description: The Advance Directive Observation template is nested within the Advance Directive Existence Observation, which indicates whether the individual has any advance directive documents. Each Advance Directive Observation template provides details about one type of advance directive document and may also include information about the documentβs author, as well as any individuals who discussed and verified its contents with the patient or their designated healthcare agent.\n\nThe Advance Directive Observation template also can be nested within an Intervention Act to serve as documentation explaining why an intervention was planned/performed or not. package_name: hl7.cda.us.ccda derivation: constraint name: AdvanceDirectiveObservation type: http://hl7.org/cda/stds/core/StructureDefinition/Observation elements: value: type: http://hl7.org/cda/stds/core/StructureDefinition/CD binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41'} index: 18 participant: index: 21 slicing: rules: open discriminator: - {path: typeCode, type: value} min: null slices: verifier: match: {typeCode: VRF} schema: constraint: should-time: {human: SHOULD contain time, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: warning, expression: time.exists()} short: 'π¨π¦πππ: Verifier - The participant "VRF" represents the clinician(s) who verified the patient advance directive.' array: true index: 22 elements: templateId: index: 23 slicing: rules: open discriminator: - {path: root, type: value} min: 1 slices: primary: match: {root: 2.16.840.1.113883.10.20.1.58} schema: _required: true index: 24 elements: root: pattern: {type: String, value: 2.16.840.1.113883.10.20.1.58} index: 25 extension: {index: 26} required: [root] extensions: {} typeCode: pattern: {type: Code, value: VRF} index: 27 time: constraint: value-only: {human: Interval fields SHALL NOT be present, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: error, expression: (low | high | width | center).empty()} index: 28 elements: value: {short: value should be used instead of low/high, index: 29} participantRole: constraint: should-code: {human: SHOULD contain code, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: warning, expression: code.exists()} index: 30 elements: code: binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.1066'} index: 31 sdtcSpecialty: binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/c80-practice-codes'} index: 32 addr: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/AD', index: 33} playingEntity: index: 34 elements: name: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/PN', index: 35} required: [name] required: [playingEntity] required: [templateId] healthcareAgent: match: {typeCode: CST} schema: short: This custodian (CST) participant identifies a legal representative for healthcare decision-making. Examples of such individuals are called health care agents, substitute decision makers and/or health care proxies. Only record a healthcare agent who is acting in that capacitiy and participating in carae decision-making during the documented care encounter. array: true index: 36 elements: typeCode: pattern: {type: Code, value: CST} index: 37 participantRole: constraint: should-code: {human: SHOULD contain code, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: warning, expression: code.exists()} should-addr: {human: SHOULD contain addr, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: warning, expression: addr.exists()} should-telecom: {human: SHOULD contain telecom, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: warning, expression: telecom.exists()} index: 38 elements: classCode: pattern: {type: Code, value: AGNT} index: 39 code: binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1046.35'} index: 40 sdtcSpecialty: binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/ValueSet/c80-practice-codes'} index: 41 addr: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/AD', index: 42} telecom: {index: 43} playingEntity: constraint: should-code: {human: SHOULD contain code, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: warning, expression: code.exists()} index: 44 elements: code: binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.12.1'} index: 45 name: {short: The name of the healthcare agent., index: 46} required: [name] required: [classCode, playingEntity] classCode: pattern: {type: Code, value: OBS} index: 4 author: {type: 'http://hl7.org/cda/stds/core/StructureDefinition/Author', short: SHOULD contain author, index: 19} reference: index: 47 slicing: rules: open discriminator: - {path: typeCode, type: value} min: 1 slices: reference1: match: {typeCode: REFR} schema: array: true min: 1 _required: true index: 48 elements: typeCode: pattern: {type: Code, value: REFR} index: 49 externalDocument: short: 'π¨π¦πππ: External Document' index: 50 elements: id: {index: 51} code: binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1115.41'} index: 52 text: index: 53 elements: reference: short: The URL of a referenced advance directive document **MAY** be present, and **SHALL** be represented in Observation/reference/ExternalDocument/text/reference (CONF:1198-8698). constraint: 1198-8699: {human: 'If a URL is referenced, then it **SHOULD** have a corresponding linkHTML element in narrative block (CONF:1198-8699).', source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: warning} index: 54 sdtcAuthor: {short: 'π¨π¦πππ: Author', index: 55} required: [id, code] required: [externalDocument] id: {index: 6} code: short: Advance Directive constraint: should-translation: {human: SHOULD contain translation, source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: warning, expression: translation.exists()} index: 7 elements: code: pattern: {type: Code, value: 75320-2} index: 8 codeSystem: short: LOINC pattern: {type: String, value: 2.16.840.1.113883.6.1} index: 9 translation: short: 'π¨π¦πππ: Advance Directive Type' binding: {strength: preferred, valueSet: 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4'} index: 10 required: [codeSystem, code] moodCode: pattern: {type: Code, value: EVN} index: 5 effectiveTime: index: 15 elements: low: {index: 16} high: short: |- If the Advance Directive does not have a specified ending time, use a nullFlavor of *NA*. If the ending time is unknown, use a nullFlavor of *UNK*. index: 17 required: [low, high] templateId: index: 0 slicing: rules: open discriminator: - {path: root, type: value} - {path: extension, type: value} min: 1 slices: advance-directive-obs: match: {root: 2.16.840.1.113883.10.20.22.4.48, extension: '2025-05-01'} schema: _required: true index: 1 elements: root: pattern: {type: String, value: 2.16.840.1.113883.10.20.22.4.48} index: 2 extension: pattern: {type: String, value: '2025-05-01'} index: 3 required: [root, extension] extensions: {} statusCode: index: 13 elements: code: pattern: {type: Code, value: completed} index: 14 required: [code] informant: {short: SHOULD contain informant, index: 20} text: short: SHOULD reference the portion of section narrative text corresponding to this entry index: 11 elements: reference: constraint: value-starts-octothorpe: {human: 'If reference/@value is present, it SHALL begin with a ''#'' and SHALL point to its corresponding narrative', source: 'http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation', severity: error, expression: value.exists() implies value.startsWith('#')} index: 12 package_version: 5.0.0-ballot class: logical kind: logical url: http://hl7.org/cda/us/ccda/StructureDefinition/AdvanceDirectiveObservation base: http://hl7.org/cda/stds/core/StructureDefinition/Observation version: 5.0.0-ballot required: [id, effectiveTime, statusCode, text, reference, templateId]