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Advance Directive Observation

[Observation: templateId 2.16.840.1.113883.10.20.22.4.48]

Advance Directives Observatations assert findings (e.g., "resuscitation status is Full Code") rather than orders, and should not be considered legal documents. A legal document can be referenced using the reference/externalReference construct.

  1. SHALL contain exactly one [1..1] templateId ( CONF:8655, CONF:10485 ) such that it
    1. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.4.48"
  2. SHALL contain exactly one [1..1] @classCode="OBS" Observation (CodeSystem: 2.16.840.1.113883.5.6 HL7ActClass) (CONF:8648)
  3. SHALL contain exactly one [1..1] @moodCode="EVN" Event (CodeSystem: 2.16.840.1.113883.5.1001 HL7ActMood) (CONF:8649)
  4. SHALL contain at least one [1..*] id (CONF:8654)
  5. SHALL contain exactly one [1..1] code, where the @code SHALL be selected from ValueSet Advance Directive Type Code 2.16.840.1.113883.1.11.20.2 STATIC 1 (CONF:8651)
  6. SHALL contain exactly one [1..1] statusCode/@code="completed" (CodeSystem: 2.16.840.1.113883.5.14 ActStatus) (CONF:8652)
  7. SHALL contain exactly one [1..1] effectiveTime (CONF:8656)
  8. SHOULD contain at least one [1..*] participant (CONF:8662)
    1. Such participants SHALL contain exactly one [1..1] @typeCode="VRF" (CONF:8663)
    2. Such participants SHALL contain exactly one [1..1] time (CONF:8665)
    3. Such participants SHALL contain exactly one [1..1] participantRole, where its type is CDA Participant Role (CONF:8666)
      1. Contains exactly one [1..1] CDA Participant Role
  9. SHOULD contain exactly one [1..1] participant (CONF:8667)
    1. This participant SHALL contain exactly one [1..1] @typeCode="CST" (CONF:8668)
    2. This participant SHALL contain exactly one [1..1] participantRole (CONF:8669)
      1. This participantRole SHALL contain exactly one [1..1] @classCode="AGNT" (CONF:8670)
      2. This participantRole SHOULD contain exactly one [1..1] addr (CONF:8671)
      3. This participantRole SHOULD contain exactly one [1..1] telecom (CONF:8672)
      4. This participantRole SHALL contain exactly one [1..1] playingEntity (ii., CONF:8824)
        1. This playingEntity SHALL contain at least one [1..*] name (CONF:8673)
        2. This playingEntity The name of the agent who can provide a copy of the Advance Directive SHALL be recorded in the <name> element inside the <playingEntity> element (CONF:8674)
  10. SHOULD contain at least one [1..*] reference (CONF:8692)
    1. Such references SHALL contain exactly one [1..1] @typeCode/@code="REFR" (CodeSystem: 2.16.840.1.113883.5.1002 HL7ActRelationshipType) (CONF:8694)
    2. Such references SHALL contain exactly one [1..1] externalDocument (CONF:8693)
      1. This externalDocument SHALL contain at least one [1..*] id (CONF:8695)
      2. This externalDocument MAY contain zero or one [0..1] text (CONF:8696)
      3. This externalDocument The text, if present, MAY contain zero or one [0..1] @mediaType (CONF:8703)
      4. This externalDocument The text, if present, MAY contain zero or one [0..1] reference. a. The URL of a referenced advance directive document MAY be present, and SHALL be represented in Observation/reference/ExternalDocument/text/reference. b. If a URL is referenced, then it SHOULD have a corresponding linkHTML element in narrative block. (CONF:8697, CONF:8698, CONF:8699)
  11. This effectiveTime SHALL contain exactly one [1..1] low i. If the starting time is unknown, the <low> element SHALL have the nullFlavor attribute set to UNK (CONF:8657, CONF:8658)
  12. This effectiveTime SHALL contain exactly one [1..1] high. i. If the ending time is unknown, the <high> element SHALL have the nullFlavor attribute set to UNK. ii. If the Advance Directive does not have a specified ending time, the <high> element SHALL have the nullFlavor attribute set to NA. (CONF:8659, CONF:8660)

Advance Directive Observation example

<observation xmlns="urn:hl7-org:v3">
  <id root="MDHT" extension="524870265"/>
  <code code="1084520164"/>
  <effectiveTime>
    <low value="2013"/>
    <high value="2013"/>
  </effectiveTime>
  <participant typeCode="VRF">
    <time>
      <low value="2013"/>
      <high value="2013"/>
    </time>
    <participantRole/>
  </participant>
  <participant typeCode="CST">
    <participantRole classCode="AGNT">
      <addr/>
      <telecom/>
      <playingEntity/>
    </participantRole>
  </participant>
  <reference typeCode="REFR">
    <externalDocument>
      <id root="MDHT" extension="107508009"/>
      <text>Text Value</text>
    </externalDocument>
  </reference>
</observation>