| 51847-2 | Eval+Plan note | required |
| 51848-0 | Eval note | required |
| 18776-5 | Plan of care note | required |
| 55109-3 | Complications Doc | required |
| 59769-0 | Postprocedure Dx | required |
| 29554-3 | Proc | required |
| 59768-2 | Procedure indications Imp | required |
| 59770-8 | Estimated blood loss | optional |
| 59771-6 | Implants | optional |
| 59772-4 | Planned procedure | optional |
| 59773-2 | Specimens taken | optional |
| 59774-0 | Anesthesia | optional |
| 59775-7 | Disposition | optional |
| 59776-5 | Findings | optional |
| 29545-1 | Physical findings note | required |
| 29299-5 | Reason for visit | conditional |
| 48765-2 | Allergies &or adverse reactions Doc | optional |
| 10154-3 | Chief complaint Reported | optional |
| 46239-0 | Chief complaint+Reason for visit | optional |
| 10157-6 | Hx of fam member ds note | optional |
| 10210-3 | Phys find General status | optional |
| 11348-0 | Hx of Past illness note | optional |
| 10160-0 | Hx of Medication use | optional |
| 29549-3 | Medication administered | optional |
| 47519-4 | Procedures Hx Doc | optional |
| 29762-2 | Social hx note | optional |
| 10187-3 | Review of systems | optional |
| 59843-3 | Proced Nte C-CDA R1.1 Sections | |