subject" : {
"address" : [ {
"line" : [ "1007 Amber Dr" ],
"use" : "home",
"city" : "Beaverton",
"state" : "OR",
"postalCode" : "97266",
"country" : "US"
}, {
"line" : [ "1002 Oak Dr" ],
"use" : "old",
"city" : "Washington",
"state" : "DC",
"postalCode" : "3423423",
"country" : "US",
"period" : {
"start" : "2017-09-21",
"end" : "2019-09-21"
}
} ],
"name" : [ {
"given" : [ "Rabecca", "Jones" ],
"family" : "Angeles",
"use" : "official",
"suffix" : null
}, {
"given" : [ "Becky", "Jones" ],
"family" : "Angeles",
"use" : "old",
"suffix" : null
} ],
"birthDate" : "1970-07-01",
"resourceType" : "Patient",
"extension" : [ {
"extension" : [ {
"value" : {
"Coding" : {
"code" : "2106-3",
"display" : "White",
"system" : "urn:oid:2.16.840.1.113883.6.238"
}
},
"url" : "ombCategory"
}, {
"value" : {
"Coding" : {
"code" : "2108-9",
"display" : "White European",
"system" : "urn:oid:2.16.840.1.113883.6.238"
}
},
"url" : "detailed"
} ],
"url" : "https://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
}, {
"value" : {
"Coding" : {
"code" : "2186-5",
"display" : "Mexican",
"system" : "urn:oid:2.16.840.1.113883.6.238"
}
},
"url" : "https://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
} ],
"id" : "patient",
"identifier" : [ {
"value" : "118283339",
"system" : "http://hl7.org/fhir/sid/us-ssn"
} ],
"telecom" : [ {
"system" : "phone",
"value" : "+1(555)-225-1234",
"use" : "mobile"
}, {
"system" : "phone",
"value" : "+1(555)-226-1544",
"use" : "home"
} ],
"gender" : "female",
"maritalStatus" : {
"coding" : [ {
"code" : "UNK",
"display" : "Unknown",
"system" : "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus"
} ]
}
},
"composition" : {
"identifier" : {
"value" : "TT107",
"system" : "urn:oid:2.16.840.1.113883.19.5.99999.1",
"extension" : [ {
"url" : "cda-assigning-authority-name",
"value" : {
"string" : "ABC"
}
} ]
}
},
"custodian" : {
"name" : "Community Health and Hospitals",
"telecom" : [ {
"system" : "phone",
"value" : "+1(555)-555-1002",
"use" : "work"
} ],
"identifier" : [ {
"system" : "http://hl7.org/fhir/sid/us-npi",
"value" : "99998899"
} ],
"address" : [ {
"line" : [ "1002 Healthcare Dr" ],
"use" : "work",
"city" : "Beaverton",
"state" : "OR",
"postalCode" : "97266",
"country" : "US"
} ],
"id" : "SOME-STRING",
"resourceType" : "Organization"
},
"authors" : [ {
"practitioner" : {
"name" : [ {
"given" : [ "Henry" ],
"family" : "Seven",
"use" : "official"
} ],
"address" : [ {
"line" : [ "1002 Healthcare Dr" ],
"city" : "Beaverton",
"state" : "OR",
"postalCode" : "97266",
"country" : "US"
} ],
"telecom" : [ {
"system" : "phone",
"value" : "+1(555)-555-1002",
"use" : "work"
} ],
"id" : "ca3e2395-79e9-d8a4-783d-252892f31fb7",
"identifier" : [ {
"value" : "111111",
"system" : "http://hl7.org/fhir/sid/us-npi"
} ],
"resourceType" : "Practitioner"
},
"specialty" : [ {
"text" : "Chronic Disease Hospital",
"coding" : [ {
"code" : "281P00000X",
"display" : "Chronic Disease Hospital",
"system" : "http://hl7.org/fhir/ValueSet/provider-taxonomy"
} ]
} ],
"id" : "dc6a82a9-8999-f7c9-b73d-160351225091",
"resourceType" : "PractitionerRole",
"period" : {
"start" : "2015-06-22"
}
} ]
}
C-CDA Equivalent:
<ClinicalDocument xmlns="urn:hl7-org:v3"
xmlns:sdtc="urn:hl7-org:sdtc"
xmlns:voc="urn:hl7-org:v3/voc"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<realmCode code="US"/>
<typeId extension="POCD_HD000040" root="2.16.840.1.113883.1.3"/>
<templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01"/>
<templateId root="2.16.840.1.113883.10.20.22.1.1"/>
<id root="ee05e1da-df1b-7f7e-166c-e182e1d39f86"/>
<id extension="TT107"
assigningAuthorityName="ABC"
root="2.16.840.1.113883.19.5.99999.1"/>
<code codeSystem="2.16.840.1.113883.6.1"
codeSystemName="http://loinc.org"
displayName="TESTDOC"
code="TESTDOC"/>
<title>Document Title</title>
<effectiveTime value="20200202"/>
<confidentialityCode code="N"
displayName="normal"
codeSystem="2.16.840.1.113883.5.25"
codeSystemName="Confidentiality"/>
<languageCode code="en-US"/>
<recordTarget>
<patientRole>
<id root="b39024ef-bc6d-e619-76f5-85c8421c6bba"/>
<id extension="118283339" root="2.16.840.1.113883.4.1"/>
<addr use="HP">
<country>US</country>
<state>OR</state>
<city>Beaverton</city>
<postalCode>97266</postalCode>
<streetAddressLine>1007 Amber Dr</streetAddressLine>
</addr>
<addr>
<country>US</country>
<state>DC</state>
<city>Washington</city>
<postalCode>3423423</postalCode>
<streetAddressLine>1002 Oak Dr</streetAddressLine>
</addr>
<telecom value="+1(555)-225-1234" use="MC"/>
<telecom value="+1(555)-226-1544" use="HP"/>
<patient>
<name use="L">
<given>Rabecca</given>
<given>Jones</given>
<family>Angeles</family>
</name>
<name>
<given qualifier="BR">Becky</given>
<given qualifier="BR">Jones</given>
<family>Angeles</family>
</name>
<administrativeGenderCode code="F"
displayName="Female"
codeSystem="2.16.840.1.113883.5.1"
codeSystemName="AdministrativeGender"/>
<birthTime value="19700701"/>
<maritalStatusCode code="UNK"
displayName="Unknown"
codeSystem="2.16.840.1.113883.1.11.12212"
codeSystemName="MaritalStatus"/>
<raceCode codeSystem="2.16.840.1.113883.6.238"
codeSystemName="urn:oid:2.16.840.1.113883.6.238"
displayName="White"
code="2106-3"/>
<sdtc:raceCode codeSystem="2.16.840.1.113883.6.238"
codeSystemName="urn:oid:2.16.840.1.113883.6.238"
displayName="White European"
code="2108-9"/>
<ethnicGroupCode codeSystem="2.16.840.1.113883.6.238"
codeSystemName="urn:oid:2.16.840.1.113883.6.238"
displayName="Mexican"
code="2186-5"/>
</patient>
</patientRole>
</recordTarget>
<author>
<time value="20150622"/>
<assignedAuthor>
<id root="c569ccb7-c838-fdf3-149b-beecd8e9bd41"/>
<addr nullFlavor="UNK"/>
<telecom nullFlavor="UNK"/>
<assignedPerson>
<name nullFlavor="UNK"/>
</assignedPerson>
</assignedAuthor>
</author>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id root="7df888b6-0268-1e62-ff60-ceb2f2f88630"/>
<id extension="99998899" root="2.16.840.1.113883.4.6"/>
<name>Community Health and Hospitals</name>
<telecom value="+1(555)-555-1002" use="WP"/>
<addr use="WP">
<country>US</country>
<state>OR</state>
<city>Beaverton</city>
<postalCode>97266</postalCode>
<streetAddressLine>1002 Healthcare Dr</streetAddressLine>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<documentationOf>
<serviceEvent classCode="PCPR">
<id root="6b5da943-050a-6ae1-5f4b-2daea74b6103"/>
<effectiveTime>
<low value="20150622"/>
<high value="20150624"/>
</effectiveTime>
</serviceEvent>
</documentationOf>
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