The article Clinical act statements, provides an overview of the clinical statements that form the “core” of a CDA document.

Clinical statements begin with an XML element of: act, encounter, procedure, observation, substanceAdministration, supply, or organizer.

Clinical act statements can be nested within each other to capture relationships between them. However, this nesting is not done directly. You can not place the elements listed above directly under each other – there is no observation/observation, or encounter/procedure, or similar XML element path in a CDA document.

Instead, clinical act statements are connected to each other via act relationship elements. There are five such XML elements in CDA:

  • <entryRelationship…
  • <component…
  • <precondition…
  • <referenceRange…
  • <reference…

The most commonly used – and also the most generic – act relationship element is the entryRelationship element. Refer to the article The entryRelationship element for additional information and examples.

The referenceRange act relationship element is only used within the observation clinical act statement.

In the context of clinical act statements in the structured entries of the CDA body (as opposed to in the CDA header or directly under section elements), the component act relationship element is only used within oraganizer clinical act statement.

Combining Clinical Act Statements with Act Relationship Elements
We noted above that act relationship elements connect clinical act statements to each other. This is not formally correct.

When an act relationship element is used, the result is a single clinical act statement.

The clinical act element nested inside the act relationship element is no longer a “clinical act statement” on its own. Rather, it is now a sub-part of the clinical act statement of the parent of the act relationship element.

Other CDA PRO Know Articles Referenced In This Article