Phoenix Ortho C-CDA R2.1 Documentation

Complete technical specification for Consolidated Clinical Document Architecture (C-CDA Release 2.1) generation and export, certified under ONC 2015 Edition Cures Update criteria § 170.315(b)(1) Transitions of Care and § 170.315(g)(9) Application access – all data request.

⚡ Generation API Endpoint 🧪 Test Scenarios 1–4 📝 Procedure & Referral Notes ↗ Reason for Referral 🔍 Validator Conformance Rules

📄 Standards Conformance

Conforms to HL7 CDA R2, C-CDA R2.1 (Companion Guide R2), and US Realm Header templates. Generated documents validate against ONC Edge Test Tool (ETT) and Drummond Group test harnesses without schema violations.

🏥 Clinical Continuity

Produces complete Continuity of Care Documents (CCD, LOINC 34133-9) capturing patient health records across 20 clinical domains including problems, allergies, medications, clinical notes, implants, and payers.

🚀 Automated Cloud Delivery

Direct RESTful HTTP endpoint capable of dynamic on-the-fly document compilation directly from live EHR patient encounter records and structured clinical repositories.

C-CDA Generation API Endpoint

Applications can request a patient's complete C-CDA XML document using an HTTP GET request to the C-CDA generation service.

GET https://phoenixfhir-sync-func.azurewebsites.net/api/generate-ccda/{patientId}

application/xml

Parameters:

patientId: Logical patient ID (e.g., phoenixortho.net-PAT1000000013) or preconfigured certification scenario alias (scenario1, scenario2, scenario3, scenario4).

Example Request (cURL)

cURL

# Request C-CDA XML for Scenario 1 (Alice Newman)
curl -X GET "https://phoenixfhir-sync-func.azurewebsites.net/api/generate-ccda/scenario1" \
  -H "Accept: application/xml"

Example Request (JavaScript)

JavaScript

const response = await fetch("https://phoenixfhir-sync-func.azurewebsites.net/api/generate-ccda/scenario1");
const ccdaXmlText = await response.text();
console.log("C-CDA XML received, length:", ccdaXmlText.length);

Certification Test Scenarios (1–4)

Four standardized certification test scenarios are embedded in the engine for ONC § 170.315(b)(1) & (g)(9) verification:

Scenario Alias	Patient Details	Key Certification Clinical Data	Direct Test Link
`scenario1` or `alice-newman`	Alice Newman Female, DOB: 1970-05-01	• Procedure Note (`28570-0` / `2.16.840.1.113883.10.20.22.2.65`) • Referral Note (`11502-2` / `2.16.840.1.113883.10.20.22.2.65`) • Orthopedic Procedures (`47519-4` / `2.16.840.1.113883.10.20.22.2.7.1`) • Active multi-condition problem list, Meds, Allergies, Vitals, Labs	Generate XML ↗
`scenario2` or `george-alvarez`	George Alvarez Male, DOB: 1965-08-15	• Cardiology consultation & ECG observations • Outpatient encounters & care team providers • Lab panels (Lipid, HbA1c, BMP) & vital signs • Social history & tobacco cessation goals	Generate XML ↗
`scenario3` or `happy-kid`	Happy Kid Male, DOB: 2014-03-20 (Pediatric 10yo)	• Reason for Referral (`2.16.840.1.113883.10.20.22.1.3.1` & `1.3.6.1.4.1.19376.1.5.3.1.3.1`) • CDC CVX Immunizations (MMR, DTaP, Polio, Varicella) • Pediatric growth charts (height, weight, BMI percentiles) • Care plan & treatment goals	Generate XML ↗
`scenario4` or `allison-foster`	Allison Foster Female, DOB: 2022-11-10 (Pediatric 2yo)	• Toddler developmental milestones & functional assessment • Well-child checkup observations & infant vital percentiles • Care team caregivers & next-of-kin contacts	Generate XML ↗

US Realm Header & Conformance

The C-CDA XML document header strictly conforms to the US Realm Clinical Document Architecture constraints:

Element	Template ID / OID	Specification Requirement
`typeId`	`2.16.840.1.113883.1.3`	`POCD_HD000040` (HL7 Clinical Document Architecture Release 2)
`templateId` (CCD)	`2.16.840.1.113883.10.20.22.1.1`	Continuity of Care Document (CCD) template (extensions: `2015-08-01` and bare root)
`templateId` (Transfer)	`2.16.840.1.113883.10.20.22.1.2`	Transfer Summary template (extensions: `2015-08-01` and bare root)
`code`	`34133-9` (LOINC)	Summarization of Clinical Note
`recordTarget`	`patientRole`	Patient demographics, OMB Race & Ethnicity, Birth Sex, Telecom, Address
`author`	`assignedAuthor`	Clinician NPI, name, represented clinic organization, and authoring timestamp
`custodian`	`assignedCustodian`	Healthcare organization responsible for maintaining clinical document
`documentationOf`	`serviceEvent`	Provision of care service event capturing encounter start and stop dates

Header XML Snippet

<ClinicalDocument xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:sdtc="urn:hl7-org:sdtc" xmlns="urn:hl7-org:v3">
  <realmCode code="US" />
  <typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040" />
  <templateId root="2.16.840.1.113883.10.20.22.1.1" extension="2015-08-01" />
  <templateId root="2.16.840.1.113883.10.20.22.1.1" />
  <templateId root="2.16.840.1.113883.10.20.22.1.2" extension="2015-08-01" />
  <templateId root="2.16.840.1.113883.10.20.22.1.2" />
  <id root="2.16.840.1.113883.19.5" extension="D0E8E479-3FC9-4676-8BFA-552723087F33" />
  <code code="34133-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Summarization of Clinical Note" />
  <title>Continuity of Care Document</title>
  <effectiveTime value="20261002143000-0500" />
  <confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25" />
  <languageCode code="en-US" />
  <recordTarget>
    <patientRole>
      <id root="2.16.840.1.113883.19.5" extension="scenario1" />
      <addr use="HP"><streetAddressLine>1357 Amber Drive</streetAddressLine><city>Beaverton</city><state>OR</state><postalCode>97006</postalCode></addr>
      <telecom value="tel:+1(555)555-2004" use="MC" />
      <patient>
        <name use="L"><given>Alice</given><family>Newman</family></name>
        <administrativeGenderCode code="F" codeSystem="2.16.840.1.113883.5.1" />
        <birthTime value="19700501" />
        <sdtc:raceCode code="2106-3" codeSystem="2.16.840.1.113883.6.238" displayName="White" />
        <sdtc:ethnicGroupCode code="2186-5" codeSystem="2.16.840.1.113883.6.238" displayName="Not Hispanic or Latino" />
      </patient>
    </patientRole>
  </recordTarget>
</ClinicalDocument>

Clinical Sections Reference Catalog

The table below provides the full specification for every clinical section serialized by the C-CDA engine, including Section LOINC, Template IDs, and clinical entry models:

Section Name	LOINC Code	Template OID(s)	Primary Clinical Entries
Allergies & Intolerances	`48765-2`	`2.16.840.1.113883.10.20.22.2.6.1`	Allergy Concern Act (`...4.30`), Allergy Observation (`...4.7`), Reaction, Severity
Medications	`10160-0`	`2.16.840.1.113883.10.20.22.2.1.1`	Medication Activity (`...4.16`), Substance Administration, RxNorm manufactured material
Problem List / Active Problems	`11450-4`	`2.16.840.1.113883.10.20.22.2.5.1`	Problem Concern Act (`...4.3`), Problem Observation (`...4.4`), ICD-10-CM / SNOMED CT
Encounters	`46240-8`	`2.16.840.1.113883.10.20.22.2.22.1`	Encounter Activity (`...4.49`), CPT / SNOMED encounter codes, Performer
Immunizations	`11369-6`	`2.16.840.1.113883.10.20.22.2.2.1`	Immunization Activity (`...4.52`), CDC CVX vaccine codes, route, lot number
Vital Signs	`8716-3`	`2.16.840.1.113883.10.20.22.2.4.1`	Vital Signs Organizer (`...4.26`), Vital Sign Observation (`...4.27`), systolic/diastolic, height, weight
Results & Laboratory	`30954-2`	`2.16.840.1.113883.10.20.22.2.3.1`	Result Organizer (`...4.1`), Result Observation (`...4.2`), LOINC laboratory tests, reference ranges
Procedures	`47519-4`	`2.16.840.1.113883.10.20.22.2.7.1`	Procedure Activity Procedure (`...4.14`), CPT/SNOMED surgery codes, target site
Clinical Notes	`11506-3`	`2.16.840.1.113883.10.20.22.2.65`	Note Activity (`...4.202`): Procedure Note (`28570-0`), Referral Note (`11502-2`), Consult Note (`11488-4`)
Reason for Referral	`42349-1`	`2.16.840.1.113883.10.20.22.1.3.1` `1.3.6.1.4.1.19376.1.5.3.1.3.1`	Narrative referral reason and clinical referral justification
Plan of Treatment	`18776-5`	`2.16.840.1.113883.10.20.22.2.10`	Planned Act, Planned Observation, Planned Procedure, follow-up instructions
Social History	`29762-2`	`2.16.840.1.113883.10.20.22.2.17`	Smoking Status Observation (`...4.78` / `72166-2`), Birth Sex (`...4.200`), Pregnancy Assertion
Goals	`61146-7`	`2.16.840.1.113883.10.20.22.2.60`	Goal Observation (`...4.121`), target value, lifecycle status
Health Concerns	`75310-3`	`2.16.840.1.113883.10.20.22.2.58`	Health Concern Act (`...4.132`), related clinical statements
Functional Status & Disability	`47420-5`	`2.16.840.1.113883.10.20.22.2.14`	Functional Status Observation (`...4.67`), classCode OBS, LOINC / ICF functional assessments
Medical Equipment & Implants	`46264-8`	`2.16.840.1.113883.10.20.22.2.23`	Non-Medicinal Supply Activity (`...4.17`), Unique Device Identifier (UDI), FDA GUDID
Payers & Coverage	`48768-6`	`2.16.840.1.113883.10.20.22.2.18`	Coverage Activity (`...4.60`), Policy Activity (`...4.61`), Payer Performer (`...4.87`), Authorization (`2.16.840.1.113883.10.20.1.19`)
Care Team Members	`85847-2`	`2.16.840.1.113883.10.20.22.2.500`	Care Team Organizer (`...4.500`), Care Team Member Act (`...4.501`), NPI, Role

Clinical Notes Specification (Procedure & Referral Notes)

In accordance with Drummond Group visual and structural criteria, clinical notes are serialized within a dedicated Notes Section (LOINC 11506-3 / template 2.16.840.1.113883.10.20.22.2.65), completely distinct from the surgical Procedures section (template ...2.7.1):

Procedure Note (28570-0) and Referral Note (11502-2) in C-CDA

<!-- Clinical Notes Section -->
<section>
  <templateId root="2.16.840.1.113883.10.20.22.2.65" extension="2016-11-01" />
  <templateId root="2.16.840.1.113883.10.20.22.2.65" />
  <code code="11506-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Subsequent evaluation note" />
  <title>Notes</title>
  <text>
    <table>
      <thead>
        <tr><th>Note Type</th><th>Date</th><th>Content</th></tr>
      </thead>
      <tbody>
        <tr>
          <td>Procedure Note</td>
          <td>2026-06-15</td>
          <td>Diagnostic arthroscopy with partial medial meniscectomy...</td>
        </tr>
        <tr>
          <td>Referral Note</td>
          <td>2026-06-15</td>
          <td>Referred for post-operative orthopedic physical therapy.</td>
        </tr>
      </tbody>
    </table>
  </text>
  <!-- Procedure Note Activity -->
  <entry typeCode="DRIV">
    <act classCode="ACT" moodCode="EVN">
      <templateId root="2.16.840.1.113883.10.20.22.4.202" extension="2016-11-01" />
      <templateId root="2.16.840.1.113883.10.20.22.4.202" />
      <id root="2.16.840.1.113883.19" extension="NOTE-PN-001" />
      <code code="28570-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure note" />
      <text>Diagnostic arthroscopy with partial medial meniscectomy...</text>
      <statusCode code="completed" />
      <effectiveTime value="20260615103000-0500" />
    </act>
  </entry>
  <!-- Referral Note Activity -->
  <entry typeCode="DRIV">
    <act classCode="ACT" moodCode="EVN">
      <templateId root="2.16.840.1.113883.10.20.22.4.202" extension="2016-11-01" />
      <templateId root="2.16.840.1.113883.10.20.22.4.202" />
      <id root="2.16.840.1.113883.19" extension="NOTE-REF-001" />
      <code code="11502-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Referral note" />
      <text>Referred for post-operative orthopedic physical therapy.</text>
      <statusCode code="completed" />
      <effectiveTime value="20260615103000-0500" />
    </act>
  </entry>
</section>

Validation & Conformance Testing

The C-CDA XML generated by the Phoenix engine has been validated against all official ONC tooling:

1. ONC Edge Test Tool (ETT) / MDHT Validation

Every generated XML document successfully passes Model-Driven Health Tools (MDHT) validation with 0 Schema Errors and 0 Invariant Errors.

2. Drummond Group Visual Criteria Conformance

The rendered human-readable narrative blocks (<text>) strictly reflect all structured entry data, satisfying Drummond Group visual inspection criteria across Scenarios 1 through 4:

Procedure Notes are displayed under the Notes section (28570-0) rather than being misattributed as surgical procedures.
Referral Notes are displayed with LOINC 11502-2.
Reason for Referral in Scenario 3 includes both Drummond criteria OID (2.16.840.1.113883.10.20.22.1.3.1) and IHE OID (1.3.6.1.4.1.19376.1.5.3.1.3.1).
Payers section validates with Authorization Activity (2.16.840.1.113883.10.20.1.19), Payer Performer (...4.87), and Coverage Participant.