# text.div
Include these codes as defined in http://terminology.hl7.org/CodeSystem/v3-ActRelationshipType

Code | Display | Definition

CAUS

is etiology for

**Description:** An assertion that an act was the cause of another act.This is stronger and more specific than the support link. The source (cause) is typically an observation, but may be any act, while the target may be any act.

**Examples:**

* a growth of Staphylococcus aureus may be considered the cause of an abscess
* contamination of the infusion bag was deemed to be the cause of the infection that the patient experienced
* lack of staff on the shift was deemed to be a supporting factor (proximal factor) causing the patient safety incident where the patient fell out of bed because the bed-sides had not been put up which caused the night patient to fall out of bed

COMP | has component | The target act is a component of the source act, with no semantics regarding composition or aggregation implied.
GEVL | evaluates (goal) | A goal-evaluation links an observation (intent or actual) to a goal to indicate that the observation evaluates the goal. Given the goal and the observation, a "goal distance" (e.g., goal to observation) can be "calculated" and need not be sent explicitly.
MFST | is manifestation of | An assertion that a new observation may be the manifestation of another existing observation or action. This assumption is attributed to the same actor who asserts the manifestation. This is stronger and more specific than an inverted support link. For example, an agitated appearance can be asserted to be the manifestation (effect) of a known hyperthyroxia. This expresses that one might not have realized a symptom if it would not be a common manifestation of a known condition. The target (cause) may be any service, while the source (manifestation) must be an observation.
REFR | refers to | A relationship in which the target act is referred to by the source act. This permits a simple reference relationship that distinguishes between the referent and the referee.

RSON

has reason

**Description:** The reason or rationale for a service. A reason link is weaker than a trigger, it only suggests that some service may be or might have been a reason for some action, but not that this reason requires/required the action to be taken. Also, as opposed to the trigger, there is no strong timely relation between the reason and the action. As well as providing various types of information about the rationale for a service, the RSON act relationship is routinely used between a SBADM act and an OBS act to describe the indication for use of a medication. Child concepts may be used to describe types of indication.

*Discussion:* In prior releases, the code "SUGG" (suggests) was expressed as "an inversion of the reason link." That code has been retired in favor of the inversion indicator that is an attribute of ActRelationship.

SAS

starts after start of

The source Act starts after the start of the target Act (i.e. if we say "ActOne SAS ActTwo", it means that ActOne starts after the start of ActTwo, therefore ActOne is the source and ActTwo is the target).

*UsageNote:* Inverse code is **SBS**

SPRT | has support | Used to indicate that an existing service is suggesting evidence for a new observation. The assumption of support is attributed to the same actor who asserts the observation. Source must be an observation, target may be any service (e.g., to indicate a status post).

SUBJ

has subject

Relates an Act to its subject Act that the first Act is primarily concerned with.

Examples

1. The first Act may be a ControlAct manipulating the subject Act
2. The first act is a region of interest (ROI) that defines a region within the subject Act.
3. The first act is a reporting or notification Act, that echos the subject Act for a specific new purpose.

Constraints

An Act may have multiple subject acts.

Rationale

The ActRelationshipType "has subject" is similar to the ParticipationType "subject", Acts that primarily operate on physical subjects use the Participation, those Acts that primarily operate on other Acts (other information) use the ActRelationship.

XCRPT | Excerpts | The source is an excerpt from the target.

# description
Used to enumerate the relationships between two CDA entries.