The CDA Header of a CDA document has XML sub-elements of the ClinicalDocument root element to represent the patient (the recordTarget element), the author of the CDA document (the author element), who the document is intended for (the informationRecipient element), and more.

However, it’s not immediately obvious where in the CDA Header the “referring physician” belongs.

The answer is that that the referring physician (or other relevant healthcare provider making the referral) – along with the admitting attending, consulting, and/or discharging physician/healthcare provider – are represented in the encounterParticipant sub-element of the encompassingEncounter element, which in turn can be found by following the path: ClincialDocument/componentOf/encompassingEncounter.

For a referring physician, the typeCode attribute of the encounterParticipant element is set to the value “REF”.

Refer to the article: The encounterParticipant element, for additional information.

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