C-CDA MDHT Conformance Error: sdtc:patient element position in patientRole

[Moisés Cedeño]

Hello, I'm Moisés Cedeño. It's a pleasure to greet you all.

First of all, thank you for maintaining and suspporting this community.

Secondly, I would like to get some help with an error that I'm still having after trying to resolve it. I'm encountering a C-CDA MDHT Conformance Error with the sdtc:patient element placement in patientRole that I haven't been able to resolve after reviewing available documentation and sample files.

Error:

C-CDA MDHT Conformance Error - cvc-complex-type.2.4.a: Invalid content was found starting with element '{"urn:hl7-org:sdtc":patient}'. One of '{"urn:hl7-org:v3":telecom, "urn:hl7-org:v3":patient, "urn:hl7-org:v3":providerOrganization}' is expected.
Line Number: Line number not available

Current Structure: 

<patientRole>
  <id extension="0332000001" root="2.16.840.1.113883.19.5"/>
  <addr use="HP">...</addr>
  <telecom use="HP" value="tel:+1(555)723-1544" />
  <telecom use="MC" value="tel:+1(555)777-1234" />
  <telecom value="mailto:..." use="HP" />
  <sdtc:patient>
    <sdtc:id extension="0332000001" root="2.16.840.1.113883.19.5" />
  </sdtc:patient>
  <patient>...</patient>
  <providerOrganization>...</providerOrganization>
</patientRole>

What I have tried:

1. Reviewed official C-CDA sample files (including 170.315_b1_toc_amb_ccd_r11_svap_uscdiv3_sample1_v1.xml) — the sample declares xmlns:sdtc="urn:hl7-org:sdtc" but does NOT include sdtc:patient in patientRole.
2. Compared XML headers and namespace declarations with official samples.
3. Reviewed C-CDA R2.1 Implementation Guide and HL7 CDA R2 schema definitions
4. Tested different sdtc:patient positions:

• After <providerOrganization> (end of patientRole) — Schema error
• After <patient> and before <providerOrganization> — Schema error
• After <telecom> and before <patient> — Schema error

Question:

What is the correct position for sdtc:patient within patientRole according to the C-CDA R2.1 schema? If sdtc:patient is not allowed in patientRole, should I remove it entirely, or is there an alternative structure for including SDTC patient extensions?

Attachments:

• CCDA_a-000001_TEST_8.xml — file XML I am trying to validate
• CCDA_a-000001_Fixed_8 - Findings — validation findings/error details
• Screenshot 1: Selected validation case in the validation tool
• Screenshot 2: Validation tool error screen showing the error

Thank you for your time and assistance,
Moisés

[Mat Davis]

Hi  Moisés

Can you help us understand why you feel sdtc:Patient is valid or needs to be used?

Unless you have a specific reason for using sdtc:Patient, you should review the examples you mentioned and mimic those then ensure you're meeting expected requirements and validation.

You've done all the things I would've done:

• checked official or other examples
• confirmed that the issue is sdtc:Patient
• confirmed that the sdtc definitions does not include Patient
• reviewed the headers expectations and already established elements in its Template

Thanks - Mat

[Mat Davis]

Additional Findings

- Maybe your use case is related to this?

- By default, this isn't supported to my understanding which means you'd have to customize in some way

https://confluence.hl7.org/spaces/SD/pages/58656440/CDA+Extensions

Thanks - Mat

[Moisés Cedeño]

Hi Mat,

Thanks for the guidance. After reviewing the documentation and the examples you referenced, I confirmed that sdtc:patient does not apply to my use case. I removed that block and, after a few small adjustments, the file validated correctly. 

The issue is resolved on my side now. 

Thanks again,
Moisés

[Mat Davis]

Thanks for the update Moisés and happy you were able to move forward.

Mat