CarePlan -> Plan de Actuación
Describe el plan de cómo uno o más médicos pretenden brindar atención a un paciente, grupo o comunidad en particular durante un período de tiempo, posiblemente limitado a la atención de una afección específica o un conjunto de afecciones.
Care Plan
- Forma Completa
CarePlan | I | CarePlan | There are no (further) constraints on this element Element idCarePlan Healthcare plan for patient or group Alternate namesCare Team DefinitionDescribes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions. CarePlan Constraints
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idCarePlan.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. id Constraints
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meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idCarePlan.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. Meta Constraints
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idCarePlan.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. uri Constraints
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). code BindingA human language. ?? (extensible)Constraints
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text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idCarePlan.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later. Narrative Constraints
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contained | 0..* | Resource | There are no (further) constraints on this element Element idCarePlan.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Resource Mappings
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCarePlan.identifier External Ids for this plan DefinitionThis records identifiers associated with this care plan that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation). Need to allow connection to a wider workflow. Identifier Constraints
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definition | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/PlanDefinition | http://hl7.org/fhir/StructureDefinition/Questionnaire) | There are no (further) constraints on this element Element idCarePlan.definition Protocol or definition DefinitionIdentifies the protocol, questionnaire, guideline or other specification the care plan should be conducted in accordance with. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/PlanDefinition | http://hl7.org/fhir/StructureDefinition/Questionnaire) Constraints
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basedOn | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) | There are no (further) constraints on this element Element idCarePlan.basedOn Fulfills care plan Alternate namesfulfills DefinitionA care plan that is fulfilled in whole or in part by this care plan. Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) Constraints
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replaces | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) | There are no (further) constraints on this element Element idCarePlan.replaces CarePlan replaced by this CarePlan Alternate namessupersedes DefinitionCompleted or terminated care plan whose function is taken by this new care plan. Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans. The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing. Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) Constraints
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partOf | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) | There are no (further) constraints on this element Element idCarePlan.partOf Part of referenced CarePlan DefinitionA larger care plan of which this particular care plan is a component or step. Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed. Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) Constraints
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status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.status draft | active | suspended | completed | entered-in-error | cancelled | unknown DefinitionIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. Allows clinicians to determine whether the plan is actionable or not. The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan. This element is labeled as a modifier because the status contains the code entered-in-error] that marks the plan as not currently valid. code BindingIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. ?? (required)Constraints
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intent | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.intent proposal | plan | order | option DefinitionIndicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain. Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. code BindingCodes indicating the degree of authority/intentionality associated with a care plan ?? (required)Constraints
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category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.category Type of plan DefinitionIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axis of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. CodeableConcept BindingIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. ?? (example)Constraints
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title | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.title Human-friendly name for the CarePlan DefinitionHuman-friendly name for the CarePlan. Note that FHIR strings may not exceed 1MB in size string Constraints
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description | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.description Summary of nature of plan DefinitionA description of the scope and nature of the plan. Provides more detail than conveyed by category. Note that FHIR strings may not exceed 1MB in size string Constraints
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subject | Σ I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group) | There are no (further) constraints on this element Element idCarePlan.subject Who care plan is for Alternate namespatient DefinitionIdentifies the patient or group whose intended care is described by the plan. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.subject.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.subject.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.subject.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCarePlan.subject.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.subject.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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context | Σ I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) | There are no (further) constraints on this element Element idCarePlan.context Created in context of Alternate namesencounter DefinitionIdentifies the original context in which this particular CarePlan was created. Activities conducted as a result of the care plan may well occur as part of other encounters/episodes. Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.context.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.context.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.context.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCarePlan.context.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.context.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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period | Σ I | 0..0 | Period | There are no (further) constraints on this element Element idCarePlan.period Time period plan covers Alternate namestiming DefinitionIndicates when the plan did (or is intended to) come into effect and end. Allows tracking what plan(s) are in effect at a particular time. Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition). Period Constraints
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author | Σ I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/RelatedPerson | http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/CareTeam) | There are no (further) constraints on this element Element idCarePlan.author Who is responsible for contents of the plan DefinitionIdentifies the individual(s) or ogranization who is responsible for the content of the care plan. Collaborative care plans may have multiple authors. Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/RelatedPerson | http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/CareTeam) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.author.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.author.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.author.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCarePlan.author.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.author.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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careTeam | I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/CareTeam) | There are no (further) constraints on this element Element idCarePlan.careTeam Who's involved in plan? DefinitionIdentifies all people and organizations who are expected to be involved in the care envisioned by this plan. Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/CareTeam) Constraints
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addresses | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/Condition) | There are no (further) constraints on this element Element idCarePlan.addresses Health issues this plan addresses DefinitionIdentifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/Condition) Constraints
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supportingInfo | I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/Resource) | There are no (further) constraints on this element Element idCarePlan.supportingInfo Information considered as part of plan DefinitionIdentifies portions of the patient's record that specifically influenced the formation of the plan. These might include co-morbidities, recent procedures, limitations, recent assessments, etc. Identifies barriers and other considerations associated with the care plan. Use "concern" to identify specific conditions addressed by the care plan. Reference(http://hl7.org/fhir/StructureDefinition/Resource) Constraints
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goal | I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/Goal) | There are no (further) constraints on this element Element idCarePlan.goal Desired outcome of plan DefinitionDescribes the intended objective(s) of carrying out the care plan. Provides context for plan. Allows plan effectiveness to be evaluated by clinicians. Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline. Reference(http://hl7.org/fhir/StructureDefinition/Goal) Constraints
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activity | I | 0..0 | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity Action to occur as part of plan DefinitionIdentifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice. BackboneElement Constraints
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note | 0..0 | Annotation | There are no (further) constraints on this element Element idCarePlan.note Comments about the plan DefinitionGeneral notes about the care plan not covered elsewhere. Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements. For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). Annotation Constraints
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- Forma Diferencial
CarePlan | I | CarePlan | There are no (further) constraints on this element Element idCarePlan Healthcare plan for patient or group Alternate namesCare Team DefinitionDescribes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions. CarePlan Constraints
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id | Σ | 0..1 | id | There are no (further) constraints on this element Element idCarePlan.id Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. id Constraints
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meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idCarePlan.meta Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource. Meta Constraints
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idCarePlan.implicitRules A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation. uri Constraints
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.language Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). code BindingA human language. ?? (extensible)Constraints
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text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idCarePlan.text Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource, and may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later. Narrative Constraints
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contained | 0..* | Resource | There are no (further) constraints on this element Element idCarePlan.contained Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Resource Mappings
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.modifierExtension Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource, and that modifies the understanding of the element that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCarePlan.identifier External Ids for this plan DefinitionThis records identifiers associated with this care plan that are defined by business processes and/or used to refer to it when a direct URL reference to the resource itself is not appropriate (e.g. in CDA documents, or in written / printed documentation). Need to allow connection to a wider workflow. Identifier Constraints
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definition | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/PlanDefinition | http://hl7.org/fhir/StructureDefinition/Questionnaire) | There are no (further) constraints on this element Element idCarePlan.definition Protocol or definition DefinitionIdentifies the protocol, questionnaire, guideline or other specification the care plan should be conducted in accordance with. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/PlanDefinition | http://hl7.org/fhir/StructureDefinition/Questionnaire) Constraints
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basedOn | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) | There are no (further) constraints on this element Element idCarePlan.basedOn Fulfills care plan Alternate namesfulfills DefinitionA care plan that is fulfilled in whole or in part by this care plan. Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) Constraints
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replaces | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) | There are no (further) constraints on this element Element idCarePlan.replaces CarePlan replaced by this CarePlan Alternate namessupersedes DefinitionCompleted or terminated care plan whose function is taken by this new care plan. Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans. The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing. Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) Constraints
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partOf | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) | There are no (further) constraints on this element Element idCarePlan.partOf Part of referenced CarePlan DefinitionA larger care plan of which this particular care plan is a component or step. Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed. Reference(http://hl7.org/fhir/StructureDefinition/CarePlan) Constraints
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status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.status draft | active | suspended | completed | entered-in-error | cancelled | unknown DefinitionIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. Allows clinicians to determine whether the plan is actionable or not. The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan. This element is labeled as a modifier because the status contains the code entered-in-error] that marks the plan as not currently valid. code BindingIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. ?? (required)Constraints
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intent | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.intent proposal | plan | order | option DefinitionIndicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain. Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. code BindingCodes indicating the degree of authority/intentionality associated with a care plan ?? (required)Constraints
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category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.category Type of plan DefinitionIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axis of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. CodeableConcept BindingIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. ?? (example)Constraints
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title | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.title Human-friendly name for the CarePlan DefinitionHuman-friendly name for the CarePlan. Note that FHIR strings may not exceed 1MB in size string Constraints
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description | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.description Summary of nature of plan DefinitionA description of the scope and nature of the plan. Provides more detail than conveyed by category. Note that FHIR strings may not exceed 1MB in size string Constraints
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subject | Σ I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group) | There are no (further) constraints on this element Element idCarePlan.subject Who care plan is for Alternate namespatient DefinitionIdentifies the patient or group whose intended care is described by the plan. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Group) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.subject.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.subject.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.subject.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCarePlan.subject.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.subject.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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context | Σ I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) | There are no (further) constraints on this element Element idCarePlan.context Created in context of Alternate namesencounter DefinitionIdentifies the original context in which this particular CarePlan was created. Activities conducted as a result of the care plan may well occur as part of other encounters/episodes. Reference(http://hl7.org/fhir/StructureDefinition/Encounter | http://hl7.org/fhir/StructureDefinition/EpisodeOfCare) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.context.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.context.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | S Σ I | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.context.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCarePlan.context.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.context.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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period | Σ I | 0..0 | Period | There are no (further) constraints on this element Element idCarePlan.period Time period plan covers Alternate namestiming DefinitionIndicates when the plan did (or is intended to) come into effect and end. Allows tracking what plan(s) are in effect at a particular time. Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition). Period Constraints
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author | Σ I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/RelatedPerson | http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/CareTeam) | There are no (further) constraints on this element Element idCarePlan.author Who is responsible for contents of the plan DefinitionIdentifies the individual(s) or ogranization who is responsible for the content of the care plan. Collaborative care plans may have multiple authors. Reference(http://hl7.org/fhir/StructureDefinition/Patient | http://hl7.org/fhir/StructureDefinition/Practitioner | http://hl7.org/fhir/StructureDefinition/RelatedPerson | http://hl7.org/fhir/StructureDefinition/Organization | http://hl7.org/fhir/StructureDefinition/CareTeam) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.author.id xml:id (or equivalent in JSON) Definitionunique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Note that FHIR strings may not exceed 1MB in size string Constraints
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extension | I | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.author.extension Additional Content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Extension Sliced:Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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reference | Σ I | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.author.reference Literal reference, Relative, internal or absolute URL DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources. Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server. string Constraints
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identifier | Σ | 0..0 | Identifier | There are no (further) constraints on this element Element idCarePlan.author.identifier Logical reference, when literal reference is not known DefinitionAn identifier for the other resource. This is used when there is no way to reference the other resource directly, either because the entity is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference. When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy. When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it. Identifier Constraints
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display | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.author.display Text alternative for the resource DefinitionPlain text narrative that identifies the resource in addition to the resource reference. This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it. string Constraints
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careTeam | I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/CareTeam) | There are no (further) constraints on this element Element idCarePlan.careTeam Who's involved in plan? DefinitionIdentifies all people and organizations who are expected to be involved in the care envisioned by this plan. Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/CareTeam) Constraints
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addresses | Σ I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/Condition) | There are no (further) constraints on this element Element idCarePlan.addresses Health issues this plan addresses DefinitionIdentifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(http://hl7.org/fhir/StructureDefinition/Condition) Constraints
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supportingInfo | I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/Resource) | There are no (further) constraints on this element Element idCarePlan.supportingInfo Information considered as part of plan DefinitionIdentifies portions of the patient's record that specifically influenced the formation of the plan. These might include co-morbidities, recent procedures, limitations, recent assessments, etc. Identifies barriers and other considerations associated with the care plan. Use "concern" to identify specific conditions addressed by the care plan. Reference(http://hl7.org/fhir/StructureDefinition/Resource) Constraints
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goal | I | 0..0 | Reference(http://hl7.org/fhir/StructureDefinition/Goal) | There are no (further) constraints on this element Element idCarePlan.goal Desired outcome of plan DefinitionDescribes the intended objective(s) of carrying out the care plan. Provides context for plan. Allows plan effectiveness to be evaluated by clinicians. Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline. Reference(http://hl7.org/fhir/StructureDefinition/Goal) Constraints
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activity | I | 0..0 | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity Action to occur as part of plan DefinitionIdentifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice. BackboneElement Constraints
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note | 0..0 | Annotation | There are no (further) constraints on this element Element idCarePlan.note Comments about the plan DefinitionGeneral notes about the care plan not covered elsewhere. Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements. For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). Annotation Constraints
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