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draft Template  Communication of Actionable Findings

Id 1.2.840.10008.9.11
ref
DICOM-
 		Effective Date 2021‑06‑22 11:10:34
Status draft Draft Version Label DICOM-20150324
Name CommunicationActionableFindings Display Name Communication of Actionable Findings
Description
A section that documents the notification of an actionable finding to a provider or other person responsible for patient care. The documentation in narrative text, and optionally in a coded entry, includes by whom, to whom, and at what date/time. Specific findings, including actionable (aka. critical) findings documented in text or as coded entries, are typically found in the 9.5 Findings. The actionable findings may be duplicated in the 9.6 Impression in either text or as coded entries. The actionable findings may be new (critical) or a change to a previous report/diagnosis (discrepant).
Context Parent nodes of template element with id 1.2.840.10008.9.11
Classification CDA Section Level Template
Open/Closed Open (other than defined elements are allowed)
Used by / Uses
Used by 0 transactions and 5 templates, Uses 0 templates
Used by as Name Version
1.2.840.10008.9.5 Containment draft Impression (DICOM-20150324) 2021‑06‑22 12:22:26
2.16.840.1.113883.2.51.10.1.9.1 link cancelled XeH Imaging Report 2021‑06‑22 14:23:06
2.16.840.1.113883.2.51.10.2 link draft XeH Diagnostic Imaging Report (0.1) 2021‑06‑21 14:23:14
2.16.840.1.113883.2.51.10.45 link cancelled XeH Diagnostic Imaging Report2 (DICOM-20150324) 2021‑11‑08 15:59:54
1.2.840.10008.9.6 Containment draft Addendum (DICOM-20150324) 2021‑06‑22 12:04:38
Example
Example
<section classCode="DOCSECT" moodCode="EVN">
  <templateId root="1.2.840.10008.9.11"/>  <id root="1.2.840.10213.2.62.7044794679.114296787"/>  <code code="73568-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Communication of Critical Results"/>  <title>Communication of Actionable Results</title>  <text>
    <content ID="CR1">Dr. Smith was phoned at 262-966-0120 at 3:14pm on Wednesday, June 4, 2014, and the 4mm lung nodule was discussed directly with Dr. Smith to explain the follow-up recommendation of ...</content>  </text>  <entry>
    <act classCode="ACT" moodCode="EVN">
      <code code="121291" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM" displayName="Results Communicated"/>      <text>
        <reference value="#CR1"/>      </text>      <effectiveTime value="20140604221400-0700"/>      <performer>
        <assignedEntity>
          <id root="1.2.840.10213.2.62.7044794679.114298686"/>          <assignedPerson>
            <name>Jane Doctor</name>          </assignedPerson>        </assignedEntity>      </performer>      <participant typeCode="NOT">
        <participantRole>
          <telecom value="tel:262-966-0120"/>          <playingEntity>
            <name>Dr. Smith</name>          </playingEntity>        </participantRole>      </participant>    </act>  </entry></section>
Item DT Card Conf Description Label
hl7:section
 		1 … 1 R (Comdotsngs)
hl7:templateId
 		II 1 … 1 M (Comdotsngs)
@root
 		uid 1 … 1 F 1.2.840.10008.9.11
hl7:id
 		II 1 … * R (Comdotsngs)
hl7:code
 		CD 1 … 1 R (Comdotsngs)
@code
 		CONF 0 … 1 F 73568-8
@codeSystem
 		0 … 1 F 2.16.840.1.113883.6.1 (LOINC)
hl7:title
 		ST 1 … 1 R (Comdotsngs)
hl7:text
 		ED 1 … 1 R (Comdotsngs)
hl7:content
 		ST 0 … * (Comdotsngs)
@id
 		XML_ID 1 … 1 R
hl7:linkHtml
 		ST 0 … * (Comdotsngs)
@href
 		url 1 … 1 R
hl7:entry
 		0 … * (Comdotsngs)
hl7:act
 		1 … 1 R (Comdotsngs)
@ID
 		XML_ID 1 … 1 R
@moodCode
 		cs 1 … 1 F EVN
@classCode
 		cs 1 … 1 F ACT
hl7:code
 		CD 1 … 1 R Results communicated (Comdotsngs)
@code
 		CONF 0 … 1 F 121291
@codeSystem
 		0 … 1 F 1.2.840.10008.2.16.4 (DCM)
hl7:effectiveTime
 		TS 1 … 1 R (Comdotsngs)
hl7:text
 		ED 1 … 1 R (Comdotsngs)
hl7:reference
 		URL 1 … 1 R (Comdotsngs)
hl7:performer
 		1 … 1 R (Comdotsngs)
  Example <cda:performer>
  <cda:assignedEntity>
    <cda:assignedPerson>
      <cda:name>name</cda:name>    </cda:assignedPerson>  </cda:assignedEntity></cda:performer>
hl7:assignedEntity
 		1 … 1 R (Comdotsngs)
hl7:assignedPerson
 		1 … 1 R (Comdotsngs)
hl7:name
 		PN 1 … 1 R (Comdotsngs)
hl7:participant
 		1 … 1 R (Comdotsngs)
@typeCode
 		cs 1 … 1 F NOT
  Example <cda:participant typeCode="NOT">
  <cda:participantRole>
    <cda:telecom value="tel:+1-12345678"/>    <cda:playingEntity>
      <cda:name>name</cda:name>    </cda:playingEntity>  </cda:participantRole></cda:participant>
hl7:participantRole
 		1 … 1 R (Comdotsngs)
hl7:telecom
 		TEL 1 … 1 R (Comdotsngs)
hl7:playingEntity
 		1 … 1 R (Comdotsngs)
hl7:name
 		PN 1 … 1 R (Comdotsngs)