description: This profile was originally based on the Continuity of Care Document (CCD) Release 1.1 which itself was derived from HITSP C32 and CCD Release 1.0.\n\nThe Continuity of Care Document (CCD) profile represents a core data set of the most relevant administrative, demographic, and clinical information facts about a patient's healthcare, covering one or more healthcare encounters. It provides a means for one healthcare practitioner, system, or setting to aggregate all of the pertinent data about a patient and forward it to another to support the continuity of care.  \n\nThe primary use case for the CCD is to provide a snapshot in time containing the germane clinical, demographic, and administrative data for a specific patient. The key characteristic of a CCD is that the Composition.event.code is constrained to \"PCPR\". This means it does not function to report new services associated with performing care. It reports on care that has already been provided. The CCD provides a historical tally of the care over a range of time and is not a record of new services delivered.\n\nMore specific use cases, such as a Discharge Summary, Transfer Summary, Referral Note, Consultation Note, or Progress Note, are available as alternative profiles.
package_name: hl7.fhir.us.ccda
derivation: constraint
name: ContinuityOfCareDocument
type: Composition
elements:
  type:
    label: Summary of episode note
    short: Summary of episode note
    mustSupport: true
    pattern:
      type: CodeableConcept
      value:
        coding:
        - {code: 34133-9, system: 'http://loinc.org'}
    index: 0
  event:
    label: serviceEvent
    short: serviceEvent
    mustSupport: true
    index: 1
    elements:
      code: {short: code, index: 2}
      period:
        short: period
        index: 3
        elements:
          start: {short: start, index: 4}
          end: {short: end, index: 5}
        required: [start, end]
    required: [period]
  section:
    index: 6
    slicing:
      rules: open
      discriminator:
      - {path: code, type: value}
      min: null
      slices:
        functional_status_section:
          match:
            code:
              coding:
              - {code: 47420-5, system: 'http://loinc.org'}
          schema:
            label: Functional Status Section
            short: Functional Status Section
            mustSupport: true
            index: 73
            elements:
              title: {short: title, mustSupport: true, index: 74}
              code:
                label: Functional status assessment
                short: Functional status assessment
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 47420-5, system: 'http://loinc.org'}
                index: 75
              text: {short: text, mustSupport: true, index: 76}
              entry:
                short: entry
                index: 77
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    functional_status_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/Observation']
                        index: 78
            required: [text, title, code]
        allergies_and_intolerances_section:
          match:
            code:
              coding:
              - {code: 48765-2, system: 'http://loinc.org'}
          schema:
            short: Allergies and Intolerances Section
            mustSupport: true
            _required: true
            label: Allergies and Intolerances Section
            index: 7
            elements:
              title: {short: title, mustSupport: true, index: 8}
              code:
                label: Allergies and adverse reactions
                short: Allergies and adverse reactions
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 48765-2, system: 'http://loinc.org'}
                index: 9
              text: {short: text, mustSupport: true, index: 10}
              entry:
                short: entry
                mustSupport: true
                index: 11
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    allergy_entry:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance']
                        index: 12
            required: [text, title, code]
        mental_status_section:
          match:
            code:
              coding:
              - {code: 10190-7, system: 'http://loinc.org'}
          schema:
            label: Mental Status Section
            short: Mental Status Section
            mustSupport: true
            index: 91
            elements:
              title: {short: title, mustSupport: true, index: 92}
              code:
                label: Mental status
                short: Mental status
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 10190-7, system: 'http://loinc.org'}
                index: 93
              text: {short: text, mustSupport: true, index: 94}
              entry:
                short: entry
                index: 95
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    mental_status_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/Observation']
                        index: 96
            required: [text, title, code]
        nutrition_section:
          match:
            code:
              coding:
              - {code: 61144-2, system: 'http://loinc.org'}
          schema:
            label: Nutrition Section
            short: Nutrition Section
            mustSupport: true
            index: 85
            elements:
              title: {short: title, mustSupport: true, index: 86}
              code:
                label: Diet and nutrition
                short: Diet and nutrition
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 61144-2, system: 'http://loinc.org'}
                index: 87
              text: {short: text, mustSupport: true, index: 88}
              entry:
                short: entry
                index: 89
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    nutrition_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/ClinicalImpression', 'http://hl7.org/fhir/StructureDefinition/NutritionOrder', 'http://hl7.org/fhir/StructureDefinition/Observation']
                        index: 90
            required: [text, title, code]
        immunizations_section:
          match:
            code:
              coding:
              - {code: 11369-6, system: 'http://loinc.org'}
          schema:
            label: Immunizations Section
            short: Immunizations Section
            mustSupport: true
            index: 79
            elements:
              title: {short: title, mustSupport: true, index: 80}
              code:
                label: History of immunization
                short: History of immunization
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 11369-6, system: 'http://loinc.org'}
                index: 81
              text: {short: text, mustSupport: true, index: 82}
              entry:
                short: entry
                index: 83
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    immunization_entry:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-immunization']
                        index: 84
            required: [text, title, code]
        health_concerns_section:
          match:
            code:
              coding:
              - {code: 75310-3, system: 'http://loinc.org'}
          schema:
            short: Health Concerns Section
            mustSupport: true
            index: 115
            elements:
              title: {short: title, mustSupport: true, index: 116}
              code:
                short: Health concerns section code
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 75310-3, system: 'http://loinc.org'}
                index: 117
              text: {short: text, mustSupport: true, index: 118}
              entry:
                short: entry
                index: 119
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    health_concerns_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/ClinicalImpression', 'http://hl7.org/fhir/StructureDefinition/DocumentReference', 'http://hl7.org/fhir/StructureDefinition/List', 'http://hl7.org/fhir/StructureDefinition/Observation', 'http://hl7.org/fhir/StructureDefinition/RiskAssessment', 'http://hl7.org/fhir/StructureDefinition/vitalsigns', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus']
                        index: 120
            required: [text, title, code]
        results_section:
          match:
            code:
              coding:
              - {code: 30954-2, system: 'http://loinc.org'}
          schema:
            short: Results Section
            mustSupport: true
            _required: true
            label: Results Section
            index: 25
            elements:
              title: {short: title, mustSupport: true, index: 26}
              code:
                label: Relevant diagnostic tests and laboratory data
                short: Relevant diagnostic tests and laboratory data
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 30954-2, system: 'http://loinc.org'}
                index: 27
              text: {short: text, mustSupport: true, index: 28}
              entry:
                short: entry
                index: 29
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    sliceEntry:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab']
                        index: 30
            required: [text, title, code]
        medications_section:
          match:
            code:
              coding:
              - {code: 10160-0, system: 'http://loinc.org'}
          schema:
            short: Medications Section
            mustSupport: true
            _required: true
            label: Medications Section
            index: 13
            elements:
              title: {short: title, mustSupport: true, index: 14}
              code:
                label: History of medication use
                short: History of medication use
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 10160-0, system: 'http://loinc.org'}
                index: 15
              text: {short: text, mustSupport: true, index: 16}
              entry:
                short: entry
                index: 17
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    medication_entry:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/MedicationStatement', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest']
                        index: 18
            required: [text, title, code]
        social_history_section:
          match:
            code:
              coding:
              - {code: 29762-2, system: 'http://loinc.org'}
          schema:
            short: Social History Section
            mustSupport: true
            _required: true
            label: Social History Section
            index: 31
            elements:
              title: {short: title, mustSupport: true, index: 32}
              code:
                label: Social history
                short: Social history
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 29762-2, system: 'http://loinc.org'}
                index: 33
              text: {short: text, mustSupport: true, index: 34}
              entry:
                short: entry
                index: 35
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    smoking_status_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: Smoking status
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus']
                        index: 36
            required: [text, title, code]
        procedures_section:
          match:
            code:
              coding:
              - {code: 47519-4, system: 'http://loinc.org'}
          schema:
            label: Procedures Section
            short: Procedures Section
            mustSupport: true
            index: 49
            elements:
              title: {short: title, mustSupport: true, index: 50}
              code:
                label: History of procedures
                short: History of procedures
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 47519-4, system: 'http://loinc.org'}
                index: 51
              text: {short: text, mustSupport: true, index: 52}
              entry:
                short: entry
                index: 53
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    procedure_entry:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure']
                        index: 54
            required: [text, title, code]
        plan_of_treatment_section:
          match:
            code:
              coding:
              - {code: 18776-5, system: 'http://loinc.org'}
          schema:
            label: Plan of Treatment Section
            short: Plan of Treatment Section
            mustSupport: true
            index: 43
            elements:
              title: {short: title, mustSupport: true, index: 44}
              code:
                label: Plan of treatment
                short: Plan of treatment
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 18776-5, system: 'http://loinc.org'}
                index: 45
              text: {short: text, mustSupport: true, index: 46}
              entry:
                short: entry
                index: 47
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    sliceEntry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        refers: ['http://hl7.org/fhir/StructureDefinition/Appointment', 'http://hl7.org/fhir/StructureDefinition/Communication', 'http://hl7.org/fhir/StructureDefinition/CommunicationRequest', 'http://hl7.org/fhir/StructureDefinition/DeviceRequest', 'http://hl7.org/fhir/StructureDefinition/NutritionOrder', 'http://hl7.org/fhir/StructureDefinition/RequestGroup', 'http://hl7.org/fhir/StructureDefinition/ServiceRequest', 'http://hl7.org/fhir/StructureDefinition/Task', 'http://hl7.org/fhir/StructureDefinition/VisionPrescription', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest']
                        index: 48
            required: [text, title, code]
        problem_section:
          match:
            code:
              coding:
              - {code: 11450-4, system: 'http://loinc.org'}
          schema:
            short: Problem Section
            mustSupport: true
            _required: true
            label: Problem Section
            index: 19
            elements:
              title: {short: title, mustSupport: true, index: 20}
              code:
                label: Problem list
                short: Problem list
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 11450-4, system: 'http://loinc.org'}
                index: 21
              text: {short: text, mustSupport: true, index: 22}
              entry:
                short: entry
                index: 23
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    problems_entry:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition']
                        index: 24
            required: [text, title, code]
        payers_section:
          match:
            code:
              coding:
              - {code: 48768-6, system: 'http://loinc.org'}
          schema:
            label: Payers Section
            short: Payers Section
            mustSupport: true
            index: 103
            elements:
              title: {short: title, mustSupport: true, index: 104}
              code:
                label: Payers
                short: Payers
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 48768-6, system: 'http://loinc.org'}
                index: 105
              text: {short: text, mustSupport: true, index: 106}
              entry:
                short: entry
                mustSupport: true
                index: 107
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    coverage_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/Coverage']
                        index: 108
            required: [text, title, code]
        vital_signs_section:
          match:
            code:
              coding:
              - {code: 8716-3, system: 'http://loinc.org'}
          schema:
            short: Vital Signs Section
            mustSupport: true
            _required: true
            label: Vital Signs Section
            index: 37
            elements:
              title: {short: title, mustSupport: true, index: 38}
              code:
                label: Vital signs
                short: Vital signs
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 8716-3, system: 'http://loinc.org'}
                index: 39
              text: {short: text, mustSupport: true, index: 40}
              entry:
                short: entry
                index: 41
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    vital_signs_entry:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/vitalsigns']
                        index: 42
            required: [text, title, code]
        medical_equipment_section:
          match:
            code:
              coding:
              - {code: 46264-8, system: 'http://loinc.org'}
          schema:
            label: Medical Equipment Section
            short: Medical Equipment Section
            mustSupport: true
            index: 97
            elements:
              title: {short: title, mustSupport: true, index: 98}
              code:
                label: Medical equipment
                short: Medical equipment
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 46264-8, system: 'http://loinc.org'}
                index: 99
              text: {short: text, mustSupport: true, index: 100}
              entry:
                short: entry
                mustSupport: true
                index: 101
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    medical_equipment_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/Device', 'http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure']
                        index: 102
            required: [text, title, code]
        goals_section:
          match:
            code:
              coding:
              - {code: 61146-7, system: 'http://loinc.org'}
          schema:
            short: Goals Section
            mustSupport: true
            index: 109
            elements:
              title: {short: title, mustSupport: true, index: 110}
              code:
                short: Goals
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 61146-7, system: 'http://loinc.org'}
                index: 111
              text: {short: text, mustSupport: true, index: 112}
              entry:
                short: entry
                index: 113
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    goals_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: entry
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal']
                        index: 114
            required: [text, title, code]
        family_history_section:
          match:
            code:
              coding:
              - {code: 10157-6, system: 'http://loinc.org'}
          schema:
            label: Family History Section
            short: Family History Section
            mustSupport: true
            index: 55
            elements:
              title: {short: title, mustSupport: true, index: 56}
              code:
                label: History of family member diseases
                short: History of family member diseases
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 10157-6, system: 'http://loinc.org'}
                index: 57
              text: {short: text, mustSupport: true, index: 58}
              entry:
                short: entry
                index: 59
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    family_history_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/FamilyMemberHistory']
                        index: 60
            required: [text, title, code]
        encounters_section:
          match:
            code:
              coding:
              - {code: 46240-8, system: 'http://loinc.org'}
          schema:
            label: Encounters Section
            short: Encounters Section
            mustSupport: true
            index: 67
            elements:
              title: {short: title, mustSupport: true, index: 68}
              code:
                label: Encounters
                short: Encounters
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 46240-8, system: 'http://loinc.org'}
                index: 69
              text: {short: text, mustSupport: true, index: 70}
              entry:
                short: entry
                index: 71
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    encounter_entry:
                      match: {}
                      schema:
                        type: Reference
                        short: This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter']
                        index: 72
            required: [text, title, code]
        advance_directives_section:
          match:
            code:
              coding:
              - {code: 42348-3, system: 'http://loinc.org'}
          schema:
            label: Advance Directives Section
            short: Advance Directives Section
            mustSupport: true
            index: 61
            elements:
              title: {short: title, mustSupport: true, index: 62}
              code:
                label: Advance directives
                short: Advance directives
                mustSupport: true
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: 42348-3, system: 'http://loinc.org'}
                index: 63
              text: {short: text, mustSupport: true, index: 64}
              entry:
                index: 65
                slicing:
                  rules: open
                  discriminator:
                  - {path: resolve(), type: profile}
                  min: null
                  slices:
                    advance_directive_entry:
                      match: {}
                      schema:
                        type: Reference
                        mustSupport: true
                        refers: ['http://hl7.org/fhir/StructureDefinition/Consent']
                        index: 66
            required: [text, title, code]
package_version: 2.0.0-ballot
class: profile
kind: resource
url: http://hl7.org/fhir/us/ccda/StructureDefinition/Continuity-of-Care-Document
base: http://hl7.org/fhir/us/ccda/StructureDefinition/US-Realm-Header
version: 2.0.0-ballot
required: [event]