The article The encompassingEncounter element, provides an overview of the use of the componentOf/encompassingEncounter element that is part of the CDA Header, as well as its XML syntax.

The encompassingEncounter XML element in the CDA Header, is used to represent the “focal point” encounter in which the clinical acts being documented in the CDA document took place (even though there may be additional encounters that are related to that “focal point” encounter also documented in the CDA Body).

In the US Realm Header – the common CDA Header template shared by all C-CDA documents – the componentOf/encompassingEncounter is optional.

C-CDA Document Templates that Require encompassingEncounter
A Consultation Note has a clear “encompassing encounter” in which the consultation took place. Thus, componentOf/encompassingEncounter is required to be present as per the rules of the Consultation Note template. Similarly, a Discharge Summary is always associated with a hospital admission and, thus, componentOf/encompassingEncounter is required to be present as per the rules for that template. The same is true for a History & Physical Note and for a Progress Note.

C-CDA Document Templates that Recommend encompassingEncounter
A Procedure Note generally describes a procedure that took place in the context of an encounter, and it is thus usually the case that there is an obvious choice for componentOf/encompassingEncounter. However, the C-CDA template doesn’t require that componentOf/encompassingEncounter be present, rather, it presents it as something that “SHOULD” be present.

If a diagnostic imaging procedure triggering a Documentation Imaging Report, took place in the context of a hospital stay or outpatient visit, the “encompassing encounter” is well-defined and should be included.

The Special Case of a CCD Document
The use of componentOf/encompassingEncounter in a C-CDA CCD is optional and depends on the nature of the CCD scope. If the CCD describes (or primarily describes) a single encounter or a single “focal point” encounter – then componentOf/encompassingEncounter should be used for that encounter. If there are additional encounters (as the encounter in componentOf/encompassingEncounter was the “focal point” encounter, but not the only one), then those additional encounters would be documented in encounter clinical statements in the CDA Body.

If the CCD covers a period spanning several encounters and there is no clear primary encounter, then componentOf/encompassingEncounter should be left out of the CDA Header and only the encounter clinical statements in the CDA Body should be used.

Refer to the article Should there be an encompassingEncounter in a C-CDA CCD?, for additional information and scenarios regarding the use of encompassingEncounter in C-CDA CCD documents.

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