| 48765-2 | Allergies &or adverse reactions Doc | optional |
| 51847-2 | Eval+Plan note | required |
| 51848-0 | Eval note | required |
| 18776-5 | Plan of care note | required |
| 10160-0 | Hx of Medication use | optional |
| 11450-4 | Problem list Reported | optional |
| 42349-1 | Reason for referral:Find:Pt:^Patient:Nar: | optional |
| 42348-3 | Adv healthcare directives | optional |
| 10157-6 | Hx of fam member ds note | optional |
| 47420-5 | Functional status note | optional |
| 10210-3 | Phys find General status | optional |
| 11348-0 | Hx of Past illness note | optional |
| 10164-2 | Hx of Pres illness | optional |
| 11369-6 | Hx of Immunization note | optional |
| 46264-8 | Hx medical device use | optional |
| 10190-7 | Mental status | optional |
| 61144-2 | Diet+nutrition | optional |
| 29545-1 | Physical findings note | required |
| 47519-4 | Procedures Hx Doc | optional |
| 30954-2 | Relevant dx tests/lab data note | optional |
| 10187-3 | Review of systems | optional |
| 29762-2 | Social hx note | optional |
| 8716-3 | Vital signs note | optional |
| 81223-0 | Referral Nte C-CDA R2.0+2.1 Sections | |