Non-Normative Content The Normative content for these specifications may be found on the HL7, IHE, and HITSP web sites.

Consultation Note

[ClinicalDocument: templateId 2.16.840.1.113883.10.20.22.1.4]

For the purpose of this Implementation Guide, a consultation visit is defined by the evaluation and management guidelines for a consultation established by the Centers for Medicare and Medicaid Services (CMS). According to those guidelines, a Consultation Note must be generated as a result of a physician or nonphysician practitioner's (NPP) request for an opinion or advice from another physician or NPP. Consultations must involve face-to-face time with the patient or fall under guidelines for telemedicine visits.
A Consultation Note must be provided to the referring physician or NPP and must include the reason for the referral, history of present illness, physical examination, and decision-making component (Assessment and Plan).
An NPP is defined as any licensed medical professional as recognized by the state in which the professional practices, including, but not limited to, physician assistants, nurse practitioners, clinical nurse specialists, social workers, registered dietitians, physical therapists, and speech therapists.
Reports on visits requested by a patient, family member, or other third party are not covered by this specification. Second opinions, sometimes called "confirmatory consultations," also are not covered here. Any question on use of the Consultation Note defined here should be resolved by reference to CMS or American Medical Association (AMA) guidelines.

Consultation Note Header Constraints

Consultation Note Body Constraints

  1. SHALL contain exactly one [1..1] templateId ( CONF:8375, CONF:10040 ) such that it
    1. SHALL contain exactly one [1..1] @root="2.16.840.1.113883.10.20.22.1.4"
  2. SHALL conform to General Header Constraints template (templateId: 2.16.840.1.113883.10.20.22.1.1) (CONF:9477, CONF:10039)
  3. SHALL contain exactly one [1..1] code (CONF:17176), where the @code SHALL be selected from ValueSet ConsultDocumentType 2.16.840.1.113883.11.20.9.31 STATIC (CONF:17177)
    • The Consultation Note limits document type codes to those codes listed in the Consultation Note LOINC Document Codes table (invalid codes are listed in a separate table). Implementation may use translation elements to specify a local code that is equivalent to a document type (see the Consultation Note translation of local code figure).
      The Consultation Note recommends use of a single document type code, 11488-4 "Consultation Note", with further specification provided by author or performer, setting, or specialty. The specialized codes in the Consultation Note LOINC Document Codes table are pre-coordinated with the practice setting or the training or professional level of the author. Use of these codes is not recommended, as this duplicates information that may be present in the header. When pre-coordinated codes are used, any coded values describing the author or performer of the service act or the practice setting must be consistent with the LOINC document type. For example, a Cardiology Consultation Note would not be authored by an Obstetrician.

  4. SHALL contain exactly one [1..1] componentOf (CONF:8386)
    1. This componentOf SHALL contain exactly one [1..1] encompassingEncounter (CONF:8387)
      1. This encompassingEncounter MAY contain zero or one [0..1] responsibleParty (CONF:8391)
        1. This responsibleParty SHALL contain zero or one [0..1] assignedEntity, where its type is CDA Assigned Entity (CONF:8394)
          1. Contains exactly one [1..1] CDA Assigned Entity
        2. This responsibleParty The responsibleParty element, if present, SHALL contain an assignedEntity element which SHALL contain an assignedPerson element, a representedOrganization element, or both. (CONF:8394)
      2. This encompassingEncounter SHALL contain exactly one [1..1] effectiveTime (CONF:8389)
      3. This encompassingEncounter SHALL contain exactly one [1..1] id (CONF:8388)
      4. This encompassingEncounter MAY contain zero or more [0..*] encounterParticipant (CONF:8392)
        1. Such encounterParticipants SHALL contain zero or one [0..1] assignedEntity, where its type is CDA Assigned Entity (CONF:8396)
          1. Contains exactly one [1..1] CDA Assigned Entity
        2. Such encounterParticipants The responsibleParty element, if present, SHALL contain an assignedEntity element which SHALL contain an assignedPerson element, a representedOrganization element, or both. (CONF:8396)
  5. MAY contain zero or one [0..1] component (CONF:9491)
    1. Contains exactly one [1..1] Assessment And Plan Section (templateId: 2.16.840.1.113883.10.20.22.2.9)
  6. MAY contain zero or one [0..1] component (CONF:9487)
    1. Contains exactly one [1..1] Assessment Section (templateId: 2.16.840.1.113883.10.20.22.2.8)
  7. MAY contain zero or one [0..1] component (CONF:9489)
    1. Contains exactly one [1..1] Plan Of Care Section (templateId: 2.16.840.1.113883.10.20.22.2.10)
  8. SHALL contain exactly one [1..1] component (CONF:9493)
    1. Contains exactly one [1..1] History Of Present Illness Section (templateId: 1.3.6.1.4.1.19376.1.5.3.1.3.4)
  9. SHOULD contain zero or one [0..1] component (CONF:9495)
    1. Contains exactly one [1..1] Physical Exam Section (templateId: 2.16.840.1.113883.10.20.2.10)
  10. MAY contain zero or one [0..1] component (CONF:9498)
    1. Contains exactly one [1..1] Reason For Referral Section (templateId: 1.3.6.1.4.1.19376.1.5.3.1.3.1)
  11. MAY contain zero or one [0..1] component (CONF:9500)
    1. Contains exactly one [1..1] Reason For Visit Section (templateId: 2.16.840.1.113883.10.20.22.2.12)
  12. MAY contain zero or one [0..1] component (CONF:9507)
    1. Contains exactly one [1..1] Allergies Section Entries Optional (templateId: 2.16.840.1.113883.10.20.22.2.6)
  13. MAY contain zero or one [0..1] component (CONF:9509)
    1. Contains exactly one [1..1] Chief Complaint Section (templateId: 1.3.6.1.4.1.19376.1.5.3.1.1.13.2.1)
  14. MAY contain zero or one [0..1] component (CONF:10029)
    1. Contains exactly one [1..1] Chief Complaint And Reason For Visit Section (templateId: 2.16.840.1.113883.10.20.22.2.13)
  15. MAY contain zero or one [0..1] component (CONF:9513)
    1. Contains exactly one [1..1] Family History Section (templateId: 2.16.840.1.113883.10.20.22.2.15)
  16. MAY contain zero or one [0..1] component (CONF:9515)
    1. Contains exactly one [1..1] General Status Section (templateId: 2.16.840.1.113883.10.20.2.5)
  17. MAY contain zero or one [0..1] component (CONF:9517)
    1. Contains exactly one [1..1] History Of Past Illness Section (templateId: 2.16.840.1.113883.10.20.22.2.20)
  18. MAY contain zero or one [0..1] component (CONF:9519)
    1. Contains exactly one [1..1] Immunizations Section (templateId: 2.16.840.1.113883.10.20.22.2.2.1)
  19. MAY contain zero or one [0..1] component (CONF:9521))
    1. Contains exactly one [1..1] Medications Section Entries Optional (templateId: 2.16.840.1.113883.10.20.22.2.1)
  20. MAY contain zero or one [0..1] component (CONF:9523)
    1. Contains exactly one [1..1] Problem Section Entries Optional (templateId: 2.16.840.1.113883.10.20.22.2.5)
  21. MAY contain zero or one [0..1] component (CONF:9525)
    1. Contains exactly one [1..1] Procedures Section Entries Optional (templateId: 2.16.840.1.113883.10.20.22.2.7)
  22. MAY contain zero or one [0..1] component (CONF:9527)
    1. Contains exactly one [1..1] Results Section Entries Optional (templateId: 2.16.840.1.113883.10.20.22.2.3)
  23. MAY contain zero or one [0..1] component (CONF:9529)
    1. Contains exactly one [1..1] Review Of Systems Section (templateId: 1.3.6.1.4.1.19376.1.5.3.1.3.18)
  24. MAY contain zero or one [0..1] component (CONF:9531)
    1. Contains exactly one [1..1] Social History Section (templateId: 2.16.840.1.113883.10.20.22.2.17)
  25. MAY contain zero or one [0..1] component (CONF:9533)
    1. Contains exactly one [1..1] Vital Signs Section Entries Optional (templateId: 2.16.840.1.113883.10.20.22.2.4)
  26. SHALL contain at least one [1..*] inFulfillmentOf (CONF:8382)
    1. Such inFulfillmentOfs SHALL contain exactly one [1..1] order (CONF:8385)
      1. This order SHALL contain at least one [1..*] id (CONF:9102)
  27. SHALL include an Assessment and Plan Section, or an Assessment Section and a Plan Section (CONF:9501)
  28. SHALL NOT include an Assessment/Plan Section when an Assessment Section and a Plan of Care Section are present (CONF:10028)
  29. SHALL NOT include a Chief Complaint and Reason for Visit Section with either a Chief Complaint Section or a Reason for Visit Section.
  30. SHALL include a Reason for Referral or Reason for Visit section (CONF:9504)

Consultation Note Example

<?xml version="1.0" encoding="UTF-8"?>
<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:hl7-org:v3" xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd">
  <typeId root="2.16.840.1.113883.1.3"/>
  <id root="MDHT" extension="166976554"/>
  <code code="1247417799"/>
  <title>TEXT FOR TITLE</title>
  <effectiveTime/>
  <confidentialityCode code="6469102"/>
  <setId root="MDHT" extension="5d54ffc2-e954-4df3-b344-b35e91c8dad6"/>
  <versionNumber value="1"/>
  <recordTarget>
    <typeId root="2.16.840.1.113883.1.3"/>
    <patientRole/>
  </recordTarget>
  <author>
    <typeId root="2.16.840.1.113883.1.3"/>
    <time/>
    <assignedAuthor/>
  </author>
  <custodian/>
  <inFulfillmentOf>
    <order>
      <id root="MDHT" extension="1837148571"/>
    </order>
  </inFulfillmentOf>
  <componentOf>
    <encompassingEncounter>
      <id root="MDHT" extension="613544271"/>
      <effectiveTime>
        <low value="2013"/>
        <high value="2013"/>
      </effectiveTime>
      <responsibleParty/>
      <encounterParticipant/>
    </encompassingEncounter>
  </componentOf>
  <component>
    <structuredBody>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="1850794316"/>
          <code code="1024051310"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="563058353"/>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="641360554"/>
          <code code="1613537766"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="142068877"/>
          <entry>
            <act>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="706461936"/>
              <code code="1143717578"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
            </act>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="430947189"/>
          <code code="134951870"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="1083738636"/>
          <entry>
            <act>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="49518775"/>
              <code code="1747736607"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
            </act>
          </entry>
          <entry>
            <encounter>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="373645915"/>
              <code code="665244960"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
            </encounter>
          </entry>
          <entry>
            <observation>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1942893828"/>
              <code code="936776958"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
            </observation>
          </entry>
          <entry>
            <procedure>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1608397649"/>
              <code code="1059614548"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
            </procedure>
          </entry>
          <entry>
            <substanceAdministration classCode="SBADM">
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="443471569"/>
              <code code="805587746"/>
              <effectiveTime value="20130627"/>
              <consumable/>
            </substanceAdministration>
          </entry>
          <entry>
            <supply classCode="SPLY">
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1465030805"/>
              <code code="951439610"/>
              <effectiveTime value="20130627"/>
            </supply>
          </entry>
          <entry>
            <act>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1546766617"/>
              <code code="97830358"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
            </act>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="983738293"/>
          <code code="1072199672"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="927313852"/>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="2118843203"/>
          <code code="1005706191"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="409220949"/>
          <entry>
            <observation>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="2023930576"/>
              <code code="59447311"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <entryRelationship typeCode="COMP"/>
              <entryRelationship typeCode="COMP"/>
              <entryRelationship typeCode="COMP"/>
            </observation>
          </entry>
          <entry>
            <observation>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1787077972"/>
              <code code="1488231877"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <author/>
              <entryRelationship typeCode="SUBJ"/>
            </observation>
          </entry>
          <entry>
            <observation>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="138664129"/>
              <code code="572400661"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
            </observation>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="861414278"/>
          <code code="1341225118"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="1456435755"/>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="181658206"/>
          <code code="265353723"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="535814038"/>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="1578651935"/>
          <code code="1006780974"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="354726000"/>
          <entry>
            <act>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1107084412"/>
              <code code="867581058"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <entryRelationship>
                <observation/>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="691114487"/>
          <code code="2103727879"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="1738919878"/>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="593386422"/>
          <code code="1906321009"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="590822831"/>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="1431641749"/>
          <code code="971055733"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="770810243"/>
          <entry>
            <organizer>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1307798576"/>
              <code code="95417612"/>
              <statusCode code="completed"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <subject/>
              <component>
                <observation/>
              </component>
            </organizer>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="1805770125"/>
          <code code="1370547276"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="1867079490"/>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="1669058656"/>
          <code code="250591762"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="897120948"/>
          <entry>
            <observation>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="877106381"/>
              <code code="1323964093"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <observation/>
              </entryRelationship>
            </observation>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="626034513"/>
          <code code="1811062413"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="440908596"/>
          <entry>
            <substanceAdministration classCode="SBADM">
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="2008036367"/>
              <code code="901768433"/>
              <effectiveTime value="20130627"/>
              <consumable/>
              <performer/>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <act/>
              </entryRelationship>
              <entryRelationship>
                <supply classCode="SPLY"/>
              </entryRelationship>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <supply classCode="SPLY"/>
              </entryRelationship>
              <precondition/>
            </substanceAdministration>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="650421846"/>
          <code code="609226833"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="110808477"/>
          <entry>
            <substanceAdministration classCode="SBADM">
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1268106940"/>
              <code code="2074404400"/>
              <effectiveTime value="20130627"/>
              <consumable/>
              <performer/>
              <entryRelationship>
                <supply classCode="SPLY"/>
              </entryRelationship>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <act/>
              </entryRelationship>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <supply classCode="SPLY"/>
              </entryRelationship>
              <precondition/>
            </substanceAdministration>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="1049455194"/>
          <code code="2140738831"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="371248255"/>
          <entry>
            <act>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1806043874"/>
              <code code="1279642280"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <entryRelationship>
                <observation/>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="1568395569"/>
          <code code="2021046843"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="883302170"/>
          <entry>
            <procedure>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="682872057"/>
              <code code="218726507"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <specimen/>
              <performer/>
              <entryRelationship typeCode="COMP" inversionInd="true"/>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <substanceAdministration classCode="SBADM"/>
              </entryRelationship>
              <entryRelationship>
                <act/>
              </entryRelationship>
            </procedure>
          </entry>
          <entry>
            <observation>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="111445074"/>
              <code code="430746610"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <performer/>
              <entryRelationship typeCode="COMP" inversionInd="true"/>
              <entryRelationship>
                <act/>
              </entryRelationship>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <substanceAdministration classCode="SBADM"/>
              </entryRelationship>
            </observation>
          </entry>
          <entry>
            <act>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="1602251828"/>
              <code code="991588714"/>
              <effectiveTime>
                <low value="2013"/>
                <high value="2013"/>
              </effectiveTime>
              <performer/>
              <entryRelationship typeCode="COMP" inversionInd="true"/>
              <entryRelationship>
                <act/>
              </entryRelationship>
              <entryRelationship>
                <observation/>
              </entryRelationship>
              <entryRelationship>
                <substanceAdministration classCode="SBADM"/>
              </entryRelationship>
            </act>
          </entry>
        </section>
      </component>
      <component>
        <section>
          <typeId root="2.16.840.1.113883.1.3"/>
          <id root="MDHT" extension="175008029"/>
          <code code="1073956254"/>
          <title>TEXT FOR TITLE</title>
          <confidentialityCode code="593247844"/>
          <entry>
            <organizer>
              <typeId root="2.16.840.1.113883.1.3"/>
              <id root="MDHT" extension="535842662"/>
              <code code="278612621"/>
              <statusCode code="completed"/>
              <effectiveTime>
                <low value="2013"/>
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