National Screening

Notice: This guidance is under active development by NHS England and content may be added or updated on a regular basis.

Profiles

StructureDefinition UKCore-Appointment

UKCoreAppointment (Appointment)	I		Appointment	There are no (further) constraints on this element Element id Appointment Short description A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s) Definition A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s). Data type Appointment Constraints app-2: Either start and end are specified, or neither `start.exists() = end.exists()` app-3: Only proposed or cancelled appointments can be missing start/end dates `(start.exists() and end.exists()) or (status in ('proposed' \| 'cancelled' \| 'waitlist'))` app-4: Cancelation reason is only used for appointments that have been cancelled, or no-show `Appointment.cancelationReason.exists() implies (Appointment.status='no-show' or Appointment.status='cancelled')` dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Request rim: Act[@moodCode <= 'INT'] ical: VEVENT
id	Σ	0..1	string	There are no (further) constraints on this element Element id Appointment.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Appointment.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Appointment.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Appointment.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Appointment.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can 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. Comments 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 information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Appointment.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These 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. Comments 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	Element id Appointment.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
bookingOrganization	I	0..1	Extension(Reference(Organization))	Element id Appointment.extension:bookingOrganization Short description A reference to the source Organization of the booked appointment. Alternate names extensions, user content Definition An extension to record the organisation booking the appointment. Comments 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. Data type Extension(Reference(Organization)) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BookingOrganization Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
deliveryChannel	I	0..1	Extension(CodeableConcept)	Element id Appointment.extension:deliveryChannel Short description Defines the delivery channel of a scheduled appointment. Alternate names extensions, user content Definition An extension to record the delivery channel of a scheduled Appointment. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeliveryChannel Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Appointment.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Appointment.identifier Short description External Ids for this item Definition This records identifiers associated with this appointment concern 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). Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.identifier w5: FiveWs.identifier v2: SCH-1, SCH-2, ARQ-1, ARQ-2 rim: .id ical: UID
status	S Σ ?!	1..1	codeBinding	Element id Appointment.status Short description The overall status of the appointment. Definition The overall status of the Appointment. Each of the participants has their own participation status which indicates their involvement in the process, however this status indicates the shared status. Comments If the Appointment's status is "cancelled" then all participants are expected to have their calendars released for the appointment period, and as such any Slots that were marked as BUSY can be re-set to FREE. This element is labeled as a modifier because the status contains the code entered-in-error that mark the Appointment as not currently valid. Data type code Binding The free/busy status of an appointment. AppointmentStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.status w5: FiveWs.status v2: SCH-25 rim: .statusCode ical: STATUS
cancelationReason	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element id Appointment.cancelationReason Short description The coded reason for the appointment being cancelled Definition The coded reason for the appointment being cancelled. This is often used in reporting/billing/futher processing to determine if further actions are required, or specific fees apply. Data type CodeableConcept Binding AppointmentCancellationReason (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
serviceCategory	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Appointment.serviceCategory Short description A broad categorization of the service that is to be performed during this appointment Definition A broad categorization of the service that is to be performed during this appointment. Data type CodeableConcept Binding ServiceCategory (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a, might be inferred from the ServiceDeliveryLocation ical: CATEGORIES
serviceType	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Appointment.serviceType Short description The specific service that is to be performed during this appointment Definition The specific service that is to be performed during this appointment. Comments For a provider to provider appointment the code "FOLLOWUP" may be appropriate, as this is expected to be discussing some patient that was seen in the past. Data type CodeableConcept Binding ServiceType (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.code rim: n/a, might be inferred from the ServiceDeliveryLocation
specialty	S Σ	0..*	CodeableConceptBinding	Element id Appointment.specialty Short description The specialty of a practitioner that would be required to perform the service requested in this appointment. Definition The specialty of a practitioner that would be required to perform the service requested in this appointment. Data type CodeableConcept Binding UKCorePracticeSettingCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class rim: .performer.AssignedPerson.code
appointmentType	S Σ	0..1	CodeableConceptBinding	Element id Appointment.appointmentType Short description The type of appointment or patient that has been booked in the slot. Definition The style of appointment or patient that has been booked in the slot (not service type). Data type CodeableConcept Binding A set of codes that define an appointment reason. UKCoreAppointmentReasonCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ARQ-7 rim: .code ical: CLASSIFICATION
reasonCode	S Σ	0..*	CodeableConceptBinding	Element id Appointment.reasonCode Short description The reason for the appointment. Definition The coded reason that this appointment is being scheduled. This is more clinical than administrative. Data type CodeableConcept Binding The Reason for the appointment to take place. EncounterReasonCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.reasonCode v2: AIS-3, SCH-7 rim: .reasonCode
reasonReference	S	0..*	Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation)	Element id Appointment.reasonReference Short description A reference to the Observation, Condition, Procedure, or ImmunizationRecommendation that is the reason for the appointment. Definition Reason the appointment has been scheduled to take place, as specified using information from another resource. When the patient arrives and the encounter begins it may be used as the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure. Data type Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.reasonReference rim: .inboundRelationship[@typeCode = 'RSON'].observation
priority		0..1	unsignedInt	There are no (further) constraints on this element Element id Appointment.priority Short description Used to make informed decisions if needing to re-prioritize Definition The priority of the appointment. Can be used to make informed decisions if needing to re-prioritize appointments. (The iCal Standard specifies 0 as undefined, 1 as highest, 9 as lowest priority). Comments Seeking implementer feedback on this property and how interoperable it is. Using an extension to record a CodeableConcept for named values may be tested at a future connectathon. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.priority w5: FiveWs.class v2: ARQ-12, SCH-11.6 / TQ1-9 rim: .priorityCode ical: PRIORITY
description		0..1	string	There are no (further) constraints on this element Element id Appointment.description Short description Shown on a subject line in a meeting request, or appointment list Definition The brief description of the appointment as would be shown on a subject line in a meeting request, or appointment list. Detailed or expanded information should be put in the comment field. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NTE-3 rim: .text ical: SUMMARY
supportingInformation		0..*	Reference(Resource)	There are no (further) constraints on this element Element id Appointment.supportingInformation Short description Additional information to support the appointment Definition Additional information to support the appointment provided when making the appointment. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.supportingInfo w5: FiveWs.context rim: .inboundRelationship[@typeCode = 'SPRT'].observation ical: ATTACH
start	S Σ	0..1	instant	Element id Appointment.start Short description The start time of the appointment. Definition Date/Time that the appointment is to take place. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.init v2: ARQ-11.1, SCH-11.4 / TQ1-7 rim: .effectiveTime.low ical: DTSTART
end	Σ	0..1	instant	There are no (further) constraints on this element Element id Appointment.end Short description When appointment is to conclude Definition Date/Time that the appointment is to conclude. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.done[x] v2: SCH-11.5 / TQ1-8/ calculated based on the start and the duration which is in ARQ-9 rim: .effectiveTime.high ical: DTEND
minutesDuration		0..1	positiveInt	There are no (further) constraints on this element Element id Appointment.minutesDuration Short description Can be less than start/end (e.g. estimate) Definition Number of minutes that the appointment is to take. This can be less than the duration between the start and end times. For example, where the actual time of appointment is only an estimate or if a 30 minute appointment is being requested, but any time would work. Also, if there is, for example, a planned 15 minute break in the middle of a long appointment, the duration may be 15 minutes less than the difference between the start and end. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] rim: .activityTime[@xsi:type = ('SXPR_TS', 'PIVL_TS')].width ical: DURATION (e.g. PT15M)
slot		0..*	Reference(Slot)	There are no (further) constraints on this element Element id Appointment.slot Short description The slots that this appointment is filling Definition The slots from the participants' schedules that will be filled by the appointment. Data type Reference(Slot) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[@typeCode = 'REFR'].act[@classCode = 'ACT'][@moodCode = 'SLOT']
created		0..1	dateTime	There are no (further) constraints on this element Element id Appointment.created Short description The date that this appointment was initially created Definition The date that this appointment was initially created. This could be different to the meta.lastModified value on the initial entry, as this could have been before the resource was created on the FHIR server, and should remain unchanged over the lifespan of the appointment. Comments This property is required for many use cases where the age of an appointment is considered in processing workflows for scheduling and billing of appointments. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.authoredOn rim: .author.time ical: CREATED
comment		0..1	string	There are no (further) constraints on this element Element id Appointment.comment Short description Additional comments Definition Additional comments about the appointment. Comments Additional text to aid in facilitating the appointment. For instance, a comment might be, "patient should proceed immediately to infusion room upon arrival" Where this is a planned appointment and the start/end dates are not set then this field can be used to provide additional guidance on the details of the appointment request, including any restrictions on when to book it. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.note v2: NTE-3 rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value ical: DESCRIPTION (for internal use)
patientInstruction		0..1	string	There are no (further) constraints on this element Element id Appointment.patientInstruction Short description Detailed information and instructions for the patient Definition While Appointment.comment contains information for internal use, Appointment.patientInstructions is used to capture patient facing information about the Appointment (e.g. please bring your referral or fast from 8pm night before). Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NTE-3 rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value ical: DESCRIPTION (for patient use)
basedOn	S	0..*	Reference(ServiceRequest)	Element id Appointment.basedOn Short description The service request this appointment is allocated to assess. Alternate names incomingReferral Definition The service request this appointment is allocated to assess (e.g. incoming referral or procedure request). Data type Reference(ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.basedOn rim: .outboundRelationship[@typeCode = 'FLFS'].act[@classCode < 'ActCareProvisionRequestType'][@moodCode = 'RQO']
participant	S I	1..*	BackboneElement	Element id Appointment.participant Short description A list of participants involved in the appointment. Definition List of participants involved in the appointment. Data type BackboneElement Constraints app-1: Either the type or actor on the participant SHALL be specified `type.exists() or actor.exists()` ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performer, Request.subject v2: PID, AIP, AIG, AIL rim: performer \| reusableDevice \| subject \| location ical: ATTENDEE component to be created
id		0..1	string	There are no (further) constraints on this element Element id Appointment.participant.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Appointment.participant.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Appointment.participant.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type	Σ	0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Appointment.participant.type Short description Role of participant in the appointment Definition Role of participant in the appointment. Comments The role of the participant can be used to declare what the actor will be doing in the scope of this appointment. If the actor is not specified, then it is expected that the actor will be filled in at a later stage of planning. This value SHALL be the same when creating an AppointmentResponse so that they can be matched, and subsequently update the Appointment. Data type CodeableConcept Binding Role of participant in encounter. ParticipantType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: AIP-4, AIG-4 rim: (performer \| reusableDevice \| subject \| location).@typeCode ical: n/a
actor	Σ	0..1	Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location)	There are no (further) constraints on this element Element id Appointment.participant.actor Short description Person, Location/HealthcareService or Device Definition A Person, Location/HealthcareService or Device that is participating in the appointment. Data type Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.who v2: PID-3-Patient ID List \| AIL-3 \| AIG-3 \| AIP-3 rim: performer.person \| reusableDevice.manufacturedDevice \| subject.patient \| location.serviceDeliveryLocation ical: ATTENDEE: (Need to provide the common name CN and also the MAILTO properties from the practitioner resource) where the participant type is not "information-only"
required	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id Appointment.participant.required Short description required \| optional \| information-only Definition Whether this participant is required to be present at the meeting. This covers a use-case where two doctors need to meet to discuss the results for a specific patient, and the patient is not required to be present. Data type code Binding Is the Participant required to attend the appointment. ParticipantRequired (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: (performer \| reusableDevice \| subject \| location).@performInd ical: ROLE=REQ-PARTICIPANT (roleparam)
status	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id Appointment.participant.status Short description accepted \| declined \| tentative \| needs-action Definition Participation status of the actor. Data type code Binding The Participation status of an appointment. ParticipationStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: AIP-12, AIG-14 rim: (performer \| reusableDevice \| subject \| location).statusCode ical: ATTENDEE;CN="John Doe";RSVP=TRUE:mailto:john@doe.com (rsvpparam \| partstatparam)
period		0..1	Period	There are no (further) constraints on this element Element id Appointment.participant.period Short description Participation period of the actor Definition Participation period of the actor. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
requestedPeriod		0..*	Period	There are no (further) constraints on this element Element id Appointment.requestedPeriod Short description Potential date/time interval(s) requested to allocate the appointment within Definition A set of date ranges (potentially including times) that the appointment is preferred to be scheduled within. The duration (usually in minutes) could also be provided to indicate the length of the appointment to fill and populate the start/end times for the actual allocated time. However, in other situations the duration may be calculated by the scheduling system. Comments This does not introduce a capacity for recurring appointments. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] v2: ARQ-11 rim: .activityTime[@xsi:type = ('SXPR_TS', 'PIVL_TS')]

Appointment
Definition	A booking of a healthcare event among patient(s), practitioner(s), related person(s) and/or device(s) for a specific date/time. This may result in one or more Encounter(s).
Cardinality	0...*
Invariants	app-2: Either start and end are specified, or neither `start.exists() = end.exists()` app-3: Only proposed or cancelled appointments can be missing start/end dates `(start.exists() and end.exists()) or (status in ('proposed' \| 'cancelled' \| 'waitlist'))` app-4: Cancelation reason is only used for appointments that have been cancelled, or no-show `Appointment.cancelationReason.exists() implies (Appointment.status='no-show' or Appointment.status='cancelled')` dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings	rim: Entity. Role, or Act workflow: Request rim: Act[@moodCode <= 'INT'] ical: VEVENT
Appointment.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Appointment.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Appointment.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Appointment.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Appointment.text
Definition	A human-readable narrative that contains a summary of the resource and can 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: Act.text?
Appointment.contained
Definition	These 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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: N/A
Appointment.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Appointment.extension:bookingOrganization
Definition	An extension to record the organisation booking the appointment.
Cardinality	0...1
Type	Extension(Reference(Organization))
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Appointment.extension:deliveryChannel
Definition	An extension to record the delivery channel of a scheduled Appointment.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Appointment.modifierExtension
Definition	May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Appointment.identifier
Definition	This records identifiers associated with this appointment concern 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).
Cardinality	0...*
Type	Identifier
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.identifier w5: FiveWs.identifier v2: SCH-1, SCH-2, ARQ-1, ARQ-2 rim: .id ical: UID
Appointment.status
Definition	The overall status of the Appointment. Each of the participants has their own participation status which indicates their involvement in the process, however this status indicates the shared status.
Cardinality	1...1
Type	code
Binding	The free/busy status of an appointment. AppointmentStatus (required)
Must Support	True
Modifier	True
Summary	True
Comments	If the Appointment's status is "cancelled" then all participants are expected to have their calendars released for the appointment period, and as such any Slots that were marked as BUSY can be re-set to FREE. This element is labeled as a modifier because the status contains the code entered-in-error that mark the Appointment as not currently valid.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.status w5: FiveWs.status v2: SCH-25 rim: .statusCode ical: STATUS
Appointment.cancelationReason
Definition	The coded reason for the appointment being cancelled. This is often used in reporting/billing/futher processing to determine if further actions are required, or specific fees apply.
Cardinality	0...1
Type	CodeableConcept
Binding	AppointmentCancellationReason (example)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Appointment.serviceCategory
Definition	A broad categorization of the service that is to be performed during this appointment.
Cardinality	0...*
Type	CodeableConcept
Binding	ServiceCategory (example)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a, might be inferred from the ServiceDeliveryLocation ical: CATEGORIES
Appointment.serviceType
Definition	The specific service that is to be performed during this appointment.
Cardinality	0...*
Type	CodeableConcept
Binding	ServiceType (example)
Summary	True
Comments	For a provider to provider appointment the code "FOLLOWUP" may be appropriate, as this is expected to be discussing some patient that was seen in the past.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.code rim: n/a, might be inferred from the ServiceDeliveryLocation
Appointment.specialty
Definition	The specialty of a practitioner that would be required to perform the service requested in this appointment.
Cardinality	0...*
Type	CodeableConcept
Binding	UKCorePracticeSettingCode (extensible)
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.class rim: .performer.AssignedPerson.code
Appointment.appointmentType
Definition	The style of appointment or patient that has been booked in the slot (not service type).
Cardinality	0...1
Type	CodeableConcept
Binding	A set of codes that define an appointment reason. UKCoreAppointmentReasonCode (extensible)
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: ARQ-7 rim: .code ical: CLASSIFICATION
Appointment.reasonCode
Definition	The coded reason that this appointment is being scheduled. This is more clinical than administrative.
Cardinality	0...*
Type	CodeableConcept
Binding	The Reason for the appointment to take place. EncounterReasonCodes (preferred)
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.reasonCode v2: AIS-3, SCH-7 rim: .reasonCode
Appointment.reasonReference
Definition	Reason the appointment has been scheduled to take place, as specified using information from another resource. When the patient arrives and the encounter begins it may be used as the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.
Cardinality	0...*
Type	Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation)
Must Support	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.reasonReference rim: .inboundRelationship[@typeCode = 'RSON'].observation
Appointment.priority
Definition	The priority of the appointment. Can be used to make informed decisions if needing to re-prioritize appointments. (The iCal Standard specifies 0 as undefined, 1 as highest, 9 as lowest priority).
Cardinality	0...1
Type	unsignedInt
Comments	Seeking implementer feedback on this property and how interoperable it is. Using an extension to record a CodeableConcept for named values may be tested at a future connectathon.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.priority w5: FiveWs.class v2: ARQ-12, SCH-11.6 / TQ1-9 rim: .priorityCode ical: PRIORITY
Appointment.description
Definition	The brief description of the appointment as would be shown on a subject line in a meeting request, or appointment list. Detailed or expanded information should be put in the comment field.
Cardinality	0...1
Type	string
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NTE-3 rim: .text ical: SUMMARY
Appointment.supportingInformation
Definition	Additional information to support the appointment provided when making the appointment.
Cardinality	0...*
Type	Reference(Resource)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.supportingInfo w5: FiveWs.context rim: .inboundRelationship[@typeCode = 'SPRT'].observation ical: ATTACH
Appointment.start
Definition	Date/Time that the appointment is to take place.
Cardinality	0...1
Type	instant
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.occurrence[x] w5: FiveWs.init v2: ARQ-11.1, SCH-11.4 / TQ1-7 rim: .effectiveTime.low ical: DTSTART
Appointment.end
Definition	Date/Time that the appointment is to conclude.
Cardinality	0...1
Type	instant
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.occurrence[x] w5: FiveWs.done[x] v2: SCH-11.5 / TQ1-8/ calculated based on the start and the duration which is in ARQ-9 rim: .effectiveTime.high ical: DTEND
Appointment.minutesDuration
Definition	Number of minutes that the appointment is to take. This can be less than the duration between the start and end times. For example, where the actual time of appointment is only an estimate or if a 30 minute appointment is being requested, but any time would work. Also, if there is, for example, a planned 15 minute break in the middle of a long appointment, the duration may be 15 minutes less than the difference between the start and end.
Cardinality	0...1
Type	positiveInt
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.occurrence[x] rim: .activityTime[@xsi:type = ('SXPR_TS', 'PIVL_TS')].width ical: DURATION (e.g. PT15M)
Appointment.slot
Definition	The slots from the participants' schedules that will be filled by the appointment.
Cardinality	0...*
Type	Reference(Slot)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[@typeCode = 'REFR'].act[@classCode = 'ACT'][@moodCode = 'SLOT']
Appointment.created
Definition	The date that this appointment was initially created. This could be different to the meta.lastModified value on the initial entry, as this could have been before the resource was created on the FHIR server, and should remain unchanged over the lifespan of the appointment.
Cardinality	0...1
Type	dateTime
Comments	This property is required for many use cases where the age of an appointment is considered in processing workflows for scheduling and billing of appointments.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.authoredOn rim: .author.time ical: CREATED
Appointment.comment
Definition	Additional comments about the appointment.
Cardinality	0...1
Type	string
Comments	Additional text to aid in facilitating the appointment. For instance, a comment might be, "patient should proceed immediately to infusion room upon arrival" Where this is a planned appointment and the start/end dates are not set then this field can be used to provide additional guidance on the details of the appointment request, including any restrictions on when to book it.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.note v2: NTE-3 rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value ical: DESCRIPTION (for internal use)
Appointment.patientInstruction
Definition	While Appointment.comment contains information for internal use, Appointment.patientInstructions is used to capture patient facing information about the Appointment (e.g. please bring your referral or fast from 8pm night before).
Cardinality	0...1
Type	string
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NTE-3 rim: .subjectOf.observation[@moodCode = 'EVN'][code = 'annotation'].value ical: DESCRIPTION (for patient use)
Appointment.basedOn
Definition	The service request this appointment is allocated to assess (e.g. incoming referral or procedure request).
Cardinality	0...*
Type	Reference(ServiceRequest)
Must Support	True
Alias	incomingReferral
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.basedOn rim: .outboundRelationship[@typeCode = 'FLFS'].act[@classCode < 'ActCareProvisionRequestType'][@moodCode = 'RQO']
Appointment.participant
Definition	List of participants involved in the appointment.
Cardinality	1...*
Type	BackboneElement
Must Support	True
Invariants	app-1: Either the type or actor on the participant SHALL be specified `type.exists() or actor.exists()` ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.performer, Request.subject v2: PID, AIP, AIG, AIL rim: performer \| reusableDevice \| subject \| location ical: ATTENDEE component to be created
Appointment.participant.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Appointment.participant.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Appointment.participant.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Appointment.participant.type
Definition	Role of participant in the appointment.
Cardinality	0...*
Type	CodeableConcept
Binding	Role of participant in encounter. ParticipantType (extensible)
Summary	True
Comments	The role of the participant can be used to declare what the actor will be doing in the scope of this appointment. If the actor is not specified, then it is expected that the actor will be filled in at a later stage of planning. This value SHALL be the same when creating an AppointmentResponse so that they can be matched, and subsequently update the Appointment.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: AIP-4, AIG-4 rim: (performer \| reusableDevice \| subject \| location).@typeCode ical: n/a
Appointment.participant.actor
Definition	A Person, Location/HealthcareService or Device that is participating in the appointment.
Cardinality	0...1
Type	Reference(Patient \| Practitioner \| PractitionerRole \| RelatedPerson \| Device \| HealthcareService \| Location)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.who v2: PID-3-Patient ID List \| AIL-3 \| AIG-3 \| AIP-3 rim: performer.person \| reusableDevice.manufacturedDevice \| subject.patient \| location.serviceDeliveryLocation ical: ATTENDEE: (Need to provide the common name CN and also the MAILTO properties from the practitioner resource) where the participant type is not "information-only"
Appointment.participant.required
Definition	Whether this participant is required to be present at the meeting. This covers a use-case where two doctors need to meet to discuss the results for a specific patient, and the patient is not required to be present.
Cardinality	0...1
Type	code
Binding	Is the Participant required to attend the appointment. ParticipantRequired (required)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: (performer \| reusableDevice \| subject \| location).@performInd ical: ROLE=REQ-PARTICIPANT (roleparam)
Appointment.participant.status
Definition	Participation status of the actor.
Cardinality	1...1
Type	code
Binding	The Participation status of an appointment. ParticipationStatus (required)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: AIP-12, AIG-14 rim: (performer \| reusableDevice \| subject \| location).statusCode ical: ATTENDEE;CN="John Doe";RSVP=TRUE:mailto:john@doe.com (rsvpparam \| partstatparam)
Appointment.participant.period
Definition	Participation period of the actor.
Cardinality	0...1
Type	Period
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Appointment.requestedPeriod
Definition	A set of date ranges (potentially including times) that the appointment is preferred to be scheduled within. The duration (usually in minutes) could also be provided to indicate the length of the appointment to fill and populate the start/end times for the actual allocated time. However, in other situations the duration may be calculated by the scheduling system.
Cardinality	0...*
Type	Period
Comments	This does not introduce a capacity for recurring appointments.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.occurrence[x] v2: ARQ-11 rim: .activityTime[@xsi:type = ('SXPR_TS', 'PIVL_TS')]

Appointment		..
Appointment.extension	Extension	..
Appointment.extension	Extension	..1
Appointment.status		..
Appointment.specialty		..
Appointment.appointmentType		..
Appointment.reasonCode		..
Appointment.reasonReference		..
Appointment.start		..
Appointment.basedOn		..
Appointment.participant		..

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Appointment" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Appointment" />
    <version value="1.3.0" />
    <name value="UKCoreAppointment" />
    <title value="UK Core Appointment" />
    <status value="active" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Appointment](https://hl7.org/fhir/R4/Appointment.html)." />
    <purpose value="This profile allows recording of detailed information about a planned meeting that may be in the future or past. The resource only describes a single meeting, a series of repeating visits would require multiple appointment resources to be created for each instance. \n\n Examples include a scheduled surgery, a follow-up for a clinical visit, a scheduled conference call between clinicians to discuss a case, the reservation of a piece of diagnostic equipment for a particular use, etc. The visit scheduled by an appointment may be in person or remote (by phone, video conference, etc.) All that matters is that the time and usage of one or more individuals, locations and/or pieces of equipment is being fully or partially reserved for a designated period of time." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Appointment" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Appointment" />
    <derivation value="constraint" />
    <differential>
        <element id="Appointment.extension:bookingOrganization">
            <path value="Appointment.extension" />
            <sliceName value="bookingOrganization" />
            <short value="A reference to the source Organization of the booked appointment." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BookingOrganization" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="Appointment.extension:deliveryChannel">
            <path value="Appointment.extension" />
            <sliceName value="deliveryChannel" />
            <short value="Defines the delivery channel of a scheduled appointment." />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeliveryChannel" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="Appointment.status">
            <path value="Appointment.status" />
            <short value="The overall status of the appointment." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.specialty">
            <path value="Appointment.specialty" />
            <short value="The specialty of a practitioner that would be required to perform the service requested in this appointment." />
            <mustSupport value="true" />
            <binding>
                <strength value="extensible" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode" />
            </binding>
        </element>
        <element id="Appointment.appointmentType">
            <path value="Appointment.appointmentType" />
            <short value="The type of appointment or patient that has been booked in the slot." />
            <mustSupport value="true" />
            <binding>
                <strength value="extensible" />
                <description value="A set of codes that define an appointment reason." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-AppointmentReasonCode" />
            </binding>
        </element>
        <element id="Appointment.reasonCode">
            <path value="Appointment.reasonCode" />
            <short value="The reason for the appointment." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.reasonReference">
            <path value="Appointment.reasonReference" />
            <short value="A reference to the Observation, Condition, Procedure, or ImmunizationRecommendation that is the reason for the appointment." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.start">
            <path value="Appointment.start" />
            <short value="The start time of the appointment." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.basedOn">
            <path value="Appointment.basedOn" />
            <short value="The service request this appointment is allocated to assess." />
            <mustSupport value="true" />
        </element>
        <element id="Appointment.participant">
            <path value="Appointment.participant" />
            <short value="A list of participants involved in the appointment." />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Appointment",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Appointment",
    "version": "1.3.0",
    "name": "UKCoreAppointment",
    "title": "UK Core Appointment",
    "status": "active",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Appointment](https://hl7.org/fhir/R4/Appointment.html).",
    "purpose": "This profile allows recording of detailed information about a planned meeting that may be in the future or past. The resource only describes a single meeting, a series of repeating visits would require multiple appointment resources to be created for each instance. \n\n Examples include a scheduled surgery, a follow-up for a clinical visit, a scheduled conference call between clinicians to discuss a case, the reservation of a piece of diagnostic equipment for a particular use, etc. The visit scheduled by an appointment may be in person or remote (by phone, video conference, etc.) All that matters is that the time and usage of one or more individuals, locations and/or pieces of equipment is being fully or partially reserved for a designated period of time.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Appointment",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Appointment",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Appointment.extension:bookingOrganization",
                "path": "Appointment.extension",
                "sliceName": "bookingOrganization",
                "short": "A reference to the source Organization of the booked appointment.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BookingOrganization"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "Appointment.extension:deliveryChannel",
                "path": "Appointment.extension",
                "sliceName": "deliveryChannel",
                "short": "Defines the delivery channel of a scheduled appointment.",
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeliveryChannel"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "Appointment.status",
                "path": "Appointment.status",
                "short": "The overall status of the appointment.",
                "mustSupport": true
            },
            {
                "id": "Appointment.specialty",
                "path": "Appointment.specialty",
                "short": "The specialty of a practitioner that would be required to perform the service requested in this appointment.",
                "mustSupport": true,
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode"
                }
            },
            {
                "id": "Appointment.appointmentType",
                "path": "Appointment.appointmentType",
                "short": "The type of appointment or patient that has been booked in the slot.",
                "mustSupport": true,
                "binding": {
                    "strength": "extensible",
                    "description": "A set of codes that define an appointment reason.",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-AppointmentReasonCode"
                }
            },
            {
                "id": "Appointment.reasonCode",
                "path": "Appointment.reasonCode",
                "short": "The reason for the appointment.",
                "mustSupport": true
            },
            {
                "id": "Appointment.reasonReference",
                "path": "Appointment.reasonReference",
                "short": "A reference to the Observation, Condition, Procedure, or ImmunizationRecommendation that is the reason for the appointment.",
                "mustSupport": true
            },
            {
                "id": "Appointment.start",
                "path": "Appointment.start",
                "short": "The start time of the appointment.",
                "mustSupport": true
            },
            {
                "id": "Appointment.basedOn",
                "path": "Appointment.basedOn",
                "short": "The service request this appointment is allocated to assess.",
                "mustSupport": true
            },
            {
                "id": "Appointment.participant",
                "path": "Appointment.participant",
                "short": "A list of participants involved in the appointment.",
                "mustSupport": true
            }
        ]
    }
}

Propose a change to UKCore-Appointment

Examples

Orthopaedic Surgery - An example to illustrate an Orthopaedic Surgery appointment.

UKCore-Appointment-OrthopaedicSurgery-Example

Booking Organization - An example to illustrate the booking organization extension associated with an appointment.

Example-UKCore-Extension-BookingOrganization

Delivery Channel - An example to illustrate the delivery channel associated with an appointment.

Example-UKCore-Extension-DeliveryChannel

StructureDefinition UKCore-CarePlan

UKCoreCarePlan (CarePlan)	I		CarePlan	There are no (further) constraints on this element Element id CarePlan Short description Healthcare plan for patient or group Alternate names Care Team Definition Describes 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. Data type CarePlan Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Request rim: Act[classCode=PCPR, moodCode=INT]
id	Σ	0..1	string	There are no (further) constraints on this element Element id CarePlan.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id CarePlan.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id CarePlan.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id CarePlan.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id CarePlan.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can 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. Comments 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 information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id CarePlan.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These 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. Comments 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id CarePlan.identifier Short description External Ids for this plan Definition Business identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Requirements Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers. Comments This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.identifier w5: FiveWs.identifier v2: PTH-3 rim: .id
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition \| Questionnaire \| Measure \| ActivityDefinition \| OperationDefinition)	There are no (further) constraints on this element Element id CarePlan.instantiatesCanonical Short description Instantiates FHIR protocol or definition Definition The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. Data type canonical(PlanDefinition \| Questionnaire \| Measure \| ActivityDefinition \| OperationDefinition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.instantiatesCanonical rim: .outboundRelationship[typeCode=DEFN].target
instantiatesUri	Σ	0..*	uri	There are no (further) constraints on this element Element id CarePlan.instantiatesUri Short description Instantiates external protocol or definition Definition The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. Comments This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.instantiatesUri rim: .outboundRelationship[typeCode=DEFN].target
basedOn	Σ	0..*	Reference(CarePlan)	There are no (further) constraints on this element Element id CarePlan.basedOn Short description Fulfills CarePlan Alternate names fulfills Definition A care plan that is fulfilled in whole or in part by this care plan. Requirements Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon. Data type Reference(CarePlan) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.basedOn
replaces	Σ	0..*	Reference(CarePlan)	There are no (further) constraints on this element Element id CarePlan.replaces Short description CarePlan replaced by this CarePlan Alternate names supersedes Definition Completed or terminated care plan whose function is taken by this new care plan. Requirements Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans. Comments 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. Data type Reference(CarePlan) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.replaces
partOf	Σ	0..*	Reference(CarePlan)	There are no (further) constraints on this element Element id CarePlan.partOf Short description Part of referenced CarePlan Definition A larger care plan of which this particular care plan is a component or step. Comments 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. Data type Reference(CarePlan) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
status	S Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id CarePlan.status Short description draft \| active \| on-hold \| revoked \| completed \| entered-in-error \| unknown Definition Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. Requirements Allows clinicians to determine whether the plan is actionable or not. Comments 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. Data type code Binding Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. RequestStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.status {uses different ValueSet} w5: FiveWs.status v2: PTH-5 rim: .statusCode planned = new active = active completed = completed
intent	S Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id CarePlan.intent Short description proposal \| plan \| order \| option Definition Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain. Requirements Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. Comments This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. Data type code Binding Codes indicating the degree of authority/intentionality associated with a care plan. CarePlanIntent (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.intent
category	S Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id CarePlan.category Short description Type of plan Definition Identifies 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. Requirements Used for filtering what plan(s) are retrieved and displayed to different types of users. Comments There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. Data type CodeableConcept Binding Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. CarePlanCategory (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class
title	Σ	0..1	string	There are no (further) constraints on this element Element id CarePlan.title Short description Human-friendly name for the care plan Definition Human-friendly name for the care plan. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
description	Σ	0..1	string	There are no (further) constraints on this element Element id CarePlan.description Short description Summary of nature of plan Definition A description of the scope and nature of the plan. Requirements Provides more detail than conveyed by category. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.what[x]
subject	S Σ	1..1	Reference(Patient \| Group)	There are no (further) constraints on this element Element id CarePlan.subject Short description Who the care plan is for Alternate names patient Definition Identifies the patient or group whose intended care is described by the plan. Data type Reference(Patient \| Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.subject w5: FiveWs.subject[x] v2: PID-3 rim: .participation[typeCode=PAT].role[classCode=PAT] w5: FiveWs.subject
encounter	Σ	0..1	Reference(Encounter)	There are no (further) constraints on this element Element id CarePlan.encounter Short description Encounter created as part of Definition The Encounter during which this CarePlan was created or to which the creation of this record is tightly associated. Comments This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.context w5: FiveWs.context v2: Associated PV1 rim: .
period	Σ	0..1	Period	There are no (further) constraints on this element Element id CarePlan.period Short description Time period plan covers Alternate names timing Definition Indicates when the plan did (or is intended to) come into effect and end. Requirements Allows tracking what plan(s) are in effect at a particular time. Comments 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). Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] w5: FiveWs.planned v2: GOL-7 / GOL-8 rim: .effectiveTime
created	Σ	0..1	dateTime	There are no (further) constraints on this element Element id CarePlan.created Short description Date record was first recorded Alternate names authoredOn Definition Represents when this particular CarePlan record was created in the system, which is often a system-generated date. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.authoredOn w5: FiveWs.recorded rim: .participation[typeCode=AUT].time
author	Σ	0..1	Reference(Patient \| Practitioner \| PractitionerRole \| Device \| RelatedPerson \| Organization \| CareTeam)	There are no (further) constraints on this element Element id CarePlan.author Short description Who is the designated responsible party Definition When populated, the author is responsible for the care plan. The care plan is attributed to the author. Comments The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor. Data type Reference(Patient \| Practitioner \| PractitionerRole \| Device \| RelatedPerson \| Organization \| CareTeam) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.requester w5: FiveWs.author
contributor		0..*	Reference(Patient \| Practitioner \| PractitionerRole \| Device \| RelatedPerson \| Organization \| CareTeam)	There are no (further) constraints on this element Element id CarePlan.contributor Short description Who provided the content of the care plan Definition Identifies the individual(s) or organization who provided the contents of the care plan. Comments Collaborative care plans may have multiple contributors. Data type Reference(Patient \| Practitioner \| PractitionerRole \| Device \| RelatedPerson \| Organization \| CareTeam) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
careTeam		0..*	Reference(CareTeam)	There are no (further) constraints on this element Element id CarePlan.careTeam Short description Who's involved in plan? Definition Identifies all people and organizations who are expected to be involved in the care envisioned by this plan. Requirements Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions. Data type Reference(CareTeam) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performer {similar but does not entail CareTeam} w5: FiveWs.actor
addresses	Σ	0..*	Reference(Condition)	There are no (further) constraints on this element Element id CarePlan.addresses Short description Health issues this plan addresses Definition Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. Requirements 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. Comments When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance. Data type Reference(Condition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.reasonReference w5: FiveWs.why[x] v2: PRB-4 rim: .actRelationship[typeCode=SUBJ].target[classCode=CONC, moodCode=EVN]
supportingInfo		0..*	Reference(Resource)	There are no (further) constraints on this element Element id CarePlan.supportingInfo Short description Information considered as part of plan Definition Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc. Requirements Identifies barriers and other considerations associated with the care plan. Comments Use "concern" to identify specific conditions addressed by the care plan. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.supportingInfo
goal		0..*	Reference(Goal)	There are no (further) constraints on this element Element id CarePlan.goal Short description Desired outcome of plan Definition Describes the intended objective(s) of carrying out the care plan. Requirements Provides context for plan. Allows plan effectiveness to be evaluated by clinicians. Comments Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline. Data type Reference(Goal) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: GOL.1 rim: .outboundRelationship[typeCode<=OBJ].
activity	I	0..*	BackboneElement	There are no (further) constraints on this element Element id CarePlan.activity Short description Action to occur as part of plan Definition Identifies 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. Requirements Allows systems to prompt for performance of planned activities, and validate plans against best practice. Data type BackboneElement Constraints cpl-3: Provide a reference or detail, not both `detail.empty() or reference.empty()` ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: {no mapping NOTE: This is a list of contained Request-Event tuples!} rim: .outboundRelationship[typeCode=COMP].target
id		0..1	string	There are no (further) constraints on this element Element id CarePlan.activity.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.activity.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.activity.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
outcomeCodeableConcept		0..*	CodeableConcept	There are no (further) constraints on this element Element id CarePlan.activity.outcomeCodeableConcept Short description Results of the activity Definition Identifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not). Comments Note that this should not duplicate the activity status (e.g. completed or in progress). Data type CodeableConcept Binding Identifies the results of the activity. CarePlanActivityOutcome (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
outcomeReference		0..*	Reference(Resource)	There are no (further) constraints on this element Element id CarePlan.activity.outcomeReference Short description Appointment, Encounter, Procedure, etc. Definition Details of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource). Requirements Links plan to resulting actions. Comments The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: {Event that is outcome of Request in activity.reference} rim: .inboundRelationship[typeCode=FLFS].source
progress		0..*	Annotation	There are no (further) constraints on this element Element id CarePlan.activity.progress Short description Comments about the activity status/progress Definition Notes about the adherence/status/progress of the activity. Requirements Can be used to capture information about adherence, progress, concerns, etc. Comments This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description. Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NTE? rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
reference	I	0..1	Reference(Appointment \| CommunicationRequest \| DeviceRequest \| MedicationRequest \| NutritionOrder \| Task \| ServiceRequest \| VisionPrescription \| RequestGroup)	There are no (further) constraints on this element Element id CarePlan.activity.reference Short description Activity details defined in specific resource Definition The details of the proposed activity represented in a specific resource. Requirements Details in a form consistent with other applications and contexts of use. Comments Standard extension exists (resource-pertainsToGoal) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference. The goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should not point to this CarePlan using the "basedOn" element. i.e. Requests that are part of a CarePlan are not "based on" the CarePlan. Data type Reference(Appointment \| CommunicationRequest \| DeviceRequest \| MedicationRequest \| NutritionOrder \| Task \| ServiceRequest \| VisionPrescription \| RequestGroup) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: {Request that resulted in Event in activity.actionResulting} rim: .outboundRelationship[typeCode=COMP].target
detail	I	0..1	BackboneElement	There are no (further) constraints on this element Element id CarePlan.activity.detail Short description In-line definition of activity Definition A simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc. Requirements Details in a simple form for generic care plan systems. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode=COMP, subsetCode=SUMM].target
id		0..1	string	There are no (further) constraints on this element Element id CarePlan.activity.detail.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.activity.detail.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.activity.detail.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
kind		0..1	codeBinding	There are no (further) constraints on this element Element id CarePlan.activity.detail.kind Short description Appointment \| CommunicationRequest \| DeviceRequest \| MedicationRequest \| NutritionOrder \| Task \| ServiceRequest \| VisionPrescription Definition A description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest. Requirements May determine what types of extensions are permitted. Data type code Binding Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity. CarePlanActivityKind (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .inboundRelationship[typeCode=COMP].source[classCode=LIST].code
instantiatesCanonical		0..*	canonical(PlanDefinition \| ActivityDefinition \| Questionnaire \| Measure \| OperationDefinition)	There are no (further) constraints on this element Element id CarePlan.activity.detail.instantiatesCanonical Short description Instantiates FHIR protocol or definition Definition The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity. Requirements Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity. Data type canonical(PlanDefinition \| ActivityDefinition \| Questionnaire \| Measure \| OperationDefinition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.instantiatesCanonical rim: .outboundRelationship[typeCode=DEFN].target
instantiatesUri		0..*	uri	There are no (further) constraints on this element Element id CarePlan.activity.detail.instantiatesUri Short description Instantiates external protocol or definition Definition The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity. Requirements Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity. Comments This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.instantiatesUri rim: .outboundRelationship[typeCode=DEFN].target
code		0..1	CodeableConcept	There are no (further) constraints on this element Element id CarePlan.activity.detail.code Short description Detail type of activity Definition Detailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter. Requirements Allows matching performed to planned as well as validation against protocols. Comments Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead. Data type CodeableConcept Binding Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter. ProcedureCodes(SNOMEDCT) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.code v2: OBR-4 / RXE-2 / RXO-1 / RXD-2 rim: .code
reasonCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id CarePlan.activity.detail.reasonCode Short description Why activity should be done or why activity was prohibited Definition Provides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited. Comments This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead. Data type CodeableConcept Binding Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc. SNOMEDCTClinicalFindings (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.reasonCode
reasonReference		0..*	Reference(Condition \| Observation \| DiagnosticReport \| DocumentReference)	There are no (further) constraints on this element Element id CarePlan.activity.detail.reasonReference Short description Why activity is needed Definition Indicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan. Comments Conditions can be identified at the activity level that are not identified as reasons for the overall plan. Data type Reference(Condition \| Observation \| DiagnosticReport \| DocumentReference) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.reasonReference
goal		0..*	Reference(Goal)	There are no (further) constraints on this element Element id CarePlan.activity.detail.goal Short description Goals this activity relates to Definition Internal reference that identifies the goals that this activity is intended to contribute towards meeting. Requirements So that participants know the link explicitly. Data type Reference(Goal) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode<=OBJ].
status	?!	1..1	codeBinding	There are no (further) constraints on this element Element id CarePlan.activity.detail.status Short description not-started \| scheduled \| in-progress \| on-hold \| completed \| cancelled \| stopped \| unknown \| entered-in-error Definition Identifies what progress is being made for the specific activity. Requirements Indicates progress against the plan, whether the activity is still relevant for the plan. Comments Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated. 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 activity. Data type code Binding Codes that reflect the current state of a care plan activity within its overall life cycle. CarePlanActivityStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.status v2: ORC-5? rim: .statusCode not-started = new scheduled = not-started (and fulfillment relationship to appointent) in-progress = active on-hold = suspended completed = completed cancelled = aborted
statusReason		0..1	CodeableConcept	There are no (further) constraints on this element Element id CarePlan.activity.detail.statusReason Short description Reason for current status Definition Provides reason why the activity isn't yet started, is on hold, was cancelled, etc. Comments Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed. Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.statusReason
doNotPerform	?!	0..1	boolean	There are no (further) constraints on this element Element id CarePlan.activity.detail.doNotPerform Short description If true, activity is prohibiting action Definition If true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan. Requirements Captures intention to not do something that may have been previously typical. Comments This element is labeled as a modifier because it marks an activity as an activity that is not to be performed. Meaning when missing If missing indicates that the described activity is one that should be engaged in when following the plan. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.doNotPerform rim: actionNegationInd
scheduled[x]		0..1		There are no (further) constraints on this element Element id CarePlan.activity.detail.scheduled[x] Short description When activity is to occur Definition The period, timing or frequency upon which the described activity is to occur. Requirements Allows prompting for activities and detection of missed planned activities. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.occurrence[x] v2: TQ1 rim: .effectiveTime
scheduledTiming			Timing	There are no (further) constraints on this element Data type Timing
scheduledPeriod			Period	There are no (further) constraints on this element Data type Period
scheduledString			string	There are no (further) constraints on this element Data type string
location		0..1	Reference(Location)	There are no (further) constraints on this element Element id CarePlan.activity.detail.location Short description Where it should happen Definition Identifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc. Requirements Helps in planning of activity. Comments May reference a specific clinical location or may identify a type of location. Data type Reference(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBR-24(???!!) rim: .participation[typeCode=LOC].role
performer		0..*	Reference(Practitioner \| PractitionerRole \| Organization \| RelatedPerson \| Patient \| CareTeam \| HealthcareService \| Device)	There are no (further) constraints on this element Element id CarePlan.activity.detail.performer Short description Who will be responsible? Definition Identifies who's expected to be involved in the activity. Requirements Helps in planning of activity. Comments A performer MAY also be a participant in the care plan. Data type Reference(Practitioner \| PractitionerRole \| Organization \| RelatedPerson \| Patient \| CareTeam \| HealthcareService \| Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.performer v2: PRT-5 : ( PRV-4 = (provider participations)); PRT-5 : ( PRV-4 = (non-provider person participations )) ; PRT-5 : ( PRV-4 = (patient non-subject of care) ) ; PRT-8 rim: .participation[typeCode=PFM]
product[x]		0..1		There are no (further) constraints on this element Element id CarePlan.activity.detail.product[x] Short description What is to be administered/supplied Definition Identifies the food, drug or other product to be consumed or supplied in the activity. Binding A product supplied or administered as part of a care plan activity. SNOMEDCTMedicationCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: RXE-2 / RXO-1 / RXD-2 rim: .participation[typeCode=PRD].role
productCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
productReference			Reference(Medication \| Substance)	There are no (further) constraints on this element Data type Reference(Medication \| Substance)
dailyAmount		0..1	SimpleQuantity	There are no (further) constraints on this element Element id CarePlan.activity.detail.dailyAmount Short description How to consume/day? Alternate names daily dose Definition Identifies the quantity expected to be consumed in a given day. Requirements Allows rough dose checking. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: RXO-23 / RXE-19 / RXD-12 rim: .outboundRelationship[typeCode=COMP][classCode=SBADM].doseQuantity
quantity		0..1	SimpleQuantity	There are no (further) constraints on this element Element id CarePlan.activity.detail.quantity Short description How much to administer/supply/consume Definition Identifies the quantity expected to be supplied, administered or consumed by the subject. Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: RXO-11 / RXE-10 / RXD-4 / RXG-5 / RXA-6 / TQ1-2.1 and RXO-12 / RXE-11 / RXD-5 / RXG-7 / RXA-7 / TQ1-2.2 rim: .outboundRelationship[typeCode=COMP][classCode=SPLY].quantity
description		0..1	string	There are no (further) constraints on this element Element id CarePlan.activity.detail.description Short description Extra info describing activity to perform Definition This provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NTE? rim: .text
note		0..*	Annotation	There are no (further) constraints on this element Element id CarePlan.note Short description Comments about the plan Definition General notes about the care plan not covered elsewhere. Requirements Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements. Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Request.note v2: NTE? rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value

CarePlan
Definition	Describes 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.
Cardinality	0...*
Alias	Care Team
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings	rim: Entity. Role, or Act workflow: Request rim: Act[classCode=PCPR, moodCode=INT]
CarePlan.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
CarePlan.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
CarePlan.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
CarePlan.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
CarePlan.text
Definition	A human-readable narrative that contains a summary of the resource and can 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: Act.text?
CarePlan.contained
Definition	These 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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: N/A
CarePlan.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
CarePlan.modifierExtension
Definition	May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
CarePlan.identifier
Definition	Business identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Cardinality	0...*
Type	Identifier
Summary	True
Requirements	Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers.
Comments	This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.identifier w5: FiveWs.identifier v2: PTH-3 rim: .id
CarePlan.instantiatesCanonical
Definition	The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.
Cardinality	0...*
Type	canonical(PlanDefinition \| Questionnaire \| Measure \| ActivityDefinition \| OperationDefinition)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.instantiatesCanonical rim: .outboundRelationship[typeCode=DEFN].target
CarePlan.instantiatesUri
Definition	The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.
Cardinality	0...*
Type	uri
Summary	True
Comments	This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.instantiatesUri rim: .outboundRelationship[typeCode=DEFN].target
CarePlan.basedOn
Definition	A care plan that is fulfilled in whole or in part by this care plan.
Cardinality	0...*
Type	Reference(CarePlan)
Summary	True
Alias	fulfills
Requirements	Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.basedOn
CarePlan.replaces
Definition	Completed or terminated care plan whose function is taken by this new care plan.
Cardinality	0...*
Type	Reference(CarePlan)
Summary	True
Alias	supersedes
Requirements	Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.replaces
CarePlan.partOf
Definition	A larger care plan of which this particular care plan is a component or step.
Cardinality	0...*
Type	Reference(CarePlan)
Summary	True
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
CarePlan.status
Definition	Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
Cardinality	1...1
Type	code
Binding	Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. RequestStatus (required)
Must Support	True
Modifier	True
Summary	True
Requirements	Allows clinicians to determine whether the plan is actionable or not.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.status {uses different ValueSet} w5: FiveWs.status v2: PTH-5 rim: .statusCode planned = new active = active completed = completed
CarePlan.intent
Definition	Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain.
Cardinality	1...1
Type	code
Binding	Codes indicating the degree of authority/intentionality associated with a care plan. CarePlanIntent (required)
Must Support	True
Modifier	True
Summary	True
Requirements	Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.
Comments	This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.intent
CarePlan.category
Definition	Identifies 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.
Cardinality	0...*
Type	CodeableConcept
Binding	Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. CarePlanCategory (example)
Must Support	True
Summary	True
Requirements	Used for filtering what plan(s) are retrieved and displayed to different types of users.
Comments	There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.class
CarePlan.title
Definition	Human-friendly name for the care plan.
Cardinality	0...1
Type	string
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
CarePlan.description
Definition	A description of the scope and nature of the plan.
Cardinality	0...1
Type	string
Summary	True
Requirements	Provides more detail than conveyed by category.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.what[x]
CarePlan.subject
Definition	Identifies the patient or group whose intended care is described by the plan.
Cardinality	1...1
Type	Reference(Patient \| Group)
Must Support	True
Summary	True
Alias	patient
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.subject w5: FiveWs.subject[x] v2: PID-3 rim: .participation[typeCode=PAT].role[classCode=PAT] w5: FiveWs.subject
CarePlan.encounter
Definition	The Encounter during which this CarePlan was created or to which the creation of this record is tightly associated.
Cardinality	0...1
Type	Reference(Encounter)
Summary	True
Comments	This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.context w5: FiveWs.context v2: Associated PV1 rim: .
CarePlan.period
Definition	Indicates when the plan did (or is intended to) come into effect and end.
Cardinality	0...1
Type	Period
Summary	True
Alias	timing
Requirements	Allows tracking what plan(s) are in effect at a particular time.
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.occurrence[x] w5: FiveWs.planned v2: GOL-7 / GOL-8 rim: .effectiveTime
CarePlan.created
Definition	Represents when this particular CarePlan record was created in the system, which is often a system-generated date.
Cardinality	0...1
Type	dateTime
Summary	True
Alias	authoredOn
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.authoredOn w5: FiveWs.recorded rim: .participation[typeCode=AUT].time
CarePlan.author
Definition	When populated, the author is responsible for the care plan. The care plan is attributed to the author.
Cardinality	0...1
Type	Reference(Patient \| Practitioner \| PractitionerRole \| Device \| RelatedPerson \| Organization \| CareTeam)
Summary	True
Comments	The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.requester w5: FiveWs.author
CarePlan.contributor
Definition	Identifies the individual(s) or organization who provided the contents of the care plan.
Cardinality	0...*
Type	Reference(Patient \| Practitioner \| PractitionerRole \| Device \| RelatedPerson \| Organization \| CareTeam)
Comments	Collaborative care plans may have multiple contributors.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
CarePlan.careTeam
Definition	Identifies all people and organizations who are expected to be involved in the care envisioned by this plan.
Cardinality	0...*
Type	Reference(CareTeam)
Requirements	Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.performer {similar but does not entail CareTeam} w5: FiveWs.actor
CarePlan.addresses
Definition	Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.
Cardinality	0...*
Type	Reference(Condition)
Summary	True
Requirements	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.
Comments	When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.reasonReference w5: FiveWs.why[x] v2: PRB-4 rim: .actRelationship[typeCode=SUBJ].target[classCode=CONC, moodCode=EVN]
CarePlan.supportingInfo
Definition	Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc.
Cardinality	0...*
Type	Reference(Resource)
Requirements	Identifies barriers and other considerations associated with the care plan.
Comments	Use "concern" to identify specific conditions addressed by the care plan.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.supportingInfo
CarePlan.goal
Definition	Describes the intended objective(s) of carrying out the care plan.
Cardinality	0...*
Type	Reference(Goal)
Requirements	Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.
Comments	Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: GOL.1 rim: .outboundRelationship[typeCode<=OBJ].
CarePlan.activity
Definition	Identifies 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.
Cardinality	0...*
Type	BackboneElement
Requirements	Allows systems to prompt for performance of planned activities, and validate plans against best practice.
Invariants	cpl-3: Provide a reference or detail, not both `detail.empty() or reference.empty()` ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: {no mapping NOTE: This is a list of contained Request-Event tuples!} rim: .outboundRelationship[typeCode=COMP].target
CarePlan.activity.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
CarePlan.activity.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
CarePlan.activity.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
CarePlan.activity.outcomeCodeableConcept
Definition	Identifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not).
Cardinality	0...*
Type	CodeableConcept
Binding	Identifies the results of the activity. CarePlanActivityOutcome (example)
Comments	Note that this should not duplicate the activity status (e.g. completed or in progress).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
CarePlan.activity.outcomeReference
Definition	Details of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource).
Cardinality	0...*
Type	Reference(Resource)
Requirements	Links plan to resulting actions.
Comments	The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: {Event that is outcome of Request in activity.reference} rim: .inboundRelationship[typeCode=FLFS].source
CarePlan.activity.progress
Definition	Notes about the adherence/status/progress of the activity.
Cardinality	0...*
Type	Annotation
Requirements	Can be used to capture information about adherence, progress, concerns, etc.
Comments	This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NTE? rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
CarePlan.activity.reference
Definition	The details of the proposed activity represented in a specific resource.
Cardinality	0...1
Type	Reference(Appointment \| CommunicationRequest \| DeviceRequest \| MedicationRequest \| NutritionOrder \| Task \| ServiceRequest \| VisionPrescription \| RequestGroup)
Requirements	Details in a form consistent with other applications and contexts of use.
Comments	Standard extension exists (resource-pertainsToGoal) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference. The goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should not point to this CarePlan using the "basedOn" element. i.e. Requests that are part of a CarePlan are not "based on" the CarePlan.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: {Request that resulted in Event in activity.actionResulting} rim: .outboundRelationship[typeCode=COMP].target
CarePlan.activity.detail
Definition	A simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc.
Cardinality	0...1
Type	BackboneElement
Requirements	Details in a simple form for generic care plan systems.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode=COMP, subsetCode=SUMM].target
CarePlan.activity.detail.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
CarePlan.activity.detail.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
CarePlan.activity.detail.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
CarePlan.activity.detail.kind
Definition	A description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.
Cardinality	0...1
Type	code
Binding	Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity. CarePlanActivityKind (required)
Requirements	May determine what types of extensions are permitted.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .inboundRelationship[typeCode=COMP].source[classCode=LIST].code
CarePlan.activity.detail.instantiatesCanonical
Definition	The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.
Cardinality	0...*
Type	canonical(PlanDefinition \| ActivityDefinition \| Questionnaire \| Measure \| OperationDefinition)
Requirements	Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.instantiatesCanonical rim: .outboundRelationship[typeCode=DEFN].target
CarePlan.activity.detail.instantiatesUri
Definition	The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.
Cardinality	0...*
Type	uri
Requirements	Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.
Comments	This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.instantiatesUri rim: .outboundRelationship[typeCode=DEFN].target
CarePlan.activity.detail.code
Definition	Detailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter.
Cardinality	0...1
Type	CodeableConcept
Binding	Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter. ProcedureCodes(SNOMEDCT) (example)
Requirements	Allows matching performed to planned as well as validation against protocols.
Comments	Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.code v2: OBR-4 / RXE-2 / RXO-1 / RXD-2 rim: .code
CarePlan.activity.detail.reasonCode
Definition	Provides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited.
Cardinality	0...*
Type	CodeableConcept
Binding	Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc. SNOMEDCTClinicalFindings (example)
Comments	This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.reasonCode
CarePlan.activity.detail.reasonReference
Definition	Indicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan.
Cardinality	0...*
Type	Reference(Condition \| Observation \| DiagnosticReport \| DocumentReference)
Comments	Conditions can be identified at the activity level that are not identified as reasons for the overall plan.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.reasonReference
CarePlan.activity.detail.goal
Definition	Internal reference that identifies the goals that this activity is intended to contribute towards meeting.
Cardinality	0...*
Type	Reference(Goal)
Requirements	So that participants know the link explicitly.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode<=OBJ].
CarePlan.activity.detail.status
Definition	Identifies what progress is being made for the specific activity.
Cardinality	1...1
Type	code
Binding	Codes that reflect the current state of a care plan activity within its overall life cycle. CarePlanActivityStatus (required)
Modifier	True
Requirements	Indicates progress against the plan, whether the activity is still relevant for the plan.
Comments	Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated. 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 activity.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.status v2: ORC-5? rim: .statusCode not-started = new scheduled = not-started (and fulfillment relationship to appointent) in-progress = active on-hold = suspended completed = completed cancelled = aborted
CarePlan.activity.detail.statusReason
Definition	Provides reason why the activity isn't yet started, is on hold, was cancelled, etc.
Cardinality	0...1
Type	CodeableConcept
Comments	Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.statusReason
CarePlan.activity.detail.doNotPerform
Definition	If true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan.
Cardinality	0...1
Type	boolean
Modifier	True
Requirements	Captures intention to not do something that may have been previously typical.
Comments	This element is labeled as a modifier because it marks an activity as an activity that is not to be performed.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.doNotPerform rim: actionNegationInd
CarePlan.activity.detail.scheduled[x]
Definition	The period, timing or frequency upon which the described activity is to occur.
Cardinality	0...1
Type	Timing
Requirements	Allows prompting for activities and detection of missed planned activities.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.occurrence[x] v2: TQ1 rim: .effectiveTime
CarePlan.activity.detail.location
Definition	Identifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc.
Cardinality	0...1
Type	Reference(Location)
Requirements	Helps in planning of activity.
Comments	May reference a specific clinical location or may identify a type of location.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: OBR-24(???!!) rim: .participation[typeCode=LOC].role
CarePlan.activity.detail.performer
Definition	Identifies who's expected to be involved in the activity.
Cardinality	0...*
Type	Reference(Practitioner \| PractitionerRole \| Organization \| RelatedPerson \| Patient \| CareTeam \| HealthcareService \| Device)
Requirements	Helps in planning of activity.
Comments	A performer MAY also be a participant in the care plan.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.performer v2: PRT-5 : ( PRV-4 = (provider participations)); PRT-5 : ( PRV-4 = (non-provider person participations )) ; PRT-5 : ( PRV-4 = (patient non-subject of care) ) ; PRT-8 rim: .participation[typeCode=PFM]
CarePlan.activity.detail.product[x]
Definition	Identifies the food, drug or other product to be consumed or supplied in the activity.
Cardinality	0...1
Type	CodeableConcept
Binding	A product supplied or administered as part of a care plan activity. SNOMEDCTMedicationCodes (example)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: RXE-2 / RXO-1 / RXD-2 rim: .participation[typeCode=PRD].role
CarePlan.activity.detail.dailyAmount
Definition	Identifies the quantity expected to be consumed in a given day.
Cardinality	0...1
Type	SimpleQuantity
Alias	daily dose
Requirements	Allows rough dose checking.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: RXO-23 / RXE-19 / RXD-12 rim: .outboundRelationship[typeCode=COMP][classCode=SBADM].doseQuantity
CarePlan.activity.detail.quantity
Definition	Identifies the quantity expected to be supplied, administered or consumed by the subject.
Cardinality	0...1
Type	SimpleQuantity
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: RXO-11 / RXE-10 / RXD-4 / RXG-5 / RXA-6 / TQ1-2.1 and RXO-12 / RXE-11 / RXD-5 / RXG-7 / RXA-7 / TQ1-2.2 rim: .outboundRelationship[typeCode=COMP][classCode=SPLY].quantity
CarePlan.activity.detail.description
Definition	This provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc.
Cardinality	0...1
Type	string
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NTE? rim: .text
CarePlan.note
Definition	General notes about the care plan not covered elsewhere.
Cardinality	0...*
Type	Annotation
Requirements	Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Request.note v2: NTE? rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value

CarePlan		..
CarePlan.status		..
CarePlan.intent		..
CarePlan.category		..
CarePlan.subject		..

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-CarePlan" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-CarePlan" />
    <version value="2.2.0" />
    <name value="UKCoreCarePlan" />
    <title value="UK Core CarePlan" />
    <status value="draft" />
    <date value="2023-12-16" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [CarePlan](https://hl7.org/fhir/R4/CarePlan.html)." />
    <purpose value="This profile allows recording of care plans which are used in many areas of healthcare with a variety of scopes. They can be as simple as a general practitioner keeping track of when an individual is next due for a tetanus immunisation through to a detailed plan for an oncology patient covering diet, chemotherapy, radiation, lab work and counselling with detailed timing relationships, pre-conditions and goals." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <mapping>
        <identity value="workflow" />
        <uri value="http://hl7.org/fhir/workflow" />
        <name value="Workflow Pattern" />
    </mapping>
    <mapping>
        <identity value="rim" />
        <uri value="http://hl7.org/v3" />
        <name value="RIM Mapping" />
    </mapping>
    <mapping>
        <identity value="w5" />
        <uri value="http://hl7.org/fhir/fivews" />
        <name value="FiveWs Pattern Mapping" />
    </mapping>
    <mapping>
        <identity value="v2" />
        <uri value="http://hl7.org/v2" />
        <name value="HL7 v2 Mapping" />
    </mapping>
    <kind value="resource" />
    <abstract value="false" />
    <type value="CarePlan" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/CarePlan" />
    <derivation value="constraint" />
    <differential>
        <element id="CarePlan.status">
            <path value="CarePlan.status" />
            <mustSupport value="true" />
        </element>
        <element id="CarePlan.intent">
            <path value="CarePlan.intent" />
            <mustSupport value="true" />
        </element>
        <element id="CarePlan.category">
            <path value="CarePlan.category" />
            <mustSupport value="true" />
        </element>
        <element id="CarePlan.subject">
            <path value="CarePlan.subject" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-CarePlan",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-CarePlan",
    "version": "2.2.0",
    "name": "UKCoreCarePlan",
    "title": "UK Core CarePlan",
    "status": "draft",
    "date": "2023-12-16",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [CarePlan](https://hl7.org/fhir/R4/CarePlan.html).",
    "purpose": "This profile allows recording of care plans which are used in many areas of healthcare with a variety of scopes. They can be as simple as a general practitioner keeping track of when an individual is next due for a tetanus immunisation through to a detailed plan for an oncology patient covering diet, chemotherapy, radiation, lab work and counselling with detailed timing relationships, pre-conditions and goals.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "mapping":  [
        {
            "identity": "workflow",
            "uri": "http://hl7.org/fhir/workflow",
            "name": "Workflow Pattern"
        },
        {
            "identity": "rim",
            "uri": "http://hl7.org/v3",
            "name": "RIM Mapping"
        },
        {
            "identity": "w5",
            "uri": "http://hl7.org/fhir/fivews",
            "name": "FiveWs Pattern Mapping"
        },
        {
            "identity": "v2",
            "uri": "http://hl7.org/v2",
            "name": "HL7 v2 Mapping"
        }
    ],
    "kind": "resource",
    "abstract": false,
    "type": "CarePlan",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/CarePlan",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "CarePlan.status",
                "path": "CarePlan.status",
                "mustSupport": true
            },
            {
                "id": "CarePlan.intent",
                "path": "CarePlan.intent",
                "mustSupport": true
            },
            {
                "id": "CarePlan.category",
                "path": "CarePlan.category",
                "mustSupport": true
            },
            {
                "id": "CarePlan.subject",
                "path": "CarePlan.subject",
                "mustSupport": true
            }
        ]
    }
}

Propose a change to UKCore-CarePlan

StructureDefinition UKCore-Encounter

UKCoreEncounter (Encounter)	I		Encounter	There are no (further) constraints on this element Element id Encounter Short description An interaction during which services are provided to the patient Alternate names Visit Definition An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient. Data type Encounter Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Event rim: Encounter[@moodCode='EVN']
id	Σ	0..1	string	There are no (further) constraints on this element Element id Encounter.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Encounter.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Encounter.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Encounter.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Encounter.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can 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. Comments 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 information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Encounter.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These 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. Comments 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	Element id Encounter.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
dischargeMethod	I	0..1	Extension(CodeableConcept)	Element id Encounter.extension:dischargeMethod Short description An extension to support the method of discharge from a hospital. Alternate names extensions, user content Definition This extension has been developed to demonstrate the representation of the method by which a patient was discharged from hospital. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DischargeMethod Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
emergencyCareDischargeStatus	I	0..1	Extension(CodeableConcept)	Element id Encounter.extension:emergencyCareDischargeStatus Short description An extension to support the status of an individual on discharge from an Emergency Care Department. Alternate names extensions, user content Definition This extension has been developed to demonstrate the representation of the status of a patient on discharge from an Emergency Care Department. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-EmergencyCareDischargeStatus Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
legalStatus	I	0..*	Extension(Complex)	Element id Encounter.extension:legalStatus Short description Information relating to a patient's legal status on admission or discharge. Alternate names extensions, user content Definition Information relating to a patient's legal status on admission or discharge. Comments 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. Data type Extension(Complex) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-LegalStatus Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
OutcomeOfAttendance	I	0..1	Extension(CodeableConcept)	Element id Encounter.extension:OutcomeOfAttendance Short description An extension to support the outcome of an Outpatient attendance. Alternate names extensions, user content Definition This extension has been developed to demonstrate the representation of the outcome of an Outpatient attendance. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OutcomeOfAttendance Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	S Σ	0..*	Identifier	Element id Encounter.identifier Short description Identifier(s) by which this encounter is known. Definition Identifier(s) by which this encounter is known. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier v2: PV1-19 rim: .id
status	S Σ ?!	1..1	codeBinding	Element id Encounter.status Short description The status of this encounter: planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled \| entered-in-error \| unknown Definition planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled +. Comments Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes). Data type code Binding Current state of the encounter. EncounterStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.status w5: FiveWs.status v2: No clear equivalent in HL7 v2; active/finished could be inferred from PV1-44, PV1-45, PV2-24; inactive could be inferred from PV2-16 rim: .statusCode
statusHistory		0..*	BackboneElement	There are no (further) constraints on this element Element id Encounter.statusHistory Short description List of past encounter statuses Definition The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them. Comments The current status is always found in the current version of the resource, not the status history. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Encounter.statusHistory.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.statusHistory.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.statusHistory.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
status		1..1	codeBinding	There are no (further) constraints on this element Element id Encounter.statusHistory.status Short description planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled + Definition planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled +. Data type code Binding Current state of the encounter. EncounterStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
period		1..1	Period	There are no (further) constraints on this element Element id Encounter.statusHistory.period Short description The time that the episode was in the specified status Definition The time that the episode was in the specified status. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
class	S Σ	1..1	CodingBinding	Element id Encounter.class Short description Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations. Definition Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations. Data type Coding Binding Classification of the encounter. v3.ActEncounterCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class v2: PV1-2 rim: .inboundRelationship[typeCode=SUBJ].source[classCode=LIST].code
classHistory		0..*	BackboneElement	There are no (further) constraints on this element Element id Encounter.classHistory Short description List of past encounter classes Definition The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Encounter.classHistory.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.classHistory.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.classHistory.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
class		1..1	CodingBinding	There are no (further) constraints on this element Element id Encounter.classHistory.class Short description inpatient \| outpatient \| ambulatory \| emergency + Definition inpatient \| outpatient \| ambulatory \| emergency +. Data type Coding Binding Classification of the encounter. v3.ActEncounterCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
period		1..1	Period	There are no (further) constraints on this element Element id Encounter.classHistory.period Short description The time that the episode was in the specified class Definition The time that the episode was in the specified class. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
type	Σ	0..*	CodeableConceptBinding	Element id Encounter.type Short description Specific type of encounter Definition Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation). Comments Since there are many ways to further classify encounters, this element is 0... Data type* CodeableConcept Binding A code from the SNOMED Clinical Terminology UK coding system that describes an encounter between a care professional and the patient (or patient's record). UKCoreEncounterType (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.class v2: PV1-4 / PV1-18 rim: .code
serviceType	Σ	0..1	CodeableConceptBinding	Element id Encounter.serviceType Short description Specific type of service Definition Broad categorization of the service that is to be provided (e.g. cardiology). Data type CodeableConcept Binding Any code from the SNOMED CT UK Refset with fully specified name 'Services simple reference set (foundation metadata concept)' with Refset Id 1127531000000102. UKCoreCareSettingType (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code v2: PV1-10 rim: n/a
priority		0..1	CodeableConcept	There are no (further) constraints on this element Element id Encounter.priority Short description Indicates the urgency of the encounter Definition Indicates the urgency of the encounter. Data type CodeableConcept Binding Indicates the urgency of the encounter. v3.ActPriority (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.grade v2: PV2-25 rim: .priorityCode
subject	S Σ	0..1	Reference(Patient \| Group)	Element id Encounter.subject Short description The patient or group present at the encounter. Alternate names patient Definition The patient or group present at the encounter. Comments While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked). Data type Reference(Patient \| Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 rim: .participation[typeCode=SBJ]/role[classCode=PAT] w5: FiveWs.subject
episodeOfCare	Σ	0..*	Reference(EpisodeOfCare)	There are no (further) constraints on this element Element id Encounter.episodeOfCare Short description Episode(s) of care that this encounter should be recorded against Definition Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years). Data type Reference(EpisodeOfCare) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.context w5: FiveWs.context v2: PV1-54, PV1-53 rim: n/a
basedOn		0..*	Reference(ServiceRequest)	There are no (further) constraints on this element Element id Encounter.basedOn Short description The ServiceRequest that initiated this encounter Alternate names incomingReferral Definition The request this encounter satisfies (e.g. incoming referral or procedure request). Data type Reference(ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.basedOn rim: .reason.ClinicalDocument
participant	S Σ	0..*	BackboneElement	Element id Encounter.participant Short description The list of people responsible for providing the service. Definition The list of people responsible for providing the service. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer v2: ROL rim: .participation[typeCode=PFM]
id		0..1	string	There are no (further) constraints on this element Element id Encounter.participant.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.participant.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.participant.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
type	Σ	0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Encounter.participant.type Short description Role of participant in encounter Definition Role of participant in encounter. Comments The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc. Data type CodeableConcept Binding Role of participant in encounter. ParticipantType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.function v2: ROL-3 (or maybe PRT-4) rim: .functionCode
period		0..1	Period	There are no (further) constraints on this element Element id Encounter.participant.period Short description Period of time during the encounter that the participant participated Definition The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: ROL-5, ROL-6 (or maybe PRT-5) rim: .time
individual	Σ	0..1	Reference(Practitioner \| PractitionerRole \| RelatedPerson)	There are no (further) constraints on this element Element id Encounter.participant.individual Short description Persons involved in the encounter other than the patient Definition Persons involved in the encounter other than the patient. Data type Reference(Practitioner \| PractitionerRole \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor w5: FiveWs.who v2: ROL-4 rim: .role
appointment	Σ	0..*	Reference(Appointment)	There are no (further) constraints on this element Element id Encounter.appointment Short description The appointment that scheduled this encounter Definition The appointment that scheduled this encounter. Data type Reference(Appointment) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.basedOn v2: SCH-1 / SCH-2 rim: .outboundRelationship[typeCode=FLFS].target[classCode=ENC, moodCode=APT]
period		0..1	Period	There are no (further) constraints on this element Element id Encounter.period Short description The start and end time of the encounter Definition The start and end time of the encounter. Comments If not (yet) known, the end of the Period may be omitted. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: PV1-44, PV1-45 rim: .effectiveTime (low & high)
length		0..1	Duration	There are no (further) constraints on this element Element id Encounter.length Short description Quantity of time the encounter lasted (less time absent) Definition Quantity of time the encounter lasted. This excludes the time during leaves of absence. Comments May differ from the time the Encounter.period lasted because of leave of absence. Data type Duration Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] v2: (PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes rim: .lengthOfStayQuantity
reasonCode	S Σ	0..*	CodeableConceptBinding	Element id Encounter.reasonCode Short description Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis. Alternate names Indication, Admission diagnosis Definition Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis. Comments For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis). Data type CodeableConcept Binding Reason why the encounter takes place. EncounterReasonCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.reasonCode w5: FiveWs.why[x] v2: EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations ) rim: .reasonCode
reasonReference	S Σ	0..*	Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation)	Element id Encounter.reasonReference Short description Reason the encounter takes place, expressed as a reference to a Condition, Procedure, Observation, or ImmunizationRecommendation. Alternate names Indication, Admission diagnosis Definition Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis. Comments For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis). Data type Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.reasonCode w5: FiveWs.why[x] v2: EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations ) rim: .reasonCode
diagnosis	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element id Encounter.diagnosis Short description The list of diagnosis relevant to this encounter Definition The list of diagnosis relevant to this encounter. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode=RSON]
id		0..1	string	There are no (further) constraints on this element Element id Encounter.diagnosis.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.diagnosis.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.diagnosis.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
condition	Σ	1..1	Reference(Condition \| Procedure)	There are no (further) constraints on this element Element id Encounter.diagnosis.condition Short description The diagnosis or procedure relevant to the encounter Alternate names Admission diagnosis, discharge diagnosis, indication Definition Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure. Comments For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis). Data type Reference(Condition \| Procedure) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.reasonReference w5: FiveWs.why[x] v2: Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively. rim: .outboundRelationship[typeCode=RSON].target
use		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Encounter.diagnosis.use Short description Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …) Definition Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …). Data type CodeableConcept Binding The type of diagnosis this condition represents. DiagnosisRole (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
rank		0..1	positiveInt	There are no (further) constraints on this element Element id Encounter.diagnosis.rank Short description Ranking of the diagnosis (for each role type) Definition Ranking of the diagnosis (for each role type). Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode=RSON].priority
account		0..*	Reference(Account)	There are no (further) constraints on this element Element id Encounter.account Short description The set of accounts that may be used for billing for this Encounter Definition The set of accounts that may be used for billing for this Encounter. Comments The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules. Data type Reference(Account) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .pertains.A_Account
hospitalization		0..1	BackboneElement	There are no (further) constraints on this element Element id Encounter.hospitalization Short description Details about the admission to a healthcare service Definition Details about the admission to a healthcare service. Comments An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included. The duration recorded in the period of this encounter covers the entire scope of this hospitalization record. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode=COMP].target[classCode=ENC, moodCode=EVN]
id		0..1	string	There are no (further) constraints on this element Element id Encounter.hospitalization.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	Element id Encounter.hospitalization.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
admissionMethod	I	0..1	Extension(CodeableConcept)	Element id Encounter.hospitalization.extension:admissionMethod Short description An extension to support the method by which an individual was admitted into hospital. Alternate names extensions, user content Definition This extension has been developed to demonstrate the representation of the method by which a patient was admitted to hospital. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.hospitalization.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
preAdmissionIdentifier		0..1	Identifier	There are no (further) constraints on this element Element id Encounter.hospitalization.preAdmissionIdentifier Short description Pre-admission identifier Definition Pre-admission identifier. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PV1-5 rim: .id
origin		0..1	Reference(Location \| Organization)	There are no (further) constraints on this element Element id Encounter.hospitalization.origin Short description The location/organization from which the patient came before admission Definition The location/organization from which the patient came before admission. Data type Reference(Location \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .participation[typeCode=ORG].role
admitSource		0..1	CodeableConceptBinding	Element id Encounter.hospitalization.admitSource Short description From where patient was admitted (physician referral, transfer) Definition From where patient was admitted (physician referral, transfer). Data type CodeableConcept Binding The source of admission to a Hospital Provider Spell or a Nursing Episode when the Patient is in a Hospital Site or a Care Home. UKCoreSourceOfAdmission (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PV1-14 rim: .admissionReferralSourceCode
reAdmission		0..1	CodeableConcept	There are no (further) constraints on this element Element id Encounter.hospitalization.reAdmission Short description The type of hospital re-admission that has occurred (if any). If the value is absent, then this is not identified as a readmission Definition Whether this hospitalization is a readmission and why if known. Data type CodeableConcept Binding The reason for re-admission of this hospitalization encounter. v2.0092 (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PV1-13 rim: n/a
dietPreference		0..*	CodeableConcept	There are no (further) constraints on this element Element id Encounter.hospitalization.dietPreference Short description Diet preferences reported by the patient Definition Diet preferences reported by the patient. Requirements Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter. Comments For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive). Data type CodeableConcept Binding Medical, cultural or ethical food preferences to help with catering requirements. Diet (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PV1-38 rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=EVN, code="diet"]
specialCourtesy		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Encounter.hospitalization.specialCourtesy Short description Special courtesies (VIP, board member) Definition Special courtesies (VIP, board member). Data type CodeableConcept Binding Special courtesies. SpecialCourtesy (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PV1-16 rim: .specialCourtesiesCode
specialArrangement		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Encounter.hospitalization.specialArrangement Short description Wheelchair, translator, stretcher, etc. Definition Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things. Data type CodeableConcept Binding Special arrangements. SpecialArrangements (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PV1-15 / OBR-30 / OBR-43 rim: .specialArrangementCode
destination		0..1	Reference(Location \| Organization)	There are no (further) constraints on this element Element id Encounter.hospitalization.destination Short description Location/organization to which the patient is discharged Definition Location/organization to which the patient is discharged. Data type Reference(Location \| Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PV1-37 rim: .participation[typeCode=DST]
dischargeDisposition		0..1	CodeableConceptBinding	Element id Encounter.hospitalization.dischargeDisposition Short description Category or kind of location after discharge Definition Category or kind of location after discharge. Data type CodeableConcept Binding The destination of a Patient on completion of a Hospital Provider Spell, or a note that the Patient died or was a still birth. UKCoreDischargeDestination (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PV1-36 rim: .dischargeDispositionCode
location		0..*	BackboneElement	There are no (further) constraints on this element Element id Encounter.location Short description List of locations where the patient has been Definition List of locations where the patient has been during this encounter. Comments Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual". Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .participation[typeCode=LOC]
id		0..1	string	There are no (further) constraints on this element Element id Encounter.location.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.location.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Encounter.location.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
location		1..1	Reference(Location)	There are no (further) constraints on this element Element id Encounter.location.location Short description Location the encounter takes place Definition The location where the encounter takes place. Data type Reference(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.location w5: FiveWs.where[x] v2: PV1-3 / PV1-6 / PV1-11 / PV1-42 / PV1-43 rim: .role
status		0..1	codeBinding	There are no (further) constraints on this element Element id Encounter.location.status Short description planned \| active \| reserved \| completed Definition The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time. Comments When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed. Data type code Binding The status of the location. EncounterLocationStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .role.statusCode
physicalType		0..1	CodeableConceptBinding	Element id Encounter.location.physicalType Short description The physical type of the location (usually the level in the location hierachy - bed room ward etc.) Definition This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query. Comments This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query. There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario. Data type CodeableConcept Binding A set of codes that define the physical type of location where an encounter takes place. UKCoreEncounterLocationType (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
period		0..1	Period	There are no (further) constraints on this element Element id Encounter.location.period Short description Time period during which the patient was present at the location Definition Time period during which the patient was present at the location. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .time
serviceProvider		0..1	Reference(Organization)	There are no (further) constraints on this element Element id Encounter.serviceProvider Short description The organization (facility) responsible for this encounter Definition The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor v2: PL.6 & PL.1 rim: .particiaption[typeCode=PFM].role
partOf		0..1	Reference(Encounter)	There are no (further) constraints on this element Element id Encounter.partOf Short description Another Encounter this encounter is part of Definition Another Encounter of which this encounter is a part of (administratively or in time). Comments This is also used for associating a child's encounter back to the mother's encounter. Refer to the Notes section in the Patient resource for further details. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.partOf rim: .inboundRelationship[typeCode=COMP].source[classCode=COMP, moodCode=EVN]

Encounter
Definition	An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.
Cardinality	0...*
Alias	Visit
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings	rim: Entity. Role, or Act workflow: Event rim: Encounter[@moodCode='EVN']
Encounter.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Encounter.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Encounter.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Encounter.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Encounter.text
Definition	A human-readable narrative that contains a summary of the resource and can 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: Act.text?
Encounter.contained
Definition	These 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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: N/A
Encounter.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Encounter.extension:dischargeMethod
Definition	This extension has been developed to demonstrate the representation of the method by which a patient was discharged from hospital.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Encounter.extension:emergencyCareDischargeStatus
Definition	This extension has been developed to demonstrate the representation of the status of a patient on discharge from an Emergency Care Department.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Encounter.extension:legalStatus
Definition	Information relating to a patient's legal status on admission or discharge.
Cardinality	0...*
Type	Extension(Complex)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Encounter.extension:OutcomeOfAttendance
Definition	This extension has been developed to demonstrate the representation of the outcome of an Outpatient attendance.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Encounter.modifierExtension
Definition	May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Encounter.identifier
Definition	Identifier(s) by which this encounter is known.
Cardinality	0...*
Type	Identifier
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.identifier w5: FiveWs.identifier v2: PV1-19 rim: .id
Encounter.status
Definition	planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled +.
Cardinality	1...1
Type	code
Binding	Current state of the encounter. EncounterStatus (required)
Must Support	True
Modifier	True
Summary	True
Comments	Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.status w5: FiveWs.status v2: No clear equivalent in HL7 v2; active/finished could be inferred from PV1-44, PV1-45, PV2-24; inactive could be inferred from PV2-16 rim: .statusCode
Encounter.statusHistory
Definition	The status history permits the encounter resource to contain the status history without needing to read through the historical versions of the resource, or even have the server store them.
Cardinality	0...*
Type	BackboneElement
Comments	The current status is always found in the current version of the resource, not the status history.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Encounter.statusHistory.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Encounter.statusHistory.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Encounter.statusHistory.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Encounter.statusHistory.status
Definition	planned \| arrived \| triaged \| in-progress \| onleave \| finished \| cancelled +.
Cardinality	1...1
Type	code
Binding	Current state of the encounter. EncounterStatus (required)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Encounter.statusHistory.period
Definition	The time that the episode was in the specified status.
Cardinality	1...1
Type	Period
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Encounter.class
Definition	Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.
Cardinality	1...1
Type	Coding
Binding	Classification of the encounter. v3.ActEncounterCode (extensible)
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.class v2: PV1-2 rim: .inboundRelationship[typeCode=SUBJ].source[classCode=LIST].code
Encounter.classHistory
Definition	The class history permits the tracking of the encounters transitions without needing to go through the resource history. This would be used for a case where an admission starts of as an emergency encounter, then transitions into an inpatient scenario. Doing this and not restarting a new encounter ensures that any lab/diagnostic results can more easily follow the patient and not require re-processing and not get lost or cancelled during a kind of discharge from emergency to inpatient.
Cardinality	0...*
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Encounter.classHistory.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Encounter.classHistory.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Encounter.classHistory.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Encounter.classHistory.class
Definition	inpatient \| outpatient \| ambulatory \| emergency +.
Cardinality	1...1
Type	Coding
Binding	Classification of the encounter. v3.ActEncounterCode (extensible)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Encounter.classHistory.period
Definition	The time that the episode was in the specified class.
Cardinality	1...1
Type	Period
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Encounter.type
Definition	Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).
Cardinality	0...*
Type	CodeableConcept
Binding	A code from the SNOMED Clinical Terminology UK coding system that describes an encounter between a care professional and the patient (or patient's record). UKCoreEncounterType (preferred)
Summary	True
Comments	Since there are many ways to further classify encounters, this element is 0..*.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.code w5: FiveWs.class v2: PV1-4 / PV1-18 rim: .code
Encounter.serviceType
Definition	Broad categorization of the service that is to be provided (e.g. cardiology).
Cardinality	0...1
Type	CodeableConcept
Binding	Any code from the SNOMED CT UK Refset with fully specified name 'Services simple reference set (foundation metadata concept)' with Refset Id 1127531000000102. UKCoreCareSettingType (preferred)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.code v2: PV1-10 rim: n/a
Encounter.priority
Definition	Indicates the urgency of the encounter.
Cardinality	0...1
Type	CodeableConcept
Binding	Indicates the urgency of the encounter. v3.ActPriority (example)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.grade v2: PV2-25 rim: .priorityCode
Encounter.subject
Definition	The patient or group present at the encounter.
Cardinality	0...1
Type	Reference(Patient \| Group)
Must Support	True
Summary	True
Alias	patient
Comments	While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 rim: .participation[typeCode=SBJ]/role[classCode=PAT] w5: FiveWs.subject
Encounter.episodeOfCare
Definition	Where a specific encounter should be classified as a part of a specific episode(s) of care this field should be used. This association can facilitate grouping of related encounters together for a specific purpose, such as government reporting, issue tracking, association via a common problem. The association is recorded on the encounter as these are typically created after the episode of care and grouped on entry rather than editing the episode of care to append another encounter to it (the episode of care could span years).
Cardinality	0...*
Type	Reference(EpisodeOfCare)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.context w5: FiveWs.context v2: PV1-54, PV1-53 rim: n/a
Encounter.basedOn
Definition	The request this encounter satisfies (e.g. incoming referral or procedure request).
Cardinality	0...*
Type	Reference(ServiceRequest)
Alias	incomingReferral
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.basedOn rim: .reason.ClinicalDocument
Encounter.participant
Definition	The list of people responsible for providing the service.
Cardinality	0...*
Type	BackboneElement
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.performer v2: ROL rim: .participation[typeCode=PFM]
Encounter.participant.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Encounter.participant.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Encounter.participant.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Encounter.participant.type
Definition	Role of participant in encounter.
Cardinality	0...*
Type	CodeableConcept
Binding	Role of participant in encounter. ParticipantType (extensible)
Summary	True
Comments	The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.performer.function v2: ROL-3 (or maybe PRT-4) rim: .functionCode
Encounter.participant.period
Definition	The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.
Cardinality	0...1
Type	Period
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: ROL-5, ROL-6 (or maybe PRT-5) rim: .time
Encounter.participant.individual
Definition	Persons involved in the encounter other than the patient.
Cardinality	0...1
Type	Reference(Practitioner \| PractitionerRole \| RelatedPerson)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.performer.actor w5: FiveWs.who v2: ROL-4 rim: .role
Encounter.appointment
Definition	The appointment that scheduled this encounter.
Cardinality	0...*
Type	Reference(Appointment)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.basedOn v2: SCH-1 / SCH-2 rim: .outboundRelationship[typeCode=FLFS].target[classCode=ENC, moodCode=APT]
Encounter.period
Definition	The start and end time of the encounter.
Cardinality	0...1
Type	Period
Comments	If not (yet) known, the end of the Period may be omitted.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: PV1-44, PV1-45 rim: .effectiveTime (low & high)
Encounter.length
Definition	Quantity of time the encounter lasted. This excludes the time during leaves of absence.
Cardinality	0...1
Type	Duration
Comments	May differ from the time the Encounter.period lasted because of leave of absence.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.occurrence[x] v2: (PV1-45 less PV1-44) iff ( (PV1-44 not empty) and (PV1-45 not empty) ); units in minutes rim: .lengthOfStayQuantity
Encounter.reasonCode
Definition	Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
Cardinality	0...*
Type	CodeableConcept
Binding	Reason why the encounter takes place. EncounterReasonCodes (preferred)
Must Support	True
Summary	True
Alias	Indication, Admission diagnosis
Comments	For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.reasonCode w5: FiveWs.why[x] v2: EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations ) rim: .reasonCode
Encounter.reasonReference
Definition	Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
Cardinality	0...*
Type	Reference(Condition \| Procedure \| Observation \| ImmunizationRecommendation)
Must Support	True
Summary	True
Alias	Indication, Admission diagnosis
Comments	For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.reasonCode w5: FiveWs.why[x] v2: EVN-4 / PV2-3 (note: PV2-3 is nominally constrained to inpatient admissions; HL7 v2 makes no vocabulary suggestions for PV2-3; would not expect PV2 segment or PV2-3 to be in use in all implementations ) rim: .reasonCode
Encounter.diagnosis
Definition	The list of diagnosis relevant to this encounter.
Cardinality	0...*
Type	BackboneElement
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode=RSON]
Encounter.diagnosis.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Encounter.diagnosis.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Encounter.diagnosis.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Encounter.diagnosis.condition
Definition	Reason the encounter takes place, as specified using information from another resource. For admissions, this is the admission diagnosis. The indication will typically be a Condition (with other resources referenced in the evidence.detail), or a Procedure.
Cardinality	1...1
Type	Reference(Condition \| Procedure)
Summary	True
Alias	Admission diagnosis, discharge diagnosis, indication
Comments	For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.reasonReference w5: FiveWs.why[x] v2: Resources that would commonly referenced at Encounter.indication would be Condition and/or Procedure. These most closely align with DG1/PRB and PR1 respectively. rim: .outboundRelationship[typeCode=RSON].target
Encounter.diagnosis.use
Definition	Role that this diagnosis has within the encounter (e.g. admission, billing, discharge …).
Cardinality	0...1
Type	CodeableConcept
Binding	The type of diagnosis this condition represents. DiagnosisRole (preferred)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: n/a
Encounter.diagnosis.rank
Definition	Ranking of the diagnosis (for each role type).
Cardinality	0...1
Type	positiveInt
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode=RSON].priority
Encounter.account
Definition	The set of accounts that may be used for billing for this Encounter.
Cardinality	0...*
Type	Reference(Account)
Comments	The billing system may choose to allocate billable items associated with the Encounter to different referenced Accounts based on internal business rules.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .pertains.A_Account
Encounter.hospitalization
Definition	Details about the admission to a healthcare service.
Cardinality	0...1
Type	BackboneElement
Comments	An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included. The duration recorded in the period of this encounter covers the entire scope of this hospitalization record.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode=COMP].target[classCode=ENC, moodCode=EVN]
Encounter.hospitalization.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Encounter.hospitalization.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Encounter.hospitalization.extension:admissionMethod
Definition	This extension has been developed to demonstrate the representation of the method by which a patient was admitted to hospital.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Encounter.hospitalization.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Encounter.hospitalization.preAdmissionIdentifier
Definition	Pre-admission identifier.
Cardinality	0...1
Type	Identifier
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PV1-5 rim: .id
Encounter.hospitalization.origin
Definition	The location/organization from which the patient came before admission.
Cardinality	0...1
Type	Reference(Location \| Organization)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .participation[typeCode=ORG].role
Encounter.hospitalization.admitSource
Definition	From where patient was admitted (physician referral, transfer).
Cardinality	0...1
Type	CodeableConcept
Binding	The source of admission to a Hospital Provider Spell or a Nursing Episode when the Patient is in a Hospital Site or a Care Home. UKCoreSourceOfAdmission (preferred)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PV1-14 rim: .admissionReferralSourceCode
Encounter.hospitalization.reAdmission
Definition	Whether this hospitalization is a readmission and why if known.
Cardinality	0...1
Type	CodeableConcept
Binding	The reason for re-admission of this hospitalization encounter. v2.0092 (example)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PV1-13 rim: n/a
Encounter.hospitalization.dietPreference
Definition	Diet preferences reported by the patient.
Cardinality	0...*
Type	CodeableConcept
Binding	Medical, cultural or ethical food preferences to help with catering requirements. Diet (example)
Requirements	Used to track patient's diet restrictions and/or preference. For a complete description of the nutrition needs of a patient during their stay, one should use the nutritionOrder resource which links to Encounter.
Comments	For example, a patient may request both a dairy-free and nut-free diet preference (not mutually exclusive).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PV1-38 rim: .outboundRelationship[typeCode=COMP].target[classCode=SBADM, moodCode=EVN, code="diet"]
Encounter.hospitalization.specialCourtesy
Definition	Special courtesies (VIP, board member).
Cardinality	0...*
Type	CodeableConcept
Binding	Special courtesies. SpecialCourtesy (preferred)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PV1-16 rim: .specialCourtesiesCode
Encounter.hospitalization.specialArrangement
Definition	Any special requests that have been made for this hospitalization encounter, such as the provision of specific equipment or other things.
Cardinality	0...*
Type	CodeableConcept
Binding	Special arrangements. SpecialArrangements (preferred)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PV1-15 / OBR-30 / OBR-43 rim: .specialArrangementCode
Encounter.hospitalization.destination
Definition	Location/organization to which the patient is discharged.
Cardinality	0...1
Type	Reference(Location \| Organization)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PV1-37 rim: .participation[typeCode=DST]
Encounter.hospitalization.dischargeDisposition
Definition	Category or kind of location after discharge.
Cardinality	0...1
Type	CodeableConcept
Binding	The destination of a Patient on completion of a Hospital Provider Spell, or a note that the Patient died or was a still birth. UKCoreDischargeDestination (preferred)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PV1-36 rim: .dischargeDispositionCode
Encounter.location
Definition	List of locations where the patient has been during this encounter.
Cardinality	0...*
Type	BackboneElement
Comments	Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual".
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .participation[typeCode=LOC]
Encounter.location.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Encounter.location.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Encounter.location.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Encounter.location.location
Definition	The location where the encounter takes place.
Cardinality	1...1
Type	Reference(Location)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.location w5: FiveWs.where[x] v2: PV1-3 / PV1-6 / PV1-11 / PV1-42 / PV1-43 rim: .role
Encounter.location.status
Definition	The status of the participants' presence at the specified location during the period specified. If the participant is no longer at the location, then the period will have an end date/time.
Cardinality	0...1
Type	code
Binding	The status of the location. EncounterLocationStatus (required)
Comments	When the patient is no longer active at a location, then the period end date is entered, and the status may be changed to completed.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .role.statusCode
Encounter.location.physicalType
Definition	This will be used to specify the required levels (bed/ward/room/etc.) desired to be recorded to simplify either messaging or query.
Cardinality	0...1
Type	CodeableConcept
Binding	A set of codes that define the physical type of location where an encounter takes place. UKCoreEncounterLocationType (preferred)
Comments	This information is de-normalized from the Location resource to support the easier understanding of the encounter resource and processing in messaging or query. There may be many levels in the hierachy, and this may only pic specific levels that are required for a specific usage scenario.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Encounter.location.period
Definition	Time period during which the patient was present at the location.
Cardinality	0...1
Type	Period
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .time
Encounter.serviceProvider
Definition	The organization that is primarily responsible for this Encounter's services. This MAY be the same as the organization on the Patient record, however it could be different, such as if the actor performing the services was from an external organization (which may be billed seperately) for an external consultation. Refer to the example bundle showing an abbreviated set of Encounters for a colonoscopy.
Cardinality	0...1
Type	Reference(Organization)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.performer.actor v2: PL.6 & PL.1 rim: .particiaption[typeCode=PFM].role
Encounter.partOf
Definition	Another Encounter of which this encounter is a part of (administratively or in time).
Cardinality	0...1
Type	Reference(Encounter)
Comments	This is also used for associating a child's encounter back to the mother's encounter. Refer to the Notes section in the Patient resource for further details.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.partOf rim: .inboundRelationship[typeCode=COMP].source[classCode=COMP, moodCode=EVN]

Encounter		..
Encounter.extension	Extension	..
Encounter.extension	Extension	..
Encounter.extension	Extension	..
Encounter.extension	Extension	..
Encounter.identifier		..
Encounter.status		..
Encounter.class		..
Encounter.type		..
Encounter.serviceType		..
Encounter.subject		..
Encounter.participant		..
Encounter.reasonCode		..
Encounter.reasonReference		..
Encounter.hospitalization		..
Encounter.hospitalization.extension	Extension	..
Encounter.hospitalization.admitSource		..
Encounter.hospitalization.dischargeDisposition		..
Encounter.location		..
Encounter.location.physicalType		..

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Encounter" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter" />
    <version value="2.5.0" />
    <name value="UKCoreEncounter" />
    <title value="UK Core Encounter" />
    <status value="active" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Encounter](https://hl7.org/fhir/R4/Encounter.html)." />
    <purpose value="This profile allows exchange of information about an interaction between an individual and healthcare providers for the purpose of providing healthcare services or assessing the health status of an individual." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Encounter" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Encounter" />
    <derivation value="constraint" />
    <differential>
        <element id="Encounter.extension:dischargeMethod">
            <path value="Encounter.extension" />
            <sliceName value="dischargeMethod" />
            <short value="An extension to support the method of discharge from a hospital." />
            <definition value="This extension has been developed to demonstrate the representation of the method by which a patient was discharged from hospital." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DischargeMethod" />
            </type>
        </element>
        <element id="Encounter.extension:emergencyCareDischargeStatus">
            <path value="Encounter.extension" />
            <sliceName value="emergencyCareDischargeStatus" />
            <short value="An extension to support the status of an individual on discharge from an Emergency Care Department." />
            <definition value="This extension has been developed to demonstrate the representation of the status of a patient on discharge from an Emergency Care Department." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-EmergencyCareDischargeStatus" />
            </type>
        </element>
        <element id="Encounter.extension:legalStatus">
            <path value="Encounter.extension" />
            <sliceName value="legalStatus" />
            <short value="Information relating to a patient&#39;s legal status on admission or discharge." />
            <definition value="Information relating to a patient&#39;s legal status on admission or discharge." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-LegalStatus" />
            </type>
        </element>
        <element id="Encounter.extension:OutcomeOfAttendance">
            <path value="Encounter.extension" />
            <sliceName value="OutcomeOfAttendance" />
            <short value="An extension to support the outcome of an Outpatient attendance." />
            <definition value="This extension has been developed to demonstrate the representation of the outcome of an Outpatient attendance." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OutcomeOfAttendance" />
            </type>
        </element>
        <element id="Encounter.identifier">
            <path value="Encounter.identifier" />
            <short value="Identifier(s) by which this encounter is known." />
            <mustSupport value="true" />
        </element>
        <element id="Encounter.status">
            <path value="Encounter.status" />
            <short value="The status of this encounter: planned | arrived | triaged | in-progress | onleave | finished | cancelled | entered-in-error | unknown" />
            <mustSupport value="true" />
        </element>
        <element id="Encounter.class">
            <path value="Encounter.class" />
            <short value="Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations." />
            <mustSupport value="true" />
        </element>
        <element id="Encounter.type">
            <path value="Encounter.type" />
            <binding>
                <strength value="preferred" />
                <description value="A code from the SNOMED Clinical Terminology UK coding system that describes an encounter between a care professional and the patient (or patient&#39;s record)." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-EncounterType" />
            </binding>
        </element>
        <element id="Encounter.serviceType">
            <path value="Encounter.serviceType" />
            <binding>
                <strength value="preferred" />
                <description value="Any code from the SNOMED CT UK Refset with fully specified name &#39;Services simple reference set (foundation metadata concept)&#39; with Refset Id 1127531000000102." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-CareSettingType" />
            </binding>
        </element>
        <element id="Encounter.subject">
            <path value="Encounter.subject" />
            <short value="The patient or group present at the encounter." />
            <mustSupport value="true" />
        </element>
        <element id="Encounter.participant">
            <path value="Encounter.participant" />
            <short value="The list of people responsible for providing the service." />
            <mustSupport value="true" />
        </element>
        <element id="Encounter.reasonCode">
            <path value="Encounter.reasonCode" />
            <short value="Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis." />
            <mustSupport value="true" />
        </element>
        <element id="Encounter.reasonReference">
            <path value="Encounter.reasonReference" />
            <short value="Reason the encounter takes place, expressed as a reference to a Condition, Procedure, Observation, or ImmunizationRecommendation." />
            <mustSupport value="true" />
        </element>
        <element id="Encounter.hospitalization.extension:admissionMethod">
            <path value="Encounter.hospitalization.extension" />
            <sliceName value="admissionMethod" />
            <short value="An extension to support the method by which an individual was admitted into hospital." />
            <definition value="This extension has been developed to demonstrate the representation of the method by which a patient was admitted to hospital." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="Encounter.hospitalization.admitSource">
            <path value="Encounter.hospitalization.admitSource" />
            <binding>
                <strength value="preferred" />
                <description value="The source of admission to a Hospital Provider Spell or a Nursing Episode when the Patient is in a Hospital Site or a Care Home." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-SourceOfAdmission" />
            </binding>
        </element>
        <element id="Encounter.hospitalization.dischargeDisposition">
            <path value="Encounter.hospitalization.dischargeDisposition" />
            <binding>
                <strength value="preferred" />
                <description value="The destination of a Patient on completion of a Hospital Provider Spell, or a note that the Patient died or was a still birth." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-DischargeDestination" />
            </binding>
        </element>
        <element id="Encounter.location.physicalType">
            <path value="Encounter.location.physicalType" />
            <binding>
                <strength value="preferred" />
                <description value="A set of codes that define the physical type of location where an encounter takes place." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-EncounterLocationType" />
            </binding>
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Encounter",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Encounter",
    "version": "2.5.0",
    "name": "UKCoreEncounter",
    "title": "UK Core Encounter",
    "status": "active",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Encounter](https://hl7.org/fhir/R4/Encounter.html).",
    "purpose": "This profile allows exchange of information about an interaction between an individual and healthcare providers for the purpose of providing healthcare services or assessing the health status of an individual.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Encounter",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Encounter",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Encounter.extension:dischargeMethod",
                "path": "Encounter.extension",
                "sliceName": "dischargeMethod",
                "short": "An extension to support the method of discharge from a hospital.",
                "definition": "This extension has been developed to demonstrate the representation of the method by which a patient was discharged from hospital.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DischargeMethod"
                        ]
                    }
                ]
            },
            {
                "id": "Encounter.extension:emergencyCareDischargeStatus",
                "path": "Encounter.extension",
                "sliceName": "emergencyCareDischargeStatus",
                "short": "An extension to support the status of an individual on discharge from an Emergency Care Department.",
                "definition": "This extension has been developed to demonstrate the representation of the status of a patient on discharge from an Emergency Care Department.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-EmergencyCareDischargeStatus"
                        ]
                    }
                ]
            },
            {
                "id": "Encounter.extension:legalStatus",
                "path": "Encounter.extension",
                "sliceName": "legalStatus",
                "short": "Information relating to a patient's legal status on admission or discharge.",
                "definition": "Information relating to a patient's legal status on admission or discharge.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-LegalStatus"
                        ]
                    }
                ]
            },
            {
                "id": "Encounter.extension:OutcomeOfAttendance",
                "path": "Encounter.extension",
                "sliceName": "OutcomeOfAttendance",
                "short": "An extension to support the outcome of an Outpatient attendance.",
                "definition": "This extension has been developed to demonstrate the representation of the outcome of an Outpatient attendance.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OutcomeOfAttendance"
                        ]
                    }
                ]
            },
            {
                "id": "Encounter.identifier",
                "path": "Encounter.identifier",
                "short": "Identifier(s) by which this encounter is known.",
                "mustSupport": true
            },
            {
                "id": "Encounter.status",
                "path": "Encounter.status",
                "short": "The status of this encounter: planned | arrived | triaged | in-progress | onleave | finished | cancelled | entered-in-error | unknown",
                "mustSupport": true
            },
            {
                "id": "Encounter.class",
                "path": "Encounter.class",
                "short": "Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.",
                "mustSupport": true
            },
            {
                "id": "Encounter.type",
                "path": "Encounter.type",
                "binding": {
                    "strength": "preferred",
                    "description": "A code from the SNOMED Clinical Terminology UK coding system that describes an encounter between a care professional and the patient (or patient's record).",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-EncounterType"
                }
            },
            {
                "id": "Encounter.serviceType",
                "path": "Encounter.serviceType",
                "binding": {
                    "strength": "preferred",
                    "description": "Any code from the SNOMED CT UK Refset with fully specified name 'Services simple reference set (foundation metadata concept)' with Refset Id 1127531000000102.",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-CareSettingType"
                }
            },
            {
                "id": "Encounter.subject",
                "path": "Encounter.subject",
                "short": "The patient or group present at the encounter.",
                "mustSupport": true
            },
            {
                "id": "Encounter.participant",
                "path": "Encounter.participant",
                "short": "The list of people responsible for providing the service.",
                "mustSupport": true
            },
            {
                "id": "Encounter.reasonCode",
                "path": "Encounter.reasonCode",
                "short": "Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.",
                "mustSupport": true
            },
            {
                "id": "Encounter.reasonReference",
                "path": "Encounter.reasonReference",
                "short": "Reason the encounter takes place, expressed as a reference to a Condition, Procedure, Observation, or ImmunizationRecommendation.",
                "mustSupport": true
            },
            {
                "id": "Encounter.hospitalization.extension:admissionMethod",
                "path": "Encounter.hospitalization.extension",
                "sliceName": "admissionMethod",
                "short": "An extension to support the method by which an individual was admitted into hospital.",
                "definition": "This extension has been developed to demonstrate the representation of the method by which a patient was admitted to hospital.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdmissionMethod"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "Encounter.hospitalization.admitSource",
                "path": "Encounter.hospitalization.admitSource",
                "binding": {
                    "strength": "preferred",
                    "description": "The source of admission to a Hospital Provider Spell or a Nursing Episode when the Patient is in a Hospital Site or a Care Home.",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-SourceOfAdmission"
                }
            },
            {
                "id": "Encounter.hospitalization.dischargeDisposition",
                "path": "Encounter.hospitalization.dischargeDisposition",
                "binding": {
                    "strength": "preferred",
                    "description": "The destination of a Patient on completion of a Hospital Provider Spell, or a note that the Patient died or was a still birth.",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-DischargeDestination"
                }
            },
            {
                "id": "Encounter.location.physicalType",
                "path": "Encounter.location.physicalType",
                "binding": {
                    "strength": "preferred",
                    "description": "A set of codes that define the physical type of location where an encounter takes place.",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-EncounterLocationType"
                }
            }
        ]
    }
}

Propose a change to UKCore-Encounter

StructureDefinition UKCore-Flag

UKCoreFlag (Flag)	I		Flag	There are no (further) constraints on this element Element id Flag Short description Key information to flag to healthcare providers Alternate names Barriers to Care, Alert, Warning Definition Prospective warnings of potential issues when providing care to the patient. Data type Flag Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act rim: Observation[classCode=ISSUE, moodCode=EVN]
id	Σ	0..1	string	There are no (further) constraints on this element Element id Flag.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Flag.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Flag.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Flag.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Flag.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can 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. Comments 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 information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Flag.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These 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. Comments 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Flag.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Flag.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Flag.identifier Short description Business identifier Definition Business identifiers assigned to this flag by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Requirements Allows identification of the flag as it is known by various participating systems and in a way that remains consistent across servers. Comments This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.identifier rim: .id
status	S Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id Flag.status Short description active \| inactive \| entered-in-error Definition Supports basic workflow. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or was entered in error. FlagStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.status rim: .status
category	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Flag.category Short description Clinical, administrative, etc. Definition Allows a flag to be divided into different categories like clinical, administrative etc. Intended to be used as a means of filtering which flags are displayed to particular user or in a given context. Comments The value set will often need to be adjusted based on local business rules and usage context. Data type CodeableConcept Binding A general category for flags for filtering/display purposes. FlagCategory (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class rim: .code
code	S Σ	1..1	CodeableConcept	There are no (further) constraints on this element Element id Flag.code Short description Coded or textual message to display to user Definition The coded value or textual component of the flag to display to the user. Comments If non-coded, use CodeableConcept.text. This element should always be included in the narrative. Data type CodeableConcept Binding Detail codes identifying specific flagged issues. FlagCode (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.what[x] rim: .value
subject	S Σ	1..1	Reference(Patient \| Location \| Group \| Organization \| Practitioner \| PlanDefinition \| Medication \| Procedure)	There are no (further) constraints on this element Element id Flag.subject Short description Who/What is flag about? Definition The patient, location, group, organization, or practitioner etc. this is about record this flag is associated with. Data type Reference(Patient \| Location \| Group \| Organization \| Practitioner \| PlanDefinition \| Medication \| Procedure) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.subject[x] rim: .participation[typeCode=SBJ].role[classCode=PAT \| LOCE \| ASSIGNED] w5: FiveWs.subject
period	Σ	0..1	Period	There are no (further) constraints on this element Element id Flag.period Short description Time period when flag is active Definition The period of time from the activation of the flag to inactivation of the flag. If the flag is active, the end of the period should be unspecified. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.context
encounter	Σ	0..1	Reference(Encounter)	There are no (further) constraints on this element Element id Flag.encounter Short description Alert relevant during encounter Definition This alert is only relevant during the encounter. Comments If both Flag.encounter and Flag.period are valued, then Flag.period.start shall not be before Encounter.period.start and Flag.period.end shall not be after Encounter.period.end. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.context
author	Σ	0..1	Reference(Device \| Organization \| Patient \| Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id Flag.author Short description Flag creator Definition The person, organization or device that created the flag. Data type Reference(Device \| Organization \| Patient \| Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.author rim: .participation[typeCode=AUT].role

Flag
Definition	Prospective warnings of potential issues when providing care to the patient.
Cardinality	0...*
Alias	Barriers to Care, Alert, Warning
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings	rim: Entity. Role, or Act rim: Observation[classCode=ISSUE, moodCode=EVN]
Flag.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Flag.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Flag.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Flag.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Flag.text
Definition	A human-readable narrative that contains a summary of the resource and can 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: Act.text?
Flag.contained
Definition	These 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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: N/A
Flag.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Flag.modifierExtension
Definition	May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Flag.identifier
Definition	Business identifiers assigned to this flag by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Cardinality	0...*
Type	Identifier
Summary	True
Requirements	Allows identification of the flag as it is known by various participating systems and in a way that remains consistent across servers.
Comments	This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.identifier rim: .id
Flag.status
Definition	Supports basic workflow.
Cardinality	1...1
Type	code
Binding	Indicates whether this flag is active and needs to be displayed to a user, or whether it is no longer needed or was entered in error. FlagStatus (required)
Must Support	True
Modifier	True
Summary	True
Comments	This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.status rim: .status
Flag.category
Definition	Allows a flag to be divided into different categories like clinical, administrative etc. Intended to be used as a means of filtering which flags are displayed to particular user or in a given context.
Cardinality	0...*
Type	CodeableConcept
Binding	A general category for flags for filtering/display purposes. FlagCategory (example)
Summary	True
Comments	The value set will often need to be adjusted based on local business rules and usage context.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.class rim: .code
Flag.code
Definition	The coded value or textual component of the flag to display to the user.
Cardinality	1...1
Type	CodeableConcept
Binding	Detail codes identifying specific flagged issues. FlagCode (example)
Must Support	True
Summary	True
Comments	If non-coded, use CodeableConcept.text. This element should always be included in the narrative.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.what[x] rim: .value
Flag.subject
Definition	The patient, location, group, organization, or practitioner etc. this is about record this flag is associated with.
Cardinality	1...1
Type	Reference(Patient \| Location \| Group \| Organization \| Practitioner \| PlanDefinition \| Medication \| Procedure)
Must Support	True
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.subject[x] rim: .participation[typeCode=SBJ].role[classCode=PAT \| LOCE \| ASSIGNED] w5: FiveWs.subject
Flag.period
Definition	The period of time from the activation of the flag to inactivation of the flag. If the flag is active, the end of the period should be unspecified.
Cardinality	0...1
Type	Period
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.context
Flag.encounter
Definition	This alert is only relevant during the encounter.
Cardinality	0...1
Type	Reference(Encounter)
Summary	True
Comments	If both Flag.encounter and Flag.period are valued, then Flag.period.start shall not be before Encounter.period.start and Flag.period.end shall not be after Encounter.period.end.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.context
Flag.author
Definition	The person, organization or device that created the flag.
Cardinality	0...1
Type	Reference(Device \| Organization \| Patient \| Practitioner \| PractitionerRole)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.author rim: .participation[typeCode=AUT].role

Flag		..
Flag.status		..
Flag.code		..
Flag.subject		..

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Flag" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Flag" />
    <version value="1.2.0" />
    <name value="UKCoreFlag" />
    <title value="UK Core Flag" />
    <status value="draft" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Flag](https://hl7.org/fhir/R4/Flag.html)." />
    <purpose value="A flag is a warning or notification of some sort presented to the user - who may be a clinician or some other person involve in patient care. It usually represents something of sufficient significance to warrant a special display of some sort - rather than just a note in the resource. A flag has a subject representing the resource that will trigger its display.   \n\nThis subject can be of different types, as described in the examples below:   \n\n- A note that a patient has an overdue account, which the provider may wish to discuss with them - in case of hardship, for example (`subject = Patient`)   \n- An outbreak of Ebola in a particular region (`subject = Location`) so that all patients from that region have a higher risk of having that condition   \n- A particular provider is unavailable for referrals over a given period (`subject = Practitioner`)   \n- A patient who is enrolled in a clinical trial (`subject = Group`)   \n- Special guidance or caveats to be aware of when following a protocol (`subject = PlanDefinition`)   \n- Warnings about using a drug in a formulary requires special approval (`subject = Medication`)" />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Flag" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Flag" />
    <derivation value="constraint" />
    <differential>
        <element id="Flag.status">
            <path value="Flag.status" />
            <mustSupport value="true" />
        </element>
        <element id="Flag.code">
            <path value="Flag.code" />
            <mustSupport value="true" />
        </element>
        <element id="Flag.subject">
            <path value="Flag.subject" />
            <mustSupport value="true" />
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Flag",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Flag",
    "version": "1.2.0",
    "name": "UKCoreFlag",
    "title": "UK Core Flag",
    "status": "draft",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Flag](https://hl7.org/fhir/R4/Flag.html).",
    "purpose": "A flag is a warning or notification of some sort presented to the user - who may be a clinician or some other person involve in patient care. It usually represents something of sufficient significance to warrant a special display of some sort - rather than just a note in the resource. A flag has a subject representing the resource that will trigger its display.   \n\nThis subject can be of different types, as described in the examples below:   \n\n- A note that a patient has an overdue account, which the provider may wish to discuss with them - in case of hardship, for example (`subject = Patient`)   \n- An outbreak of Ebola in a particular region (`subject = Location`) so that all patients from that region have a higher risk of having that condition   \n- A particular provider is unavailable for referrals over a given period (`subject = Practitioner`)   \n- A patient who is enrolled in a clinical trial (`subject = Group`)   \n- Special guidance or caveats to be aware of when following a protocol (`subject = PlanDefinition`)   \n- Warnings about using a drug in a formulary requires special approval (`subject = Medication`)",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Flag",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Flag",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Flag.status",
                "path": "Flag.status",
                "mustSupport": true
            },
            {
                "id": "Flag.code",
                "path": "Flag.code",
                "mustSupport": true
            },
            {
                "id": "Flag.subject",
                "path": "Flag.subject",
                "mustSupport": true
            }
        ]
    }
}

Propose a change to UKCore-Flag

StructureDefinition Group

Group	I		DomainResource	Element id Group Short description Group of multiple entities Definition Represents a defined collection of entities that may be discussed or acted upon collectively but which are not expected to act collectively, and are not formally or legally recognized; i.e. a collection of entities that isn't an Organization. Comments If both Group.characteristic and Group.member are present, then the members are the individuals who were found who met the characteristic. It's possible that there might be other candidate members who meet the characteristic and aren't (yet) in the list. All members SHALL have the listed characteristics. Data type DomainResource Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() grp-1: Can only have members if group is "actual" `member.empty() or (actual = true)` Mappings rim: Entity. Role, or Act rim: Entity[determinerCode="GRP" or determinerCode="GRP_KIND"]
id	Σ	0..1	string	There are no (further) constraints on this element Element id Group.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Group.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Group.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Group.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Group.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can 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. Comments 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 information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Group.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These 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. Comments 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Group.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Group.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	Σ	0..*	Identifier	Element id Group.identifier Short description Unique id Definition A unique business identifier for this group. Requirements Allows the group to be referenced from external specifications. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier w5: FiveWs.identifier rim: unique(./id[displayable="true" and scope="OBJ"])
active	Σ	0..1	boolean	Element id Group.active Short description Whether this group's record is in active use Definition Indicates whether the record for the group is available for use or is merely being retained for historical purposes. Requirements Need to be able to mark a group record as not to be used because it was created in error or is otherwise no longer available (e.g. a herd that no longer exists). Meaning when missing This resource is generally assumed to be active if no value is provided for the active element Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.status rim: ./statusCode
type	Σ	1..1	codeBinding	Element id Group.type Short description person \| animal \| practitioner \| device \| medication \| substance Definition Identifies the broad classification of the kind of resources the group includes. Requirements Identifies what type of resources the group is made up of. Comments Group members SHALL be of the appropriate resource type (Patient for person or animal; or Practitioner, Device, Medication or Substance for the other types.). Data type code Binding Types of resources that are part of group. GroupType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class rim: person: ./classCode="PSN" animal: ./classCode="ANM" device: ./classCode="DEV" medication: ./classCode="MMAT" and ./playedRole[isNormalRole() and classCode="THER"] food: ./classCode="FOOD"
actual	Σ I	1..1	boolean	Element id Group.actual Short description Descriptive or actual Definition If true, indicates that the resource refers to a specific group of real individuals. If false, the group defines a set of intended individuals. Requirements There are use-cases for groups that define specific collections of individuals, and other groups that define "types" of intended individuals. The requirements for both kinds of groups are similar, so we use a single resource, distinguished by this flag. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class rim: true: ./determinerCode="GRP" false: ./determinerCode="GRP_KIND"
code	Σ	0..1	CodeableConcept	Element id Group.code Short description Kind of Group members Definition Provides a specific type of resource the group includes; e.g. "cow", "syringe", etc. Comments This would generally be omitted for Person resources. Data type CodeableConcept Binding Kind of particular resource; e.g. cow, syringe, lake, etc. (unbound) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.what[x] rim: ./code
name	Σ	0..1	string	Element id Group.name Short description Label for Group Definition A label assigned to the group for human identification and communication. Requirements Used to identify the group in human communication. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: ./name[type="ST"]
quantity	Σ	0..1	unsignedInt	Element id Group.quantity Short description Number of members Definition A count of the number of resource instances that are part of the group. Requirements Group size is a common defining characteristic. Comments Note that the quantity may be less than the number of members if some of the members are not active. Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: ./quantity
managingEntity	Σ I	0..1	Reference(Organization \| RelatedPerson \| Practitioner \| PractitionerRole)	Element id Group.managingEntity Short description Entity that is the custodian of the Group's definition Definition Entity responsible for defining and maintaining Group characteristics and/or registered members. Comments This does not strictly align with ownership of a herd or flock, but may suffice to represent that relationship in simple cases. More complex cases will require an extension. Data type Reference(Organization \| RelatedPerson \| Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
characteristic		0..*	BackboneElement	Element id Group.characteristic Short description Include / Exclude group members by Trait Definition Identifies traits whose presence r absence is shared by members of the group. Requirements Needs to be a generic mechanism for identifying what individuals can be part of a group. Comments All the identified characteristics must be true for an entity to a member of the group. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: ./playedRole[isNormalRole()]/participation[isNormalParticipation() and typeCode="SBJ"]/act[isNormalAct and classCode="OBS" and moodCode="EVN"]
id		0..1	string	There are no (further) constraints on this element Element id Group.characteristic.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Group.characteristic.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Group.characteristic.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
code		1..1	CodeableConcept	Element id Group.characteristic.code Short description Kind of characteristic Definition A code that identifies the kind of trait being asserted. Requirements Need a formal way of identifying the characteristic being described. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding List of characteristics used to describe group members; e.g. gender, age, owner, location, etc. (unbound) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD rim: ./code
value[x]		1..1		Element id Group.characteristic.value[x] Short description Value held by characteristic Definition The value of the trait that holds (or does not hold - see 'exclude') for members of the group. Requirements The value of the characteristic is what determines group membership. Comments For Range, it means members of the group have a value that falls somewhere within the specified range. Binding Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc. (unbound) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: ./value
valueCodeableConcept			CodeableConcept	Data type CodeableConcept
valueBoolean			boolean	Data type boolean
valueQuantity			Quantity	Data type Quantity
valueRange			Range	Data type Range
valueReference			Reference()	Data type Reference()
exclude		1..1	boolean	Element id Group.characteristic.exclude Short description Group includes or excludes Definition If true, indicates the characteristic is one that is NOT held by members of the group. Requirements Sometimes group membership is determined by characteristics not possessed. Comments This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: ./valueNegationInd
period	I	0..1	Period	Element id Group.characteristic.period Short description Period over which characteristic is tested Definition The period over which the characteristic is tested; e.g. the patient had an operation during the month of June. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
member	I	0..*	BackboneElement	Element id Group.member Short description Who or what is in group Definition Identifies the resource instances that are members of the group. Requirements Often the only thing of interest about a group is "who's in it". Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: ./scopedRole[isNormalRole() and classCode="MBR"]/player
id		0..1	string	There are no (further) constraints on this element Element id Group.member.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Group.member.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Group.member.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
entity	I	1..1	Reference(Patient \| Practitioner \| PractitionerRole \| Device \| Medication \| Substance \| Group)	Element id Group.member.entity Short description Reference to the group member Definition A reference to the entity that is a member of the group. Must be consistent with Group.type. If the entity is another group, then the type must be the same. Comments 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. Data type Reference(Patient \| Practitioner \| PractitionerRole \| Device \| Medication \| Substance \| Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
period	I	0..1	Period	Element id Group.member.period Short description Period member belonged to the group Definition The period that the member was in the group, if known. Requirements Need to track who was in a group at a particular time. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Meaning when missing The member is in the group at this time Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
inactive		0..1	boolean	Element id Group.member.inactive Short description If member is no longer in group Definition A flag to indicate that the member is no longer in the group, but previously may have been a member. Requirements Sometimes you don't know when someone stopped being in a group, but not when. Meaning when missing Members are considered active unless explicitly specified otherwise Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`

StructureDefinition UKCore-Observation

UKCoreObservation (Observation)	I		Observation	There are no (further) constraints on this element Element id Observation Short description Measurements and simple assertions Alternate names Vital Signs, Measurement, Results, Tests Definition Measurements and simple assertions made about a patient, device or other subject. Comments Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc. Data type Observation Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present `dataAbsentReason.empty() or value.empty()` obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()` Mappings rim: Entity. Role, or Act workflow: Event sct-concept: < 363787002 \|Observable entity\| v2: OBX rim: Observation[classCode=OBS, moodCode=EVN]
id	Σ	0..1	string	There are no (further) constraints on this element Element id Observation.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Observation.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Observation.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Observation.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Observation.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can 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. Comments 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 information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Observation.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These 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. Comments 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	Element id Observation.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
triggeredByR5	I	0..*	Extension(Complex)	Element id Observation.extension:triggeredByR5 Short description Triggering observation(s). This is a R5 backport. Alternate names extensions, user content Definition Identifies the observation(s) that triggered the performance of this observation. Comments 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. Data type Extension(Complex) Extension URL http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	2..*	Extension	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
observation	I	1..1	Extension	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:observation Short description Triggering observation Alternate names extensions, user content Definition Reference to the triggering observation. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:observation.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:observation.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:observation.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value observation Mappings rim: N/A
value[x]		1..1		Element id Observation.extension:triggeredByR5.extension:observation.value[x] Short description Triggering observation. Definition A reference to the triggering observation. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueReference			Reference(Observation)	There are no (further) constraints on this element Data type Reference(Observation)
type	I	1..1	ExtensionBinding	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:type Short description reflex \| repeat \| re-run Alternate names extensions, user content Definition The type of trigger. Reflex \| Repeat \| Re-run. Comments 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. Data type Extension Binding http://hl7.org/fhir/ValueSet/observation-triggeredbytype (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:type.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:type.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:type.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value type Mappings rim: N/A
value[x]		1..1		Element id Observation.extension:triggeredByR5.extension:type.value[x] Short description The type of trigger. Reflex \| Repeat \| Re-run Definition The type of trigger. Reflex \| Repeat \| Re-run Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueCode			code	There are no (further) constraints on this element Data type code
reason	I	0..1	Extension	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:reason Short description Reason that the observation was triggered Alternate names extensions, user content Definition Provides the reason why this observation was performed as a result of the observation(s) referenced. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:reason.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:reason.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.extension:reason.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value reason Mappings rim: N/A
value[x]		1..1		Element id Observation.extension:triggeredByR5.extension:reason.value[x] Short description Reason that the observation was triggered. Definition Provides the reason why this observation was performed as a result of the observation referenced. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueString			string	There are no (further) constraints on this element Data type string
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy Mappings rim: N/A
value[x]		0..0		There are no (further) constraints on this element Element id Observation.extension:triggeredByR5.value[x] Short description Value of extension Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
bodyStructureR5	I	0..1	Extension(Reference(BodyStructure))	Element id Observation.extension:bodyStructureR5 Short description Observed body structure. This is a R5 backport. Alternate names extensions, user content Definition Indicates the body structure on the subject's body where the observation was made (i.e. the target site). Comments 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. Data type Extension(Reference(BodyStructure)) Extension URL http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Observation.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Observation.identifier Short description Business Identifier for observation Definition A unique identifier assigned to this observation. Requirements Allows observations to be distinguished and referenced. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier v2: OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4. rim: id
basedOn	Σ	0..*	Reference(CarePlan \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| ServiceRequest)	There are no (further) constraints on this element Element id Observation.basedOn Short description Fulfills plan, proposal or order Alternate names Fulfills Definition A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed. Requirements Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon. Data type Reference(CarePlan \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.basedOn v2: ORC rim: .inboundRelationship[typeCode=COMP].source[moodCode=EVN]
partOf	Σ	0..*	Reference(MedicationAdministration \| MedicationDispense \| MedicationStatement \| Procedure \| Immunization \| ImagingStudy)	There are no (further) constraints on this element Element id Observation.partOf Short description Part of referenced event Alternate names Container Definition A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure. Comments To link an Observation to an Encounter use `encounter`. See the Notes below for guidance on referencing another Observation. Data type Reference(MedicationAdministration \| MedicationDispense \| MedicationStatement \| Procedure \| Immunization \| ImagingStudy) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.partOf v2: Varies by domain rim: .outboundRelationship[typeCode=FLFS].target
status	S Σ ?!	1..1	codeBinding	Element id Observation.status Short description The status of the result value. Definition The status of the result value. Requirements Need to track the status of individual results. Some results are finalized before the whole report is finalized. Comments This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding Codes providing the status of an observation. ObservationStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.status w5: FiveWs.status sct-concept: < 445584004 \|Report by finality status\| v2: OBX-11 rim: status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"
category	S	0..*	CodeableConceptBinding	Element id Observation.category Short description A code that classifies the general type of observation being made. Definition A code that classifies the general type of observation being made. Requirements Used for filtering what observations are retrieved and displayed. Comments In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set. Data type CodeableConcept Binding Codes for high level observation categories. ObservationCategoryCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
code	S Σ	1..1	CodeableConceptBinding	Element id Observation.code Short description The type of observation (code / type). Alternate names Name Definition Describes what was observed. Sometimes this is called the observation "name". Requirements Knowing what kind of observation is being made is essential to understanding the observation. Comments All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation. Data type CodeableConcept Binding A code from the SNOMED Clinical Terminology UK coding system describing a type of observation UKCoreObservationType (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.what[x] sct-concept: < 363787002 \|Observable entity\| OR < 386053000 \|Evaluation procedure\| v2: OBX-3 rim: code sct-attr: 116680003 \|Is a\|
subject	S Σ	0..1	Reference(Patient \| Group \| Device \| Location)	Element id Observation.subject Short description Who and / or what the observation is about. Definition The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation. Requirements Observations have no value if you don't know who or what they're about. Comments One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated. Data type Reference(Patient \| Group \| Device \| Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 rim: participation[typeCode=RTGT] w5: FiveWs.subject
focus	Σ	0..*	Reference(Resource)	There are no (further) constraints on this element Element id Observation.focus Short description What the observation is about, when it is not about the subject of record Definition The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus. Comments Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension focusCode. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.subject[x] v2: OBX-3 rim: participation[typeCode=SBJ] w5: FiveWs.subject
encounter	Σ	0..1	Reference(Encounter)	There are no (further) constraints on this element Element id Observation.encounter Short description Healthcare event during which this observation is made Alternate names Context Definition The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made. Requirements For some observations it may be important to know the link between an observation and a particular encounter. Comments This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests). Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.context w5: FiveWs.context v2: PV1 rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
effective[x]	S Σ	0..1		Element id Observation.effective[x] Short description A clinically relevant time / time-period for observation. Alternate names Occurrence Definition The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself. Requirements Knowing when an observation was deemed true is important to its relevance as well as determining trends. Comments At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made) rim: effectiveTime
effectiveDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
effectivePeriod			Period	There are no (further) constraints on this element Data type Period
effectiveTiming			Timing	There are no (further) constraints on this element Data type Timing
effectiveInstant			instant	There are no (further) constraints on this element Data type instant
issued	Σ	0..1	instant	There are no (further) constraints on this element Element id Observation.issued Short description Date/Time this version was made available Definition The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified. Comments For Observations that don’t require review and verification, it may be the same as the `lastUpdated` time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again. Data type instant Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.recorded v2: OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made) rim: participation[typeCode=AUT].time
performer	S Σ	0..*	Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam \| Patient \| RelatedPerson)	Element id Observation.performer Short description Who is responsible for the observation. Definition Who was responsible for asserting the observed value as "true". Requirements May give a degree of confidence in the observation and also indicates where follow-up questions should be directed. Data type Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam \| Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor w5: FiveWs.actor v2: OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization) OBX-23, PRT-8:PRT-4='PO' rim: participation[typeCode=PRF]
value[x]	S Σ I	0..1		Element id Observation.value[x] Short description The actual observed result. Definition The information determined as a result of making the observation, if the information has a simple value. Requirements An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations. Comments An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: < 441742003 \|Evaluation finding\| v2: OBX.2, OBX.5, OBX.6 rim: value sct-attr: 363714003 \|Interprets\|
valueQuantity			Quantity	There are no (further) constraints on this element Data type Quantity
valueCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
valueString			string	There are no (further) constraints on this element Data type string
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
valueInteger			integer	There are no (further) constraints on this element Data type integer
valueRange			Range	There are no (further) constraints on this element Data type Range
valueRatio			Ratio	There are no (further) constraints on this element Data type Ratio
valueSampledData			SampledData	There are no (further) constraints on this element Data type SampledData
valueTime			time	There are no (further) constraints on this element Data type time
valueDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
valuePeriod			Period	There are no (further) constraints on this element Data type Period
dataAbsentReason	I	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.dataAbsentReason Short description Why the result is missing Definition Provides a reason why the expected value in the element Observation.value[x] is missing. Requirements For many results it is necessary to handle exceptional values in measurements. Comments Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values. Data type CodeableConcept Binding Codes specifying why the result (`Observation.value[x]`) is missing. DataAbsentReason (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: N/A rim: value.nullFlavor
interpretation		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.interpretation Short description High, low, normal, etc. Alternate names Abnormal Flag Definition A categorical assessment of an observation value. For example, high, low, normal. Requirements For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. Comments Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Data type CodeableConcept Binding Codes identifying interpretations of observations. ObservationInterpretationCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: < 260245000 \|Findings values\| v2: OBX-8 rim: interpretationCode sct-attr: 363713009 \|Has interpretation\|
note		0..*	Annotation	There are no (further) constraints on this element Element id Observation.note Short description Comments about the observation Definition Comments about the observation or the results. Requirements Need to be able to provide free text additional information. Comments May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation. Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX) rim: subjectOf.observationEvent[code="annotation"].value
bodySite		0..1	CodeableConceptBinding	Element id Observation.bodySite Short description Observed body part Definition Indicates the site on the subject's body where the observation was made (i.e. the target site). Comments Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite. Data type CodeableConcept Binding Codes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: < 123037004 \|Body structure\| v2: OBX-20 rim: targetSiteCode sct-attr: 718497002 \|Inherent location\|
method		0..1	CodeableConceptBinding	Element id Observation.method Short description How it was done Definition Indicates the mechanism used to perform the observation. Requirements In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results. Comments Only used if not implicit in code for Observation.code. Data type CodeableConcept Binding Methods for simple observations. ObservationMethods (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-17 rim: methodCode
specimen		0..1	Reference(Specimen)	There are no (further) constraints on this element Element id Observation.specimen Short description Specimen used for this observation Definition The specimen that was used when this observation was made. Comments Should only be used if not implicit in code found in `Observation.code`. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report). Data type Reference(Specimen) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: < 123038009 \|Specimen\| v2: SPM segment rim: participation[typeCode=SPC].specimen sct-attr: 704319004 \|Inherent in\|
device		0..1	Reference(Device \| DeviceMetric)	There are no (further) constraints on this element Element id Observation.device Short description (Measurement) Device Definition The device used to generate the observation data. Comments Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant. Data type Reference(Device \| DeviceMetric) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: < 49062001 \|Device\| v2: OBX-17 / PRT -10 rim: participation[typeCode=DEV] sct-attr: 424226004 \|Using device\|
referenceRange	I	0..*	BackboneElement	There are no (further) constraints on this element Element id Observation.referenceRange Short description Provides guide for interpretation Definition Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two `referenceRange` elements would be used. Requirements Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts. Comments Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` obs-3: Must have at least a low or a high or text `low.exists() or high.exists() or text.exists()` Mappings v2: OBX.7 rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
id		0..1	string	There are no (further) constraints on this element Element id Observation.referenceRange.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Observation.referenceRange.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Observation.referenceRange.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
low	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element id Observation.referenceRange.low Short description Low Range, if relevant Definition The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3). Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-7 rim: value:IVL_PQ.low
high	I	0..1	SimpleQuantity	There are no (further) constraints on this element Element id Observation.referenceRange.high Short description High Range, if relevant Definition The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3). Data type SimpleQuantity Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-7 rim: value:IVL_PQ.high
type		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.referenceRange.type Short description Reference range qualifier Definition Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range. Requirements Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation. Comments This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed. Data type CodeableConcept Binding Code for the meaning of a reference range. ObservationReferenceRangeMeaningCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: < 260245000 \|Findings values\| OR < 365860008 \|General clinical state finding\| OR < 250171008 \|Clinical history or observation findings\| OR < 415229000 \|Racial group\| OR < 365400002 \|Finding of puberty stage\| OR < 443938003 \|Procedure carried out on subject\| v2: OBX-10 rim: interpretationCode
appliesTo		0..*	CodeableConcept	There are no (further) constraints on this element Element id Observation.referenceRange.appliesTo Short description Reference range population Definition Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple `appliesTo` are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used. Requirements Need to be able to identify the target population for proper interpretation. Comments This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed. Data type CodeableConcept Binding Codes identifying the population the reference range applies to. ObservationReferenceRangeAppliesToCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: < 260245000 \|Findings values\| OR < 365860008 \|General clinical state finding\| OR < 250171008 \|Clinical history or observation findings\| OR < 415229000 \|Racial group\| OR < 365400002 \|Finding of puberty stage\| OR < 443938003 \|Procedure carried out on subject\| v2: OBX-10 rim: interpretationCode
age		0..1	Range	There are no (further) constraints on this element Element id Observation.referenceRange.age Short description Applicable age range, if relevant Definition The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so. Requirements Some analytes vary greatly over age. Data type Range Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value
text		0..1	string	There are no (further) constraints on this element Element id Observation.referenceRange.text Short description Text based reference range in an observation Definition Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals". Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-7 rim: value:ST
hasMember	Σ	0..*	Reference(Observation \| QuestionnaireResponse \| MolecularSequence)	There are no (further) constraints on this element Element id Observation.hasMember Short description Related resource that belongs to the Observation group Definition This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group. Comments When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation. Data type Reference(Observation \| QuestionnaireResponse \| MolecularSequence) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Relationships established by OBX-4 usage rim: outBoundRelationship
derivedFrom	Σ	0..*	Reference(DocumentReference \| ImagingStudy \| Media \| QuestionnaireResponse \| Observation \| MolecularSequence)	There are no (further) constraints on this element Element id Observation.derivedFrom Short description Related measurements the observation is made from Definition The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image. Comments All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below. Data type Reference(DocumentReference \| ImagingStudy \| Media \| QuestionnaireResponse \| Observation \| MolecularSequence) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: Relationships established by OBX-4 usage rim: .targetObservation
component	S Σ	0..*	BackboneElement	Element id Observation.component Short description Component / sub results. Definition Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations. Requirements Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation. Comments For a discussion on the ways Observations can be assembled in groups together see Notes below. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: containment by OBX-4? rim: outBoundRelationship[typeCode=COMP]
id		0..1	string	There are no (further) constraints on this element Element id Observation.component.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Observation.component.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Observation.component.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
code	Σ	1..1	CodeableConceptBinding	Element id Observation.component.code Short description Type of component observation (code / type) Definition Describes what was observed. Sometimes this is called the observation "code". Requirements Knowing what kind of observation is being made is essential to understanding the observation. Comments All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation. Data type CodeableConcept Binding A code from the SNOMED Clinical Terminology UK coding system describing a type of observation UKCoreObservationType (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.what[x] sct-concept: < 363787002 \|Observable entity\| OR < 386053000 \|Evaluation procedure\| v2: OBX-3 rim: code
value[x]	Σ	0..1		There are no (further) constraints on this element Element id Observation.component.value[x] Short description Actual component result Definition The information determined as a result of making the observation, if the information has a simple value. Requirements An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations. Comments Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: 363714003 \|Interprets\| < 441742003 \|Evaluation finding\| v2: OBX.2, OBX.5, OBX.6 rim: value sct-attr: 363714003 \|Interprets\|
valueQuantity			Quantity	There are no (further) constraints on this element Data type Quantity
valueCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
valueString			string	There are no (further) constraints on this element Data type string
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
valueInteger			integer	There are no (further) constraints on this element Data type integer
valueRange			Range	There are no (further) constraints on this element Data type Range
valueRatio			Ratio	There are no (further) constraints on this element Data type Ratio
valueSampledData			SampledData	There are no (further) constraints on this element Data type SampledData
valueTime			time	There are no (further) constraints on this element Data type time
valueDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
valuePeriod			Period	There are no (further) constraints on this element Data type Period
dataAbsentReason	I	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.component.dataAbsentReason Short description Why the component result is missing Definition Provides a reason why the expected value in the element Observation.component.value[x] is missing. Requirements For many results it is necessary to handle exceptional values in measurements. Comments "Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values. Data type CodeableConcept Binding Codes specifying why the result (`Observation.value[x]`) is missing. DataAbsentReason (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: N/A rim: value.nullFlavor
interpretation		0..*	CodeableConceptBinding	There are no (further) constraints on this element Element id Observation.component.interpretation Short description High, low, normal, etc. Alternate names Abnormal Flag Definition A categorical assessment of an observation value. For example, high, low, normal. Requirements For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result. Comments Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result. Data type CodeableConcept Binding Codes identifying interpretations of observations. ObservationInterpretationCodes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings sct-concept: < 260245000 \|Findings values\| v2: OBX-8 rim: interpretationCode sct-attr: 363713009 \|Has interpretation\|
referenceRange		0..*	see (referenceRange)	There are no (further) constraints on this element Element id Observation.component.referenceRange Short description Provides guide for interpretation of component result Definition Guidance on how to interpret the value by comparison to a normal or recommended range. Requirements Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts. Comments Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX.7 rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]

Observation
Definition	Measurements and simple assertions made about a patient, device or other subject.
Cardinality	0...*
Alias	Vital Signs, Measurement, Results, Tests
Comments	Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present `dataAbsentReason.empty() or value.empty()` obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present `value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()`
Mappings	rim: Entity. Role, or Act workflow: Event sct-concept: < 363787002 \|Observable entity\| v2: OBX rim: Observation[classCode=OBS, moodCode=EVN]
Observation.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Observation.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Observation.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Observation.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Observation.text
Definition	A human-readable narrative that contains a summary of the resource and can 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: Act.text?
Observation.contained
Definition	These 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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: N/A
Observation.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Observation.extension:triggeredByR5
Definition	Identifies the observation(s) that triggered the performance of this observation.
Cardinality	0...*
Type	Extension(Complex)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Observation.extension:triggeredByR5.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	2...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:observation
Definition	Reference to the triggering observation.
Cardinality	1...1
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:observation.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:observation.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:observation.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	observation
Mappings	rim: N/A
Observation.extension:triggeredByR5.extension:observation.value[x]
Definition	A reference to the triggering observation.
Cardinality	1...1
Type	Reference(Observation)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Observation.extension:triggeredByR5.extension:type
Definition	The type of trigger. Reflex \| Repeat \| Re-run.
Cardinality	1...1
Type	Extension
Binding	http://hl7.org/fhir/ValueSet/observation-triggeredbytype (required)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:type.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:type.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:type.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	type
Mappings	rim: N/A
Observation.extension:triggeredByR5.extension:type.value[x]
Definition	The type of trigger. Reflex \| Repeat \| Re-run
Cardinality	1...1
Type	code
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Observation.extension:triggeredByR5.extension:reason
Definition	Provides the reason why this observation was performed as a result of the observation(s) referenced.
Cardinality	0...1
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:reason.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:reason.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.extension:triggeredByR5.extension:reason.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	reason
Mappings	rim: N/A
Observation.extension:triggeredByR5.extension:reason.value[x]
Definition	Provides the reason why this observation was performed as a result of the observation referenced.
Cardinality	1...1
Type	string
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Observation.extension:triggeredByR5.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy
Mappings	rim: N/A
Observation.extension:triggeredByR5.value[x]
Definition	Value of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality	0...0
Type	base64Binary
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Observation.extension:bodyStructureR5
Definition	Indicates the body structure on the subject's body where the observation was made (i.e. the target site).
Cardinality	0...1
Type	Extension(Reference(BodyStructure))
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Observation.modifierExtension
Definition	May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Observation.identifier
Definition	A unique identifier assigned to this observation.
Cardinality	0...*
Type	Identifier
Summary	True
Requirements	Allows observations to be distinguished and referenced.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.identifier w5: FiveWs.identifier v2: OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4. rim: id
Observation.basedOn
Definition	A plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.
Cardinality	0...*
Type	Reference(CarePlan \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| ServiceRequest)
Summary	True
Alias	Fulfills
Requirements	Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.basedOn v2: ORC rim: .inboundRelationship[typeCode=COMP].source[moodCode=EVN]
Observation.partOf
Definition	A larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.
Cardinality	0...*
Type	Reference(MedicationAdministration \| MedicationDispense \| MedicationStatement \| Procedure \| Immunization \| ImagingStudy)
Summary	True
Alias	Container
Comments	To link an Observation to an Encounter use `encounter`. See the Notes below for guidance on referencing another Observation.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.partOf v2: Varies by domain rim: .outboundRelationship[typeCode=FLFS].target
Observation.status
Definition	The status of the result value.
Cardinality	1...1
Type	code
Binding	Codes providing the status of an observation. ObservationStatus (required)
Must Support	True
Modifier	True
Summary	True
Requirements	Need to track the status of individual results. Some results are finalized before the whole report is finalized.
Comments	This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.status w5: FiveWs.status sct-concept: < 445584004 \|Report by finality status\| v2: OBX-11 rim: status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"
Observation.category
Definition	A code that classifies the general type of observation being made.
Cardinality	0...*
Type	CodeableConcept
Binding	Codes for high level observation categories. ObservationCategoryCodes (preferred)
Must Support	True
Requirements	Used for filtering what observations are retrieved and displayed.
Comments	In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.class rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
Observation.code
Definition	Describes what was observed. Sometimes this is called the observation "name".
Cardinality	1...1
Type	CodeableConcept
Binding	A code from the SNOMED Clinical Terminology UK coding system describing a type of observation UKCoreObservationType (preferred)
Must Support	True
Summary	True
Alias	Name
Requirements	Knowing what kind of observation is being made is essential to understanding the observation.
Comments	All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.code w5: FiveWs.what[x] sct-concept: < 363787002 \|Observable entity\| OR < 386053000 \|Evaluation procedure\| v2: OBX-3 rim: code sct-attr: 116680003 \|Is a\|
Observation.subject
Definition	The patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation.
Cardinality	0...1
Type	Reference(Patient \| Group \| Device \| Location)
Must Support	True
Summary	True
Requirements	Observations have no value if you don't know who or what they're about.
Comments	One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 rim: participation[typeCode=RTGT] w5: FiveWs.subject
Observation.focus
Definition	The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.
Cardinality	0...*
Type	Reference(Resource)
Summary	True
Comments	Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use `specimen` if a reference to a specimen is required. If a code is required instead of a resource use either `bodysite` for bodysites or the standard extension focusCode.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.subject[x] v2: OBX-3 rim: participation[typeCode=SBJ] w5: FiveWs.subject
Observation.encounter
Definition	The healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
Cardinality	0...1
Type	Reference(Encounter)
Summary	True
Alias	Context
Requirements	For some observations it may be important to know the link between an observation and a particular encounter.
Comments	This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.context w5: FiveWs.context v2: PV1 rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Observation.effective[x]
Definition	The time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.
Cardinality	0...1
Type	dateTime
Must Support	True
Summary	True
Alias	Occurrence
Requirements	Knowing when an observation was deemed true is important to its relevance as well as determining trends.
Comments	At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made) rim: effectiveTime
Observation.issued
Definition	The date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.
Cardinality	0...1
Type	instant
Summary	True
Comments	For Observations that don’t require review and verification, it may be the same as the `lastUpdated` time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the `lastUpdated` time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.recorded v2: OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made) rim: participation[typeCode=AUT].time
Observation.performer
Definition	Who was responsible for asserting the observed value as "true".
Cardinality	0...*
Type	Reference(Practitioner \| PractitionerRole \| Organization \| CareTeam \| Patient \| RelatedPerson)
Must Support	True
Summary	True
Requirements	May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.performer.actor w5: FiveWs.actor v2: OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization) OBX-23, PRT-8:PRT-4='PO' rim: participation[typeCode=PRF]
Observation.value[x]
Definition	The information determined as a result of making the observation, if the information has a simple value.
Cardinality	0...1
Type	Quantity
Must Support	True
Summary	True
Requirements	An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
Comments	An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: < 441742003 \|Evaluation finding\| v2: OBX.2, OBX.5, OBX.6 rim: value sct-attr: 363714003 \|Interprets\|
Observation.dataAbsentReason
Definition	Provides a reason why the expected value in the element Observation.value[x] is missing.
Cardinality	0...1
Type	CodeableConcept
Binding	Codes specifying why the result (`Observation.value[x]`) is missing. DataAbsentReason (extensible)
Requirements	For many results it is necessary to handle exceptional values in measurements.
Comments	Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: N/A rim: value.nullFlavor
Observation.interpretation
Definition	A categorical assessment of an observation value. For example, high, low, normal.
Cardinality	0...*
Type	CodeableConcept
Binding	Codes identifying interpretations of observations. ObservationInterpretationCodes (extensible)
Alias	Abnormal Flag
Requirements	For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Comments	Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: < 260245000 \|Findings values\| v2: OBX-8 rim: interpretationCode sct-attr: 363713009 \|Has interpretation\|
Observation.note
Definition	Comments about the observation or the results.
Cardinality	0...*
Type	Annotation
Requirements	Need to be able to provide free text additional information.
Comments	May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX) rim: subjectOf.observationEvent[code="annotation"].value
Observation.bodySite
Definition	Indicates the site on the subject's body where the observation was made (i.e. the target site).
Cardinality	0...1
Type	CodeableConcept
Binding	Codes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (preferred)
Comments	Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component. If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: < 123037004 \|Body structure\| v2: OBX-20 rim: targetSiteCode sct-attr: 718497002 \|Inherent location\|
Observation.method
Definition	Indicates the mechanism used to perform the observation.
Cardinality	0...1
Type	CodeableConcept
Binding	Methods for simple observations. ObservationMethods (preferred)
Requirements	In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.
Comments	Only used if not implicit in code for Observation.code.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: OBX-17 rim: methodCode
Observation.specimen
Definition	The specimen that was used when this observation was made.
Cardinality	0...1
Type	Reference(Specimen)
Comments	Should only be used if not implicit in code found in `Observation.code`. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: < 123038009 \|Specimen\| v2: SPM segment rim: participation[typeCode=SPC].specimen sct-attr: 704319004 \|Inherent in\|
Observation.device
Definition	The device used to generate the observation data.
Cardinality	0...1
Type	Reference(Device \| DeviceMetric)
Comments	Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: < 49062001 \|Device\| v2: OBX-17 / PRT -10 rim: participation[typeCode=DEV] sct-attr: 424226004 \|Using device\|
Observation.referenceRange
Definition	Guidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two `referenceRange` elements would be used.
Cardinality	0...*
Type	BackboneElement
Requirements	Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Comments	Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` obs-3: Must have at least a low or a high or text `low.exists() or high.exists() or text.exists()`
Mappings	v2: OBX.7 rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
Observation.referenceRange.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Observation.referenceRange.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.referenceRange.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Observation.referenceRange.low
Definition	The value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).
Cardinality	0...1
Type	SimpleQuantity
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: OBX-7 rim: value:IVL_PQ.low
Observation.referenceRange.high
Definition	The value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).
Cardinality	0...1
Type	SimpleQuantity
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: OBX-7 rim: value:IVL_PQ.high
Observation.referenceRange.type
Definition	Codes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
Cardinality	0...1
Type	CodeableConcept
Binding	Code for the meaning of a reference range. ObservationReferenceRangeMeaningCodes (preferred)
Requirements	Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.
Comments	This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: < 260245000 \|Findings values\| OR < 365860008 \|General clinical state finding\| OR < 250171008 \|Clinical history or observation findings\| OR < 415229000 \|Racial group\| OR < 365400002 \|Finding of puberty stage\| OR < 443938003 \|Procedure carried out on subject\| v2: OBX-10 rim: interpretationCode
Observation.referenceRange.appliesTo
Definition	Codes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple `appliesTo` are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.
Cardinality	0...*
Type	CodeableConcept
Binding	Codes identifying the population the reference range applies to. ObservationReferenceRangeAppliesToCodes (example)
Requirements	Need to be able to identify the target population for proper interpretation.
Comments	This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: < 260245000 \|Findings values\| OR < 365860008 \|General clinical state finding\| OR < 250171008 \|Clinical history or observation findings\| OR < 415229000 \|Racial group\| OR < 365400002 \|Finding of puberty stage\| OR < 443938003 \|Procedure carried out on subject\| v2: OBX-10 rim: interpretationCode
Observation.referenceRange.age
Definition	The age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.
Cardinality	0...1
Type	Range
Requirements	Some analytes vary greatly over age.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value
Observation.referenceRange.text
Definition	Text based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".
Cardinality	0...1
Type	string
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: OBX-7 rim: value:ST
Observation.hasMember
Definition	This observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.
Cardinality	0...*
Type	Reference(Observation \| QuestionnaireResponse \| MolecularSequence)
Summary	True
Comments	When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: Relationships established by OBX-4 usage rim: outBoundRelationship
Observation.derivedFrom
Definition	The target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.
Cardinality	0...*
Type	Reference(DocumentReference \| ImagingStudy \| Media \| QuestionnaireResponse \| Observation \| MolecularSequence)
Summary	True
Comments	All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: Relationships established by OBX-4 usage rim: .targetObservation
Observation.component
Definition	Some observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.
Cardinality	0...*
Type	BackboneElement
Must Support	True
Summary	True
Requirements	Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.
Comments	For a discussion on the ways Observations can be assembled in groups together see Notes below.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: containment by OBX-4? rim: outBoundRelationship[typeCode=COMP]
Observation.component.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Observation.component.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Observation.component.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Observation.component.code
Definition	Describes what was observed. Sometimes this is called the observation "code".
Cardinality	1...1
Type	CodeableConcept
Binding	A code from the SNOMED Clinical Terminology UK coding system describing a type of observation UKCoreObservationType (preferred)
Summary	True
Requirements	Knowing what kind of observation is being made is essential to understanding the observation.
Comments	All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.what[x] sct-concept: < 363787002 \|Observable entity\| OR < 386053000 \|Evaluation procedure\| v2: OBX-3 rim: code
Observation.component.value[x]
Definition	The information determined as a result of making the observation, if the information has a simple value.
Cardinality	0...1
Type	Quantity
Summary	True
Requirements	An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.
Comments	Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: 363714003 \|Interprets\| < 441742003 \|Evaluation finding\| v2: OBX.2, OBX.5, OBX.6 rim: value sct-attr: 363714003 \|Interprets\|
Observation.component.dataAbsentReason
Definition	Provides a reason why the expected value in the element Observation.component.value[x] is missing.
Cardinality	0...1
Type	CodeableConcept
Binding	Codes specifying why the result (`Observation.value[x]`) is missing. DataAbsentReason (extensible)
Requirements	For many results it is necessary to handle exceptional values in measurements.
Comments	"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done". The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: N/A rim: value.nullFlavor
Observation.component.interpretation
Definition	A categorical assessment of an observation value. For example, high, low, normal.
Cardinality	0...*
Type	CodeableConcept
Binding	Codes identifying interpretations of observations. ObservationInterpretationCodes (extensible)
Alias	Abnormal Flag
Requirements	For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.
Comments	Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	sct-concept: < 260245000 \|Findings values\| v2: OBX-8 rim: interpretationCode sct-attr: 363713009 \|Has interpretation\|
Observation.component.referenceRange
Definition	Guidance on how to interpret the value by comparison to a normal or recommended range.
Cardinality	0...*
Type	see (referenceRange)
Requirements	Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.
Comments	Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: OBX.7 rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]

Observation		..
Observation.extension	Extension	..
Observation.extension.extension		..
Observation.extension.extension.value[x]		..
Observation.extension.extension		..
Observation.extension.extension.value[x]		..
Observation.extension.extension		..
Observation.extension.extension.value[x]		..
Observation.extension	Extension	..
Observation.status		..
Observation.category		..
Observation.code		..
Observation.subject		..
Observation.effective[x]		..
Observation.performer		..
Observation.value[x]		..
Observation.bodySite		..
Observation.method		..
Observation.component		..
Observation.component.code		..

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Observation" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation" />
    <version value="2.5.0" />
    <name value="UKCoreObservation" />
    <title value="UK Core Observation" />
    <status value="active" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Observation](https://hl7.org/fhir/R4/Observation.html)." />
    <purpose value="This profile allows exchange of information of Measurements and simple assertions made about an individual, device or other subject.\n\nNote: this profile SHALL NOT be used where a more specific UK Core profile exists." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Observation" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Observation" />
    <derivation value="constraint" />
    <differential>
        <element id="Observation.extension:triggeredByR5">
            <path value="Observation.extension" />
            <sliceName value="triggeredByR5" />
            <short value="Triggering observation(s). This is a R5 backport." />
            <type>
                <code value="Extension" />
                <profile value="http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy" />
            </type>
        </element>
        <element id="Observation.extension:triggeredByR5.extension:observation">
            <path value="Observation.extension.extension" />
            <sliceName value="observation" />
        </element>
        <element id="Observation.extension:triggeredByR5.extension:observation.value[x]">
            <path value="Observation.extension.extension.value[x]" />
            <short value="Triggering observation." />
            <definition value="A reference to the triggering observation." />
        </element>
        <element id="Observation.extension:triggeredByR5.extension:type">
            <path value="Observation.extension.extension" />
            <sliceName value="type" />
        </element>
        <element id="Observation.extension:triggeredByR5.extension:type.value[x]">
            <path value="Observation.extension.extension.value[x]" />
            <short value="The type of trigger. Reflex | Repeat | Re-run" />
            <definition value="The type of trigger. Reflex | Repeat | Re-run" />
        </element>
        <element id="Observation.extension:triggeredByR5.extension:reason">
            <path value="Observation.extension.extension" />
            <sliceName value="reason" />
        </element>
        <element id="Observation.extension:triggeredByR5.extension:reason.value[x]">
            <path value="Observation.extension.extension.value[x]" />
            <short value="Reason that the observation was triggered." />
            <definition value="Provides the reason why this observation was performed as a result of the observation referenced." />
        </element>
        <element id="Observation.extension:bodyStructureR5">
            <path value="Observation.extension" />
            <sliceName value="bodyStructureR5" />
            <short value="Observed body structure. This is a R5 backport." />
            <type>
                <code value="Extension" />
                <profile value="http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure" />
            </type>
        </element>
        <element id="Observation.status">
            <path value="Observation.status" />
            <short value="The status of the result value." />
            <mustSupport value="true" />
        </element>
        <element id="Observation.category">
            <path value="Observation.category" />
            <short value="A code that classifies the general type of observation being made." />
            <mustSupport value="true" />
        </element>
        <element id="Observation.code">
            <path value="Observation.code" />
            <short value="The type of observation (code / type)." />
            <mustSupport value="true" />
            <binding>
                <strength value="preferred" />
                <description value="A code from the SNOMED Clinical Terminology UK coding system describing a type of observation" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType" />
            </binding>
        </element>
        <element id="Observation.subject">
            <path value="Observation.subject" />
            <short value="Who and / or what the observation is about." />
            <mustSupport value="true" />
        </element>
        <element id="Observation.effective[x]">
            <path value="Observation.effective[x]" />
            <short value="A clinically relevant time / time-period for observation." />
            <mustSupport value="true" />
        </element>
        <element id="Observation.performer">
            <path value="Observation.performer" />
            <short value="Who is responsible for the observation." />
            <mustSupport value="true" />
        </element>
        <element id="Observation.value[x]">
            <path value="Observation.value[x]" />
            <short value="The actual observed result." />
            <mustSupport value="true" />
        </element>
        <element id="Observation.bodySite">
            <path value="Observation.bodySite" />
            <binding>
                <strength value="preferred" />
            </binding>
        </element>
        <element id="Observation.method">
            <path value="Observation.method" />
            <binding>
                <strength value="preferred" />
            </binding>
        </element>
        <element id="Observation.component">
            <path value="Observation.component" />
            <short value="Component / sub results." />
            <mustSupport value="true" />
        </element>
        <element id="Observation.component.code">
            <path value="Observation.component.code" />
            <binding>
                <strength value="preferred" />
                <description value="A code from the SNOMED Clinical Terminology UK coding system describing a type of observation" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType" />
            </binding>
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Observation",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation",
    "version": "2.5.0",
    "name": "UKCoreObservation",
    "title": "UK Core Observation",
    "status": "active",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Observation](https://hl7.org/fhir/R4/Observation.html).",
    "purpose": "This profile allows exchange of information of Measurements and simple assertions made about an individual, device or other subject.\n\nNote: this profile SHALL NOT be used where a more specific UK Core profile exists.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Observation",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Observation",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Observation.extension:triggeredByR5",
                "path": "Observation.extension",
                "sliceName": "triggeredByR5",
                "short": "Triggering observation(s). This is a R5 backport.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy"
                        ]
                    }
                ]
            },
            {
                "id": "Observation.extension:triggeredByR5.extension:observation",
                "path": "Observation.extension.extension",
                "sliceName": "observation"
            },
            {
                "id": "Observation.extension:triggeredByR5.extension:observation.value[x]",
                "path": "Observation.extension.extension.value[x]",
                "short": "Triggering observation.",
                "definition": "A reference to the triggering observation."
            },
            {
                "id": "Observation.extension:triggeredByR5.extension:type",
                "path": "Observation.extension.extension",
                "sliceName": "type"
            },
            {
                "id": "Observation.extension:triggeredByR5.extension:type.value[x]",
                "path": "Observation.extension.extension.value[x]",
                "short": "The type of trigger. Reflex | Repeat | Re-run",
                "definition": "The type of trigger. Reflex | Repeat | Re-run"
            },
            {
                "id": "Observation.extension:triggeredByR5.extension:reason",
                "path": "Observation.extension.extension",
                "sliceName": "reason"
            },
            {
                "id": "Observation.extension:triggeredByR5.extension:reason.value[x]",
                "path": "Observation.extension.extension.value[x]",
                "short": "Reason that the observation was triggered.",
                "definition": "Provides the reason why this observation was performed as a result of the observation referenced."
            },
            {
                "id": "Observation.extension:bodyStructureR5",
                "path": "Observation.extension",
                "sliceName": "bodyStructureR5",
                "short": "Observed body structure. This is a R5 backport.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.bodyStructure"
                        ]
                    }
                ]
            },
            {
                "id": "Observation.status",
                "path": "Observation.status",
                "short": "The status of the result value.",
                "mustSupport": true
            },
            {
                "id": "Observation.category",
                "path": "Observation.category",
                "short": "A code that classifies the general type of observation being made.",
                "mustSupport": true
            },
            {
                "id": "Observation.code",
                "path": "Observation.code",
                "short": "The type of observation (code / type).",
                "mustSupport": true,
                "binding": {
                    "strength": "preferred",
                    "description": "A code from the SNOMED Clinical Terminology UK coding system describing a type of observation",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType"
                }
            },
            {
                "id": "Observation.subject",
                "path": "Observation.subject",
                "short": "Who and / or what the observation is about.",
                "mustSupport": true
            },
            {
                "id": "Observation.effective[x]",
                "path": "Observation.effective[x]",
                "short": "A clinically relevant time / time-period for observation.",
                "mustSupport": true
            },
            {
                "id": "Observation.performer",
                "path": "Observation.performer",
                "short": "Who is responsible for the observation.",
                "mustSupport": true
            },
            {
                "id": "Observation.value[x]",
                "path": "Observation.value[x]",
                "short": "The actual observed result.",
                "mustSupport": true
            },
            {
                "id": "Observation.bodySite",
                "path": "Observation.bodySite",
                "binding": {
                    "strength": "preferred"
                }
            },
            {
                "id": "Observation.method",
                "path": "Observation.method",
                "binding": {
                    "strength": "preferred"
                }
            },
            {
                "id": "Observation.component",
                "path": "Observation.component",
                "short": "Component / sub results.",
                "mustSupport": true
            },
            {
                "id": "Observation.component.code",
                "path": "Observation.component.code",
                "binding": {
                    "strength": "preferred",
                    "description": "A code from the SNOMED Clinical Terminology UK coding system describing a type of observation",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ObservationType"
                }
            }
        ]
    }
}

Propose a change to UKCore-Observation

StructureDefinition UKCore-Patient

UKCorePatient (Patient)	I		Patient	There are no (further) constraints on this element Element id Patient Short description Information about an individual or animal receiving health care services Alternate names SubjectOfCare Client Resident Definition Demographics and other administrative information about an individual or animal receiving care or other health-related services. Data type Patient Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act rim: Patient[classCode=PAT] cda: ClinicalDocument.recordTarget.patientRole
id	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Patient.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Patient.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Patient.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Patient.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can 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. Comments 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 information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Patient.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These 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. Comments 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	Element id Patient.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
birthPlace	I	0..1	Extension(Address)	Element id Patient.extension:birthPlace Short description The registered place of birth of the patient. Alternate names extensions, user content Definition The registered place of birth of the patient. Comments 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. Data type Extension(Address) Extension URL http://hl7.org/fhir/StructureDefinition/patient-birthPlace Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Patient.extension:birthPlace.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..0	Extension	There are no (further) constraints on this element Element id Patient.extension:birthPlace.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.extension:birthPlace.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://hl7.org/fhir/StructureDefinition/patient-birthPlace Mappings rim: N/A
value[x]		1..1		Element id Patient.extension:birthPlace.value[x] Short description The registered place of birth of the patient. Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueAddress			Address	There are no (further) constraints on this element Data type Address
birthSex	I	0..1	Extension(CodeableConcept)	Element id Patient.extension:birthSex Short description The patient's phenotypic sex at birth. Alternate names extensions, user content Definition The patient's phenotypic sex at birth. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BirthSex Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
cadavericDonor	I	0..1	Extension(boolean)	Element id Patient.extension:cadavericDonor Short description Post-mortem donor status. Alternate names extensions, user content Definition Flag indicating whether the patient authorized the donation of body parts after death. Comments 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. Data type Extension(boolean) Extension URL http://hl7.org/fhir/StructureDefinition/patient-cadavericDonor Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Patient.extension:cadavericDonor.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..0	Extension	There are no (further) constraints on this element Element id Patient.extension:cadavericDonor.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.extension:cadavericDonor.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://hl7.org/fhir/StructureDefinition/patient-cadavericDonor Mappings rim: N/A
value[x]		1..1		Element id Patient.extension:cadavericDonor.value[x] Short description Post-mortem donor status. Definition Flag indicating whether the patient authorized the donation of body parts after death. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
contactPreference	I	0..1	Extension(Complex)	Element id Patient.extension:contactPreference Short description The preferred method of contact, contact times and written communication format given by a Patient or Related Person. Alternate names extensions, user content Definition The preferred method of contact, contact times and written communication format given by a Patient or Related Person. Comments 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. Data type Extension(Complex) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ContactPreference Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
deathNotificationStatus	I	0..1	Extension(Complex)	Element id Patient.extension:deathNotificationStatus Short description The patient's death notification status. Alternate names extensions, user content Definition The patient's death notification status. Comments 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. Data type Extension(Complex) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeathNotificationStatus Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	1..*	Extension	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
deathNotificationStatus	I	1..1	Extension	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:deathNotificationStatus Short description The patient's death notification status. Alternate names extensions, user content Definition The patient's death notification status. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:deathNotificationStatus.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:deathNotificationStatus.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:deathNotificationStatus.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value deathNotificationStatus Mappings rim: N/A
value[x]		1..1	Binding	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:deathNotificationStatus.value[x] Short description The patient's death notification status. Definition The patient's death notification status. Binding UKCoreDeathNotificationStatus (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueCodeableConcept			CodeableConcept	There are no (further) constraints on this element Data type CodeableConcept
systemEffectiveDate	I	0..1	Extension	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:systemEffectiveDate Short description System effective date for patient's death notification status. Alternate names extensions, user content Definition System effective date for patient's death notification status. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:systemEffectiveDate.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:systemEffectiveDate.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:systemEffectiveDate.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value systemEffectiveDate Mappings rim: N/A
value[x]		1..1		There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.extension:systemEffectiveDate.value[x] Short description System effective date for patient's death notification status. Definition System effective date for patient's death notification status. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeathNotificationStatus Mappings rim: N/A
value[x]		0..0		There are no (further) constraints on this element Element id Patient.extension:deathNotificationStatus.value[x] Short description Value of extension Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
ethnicCategory	I	0..1	Extension(CodeableConcept)	Element id Patient.extension:ethnicCategory Short description The ethnicity of the subject. Alternate names extensions, user content Definition The ethnicity of the subject. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-EthnicCategory Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
residentialStatus	I	0..1	Extension(CodeableConcept)	Element id Patient.extension:residentialStatus Short description The residential status of the patient. Alternate names extensions, user content Definition The residential status of the patient. For example if this patient is a UK resident. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ResidentialStatus Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
patientInterpreterRequired	I	0..1	Extension(boolean)	Element id Patient.extension:patientInterpreterRequired Short description Indicator showing whether the patient needs an interpreter. Alternate names extensions, user content Definition This Patient requires an interpreter to communicate healthcare information to the practitioner. Comments The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required. Data type Extension(boolean) Extension URL http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Patient.extension:patientInterpreterRequired.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..0	Extension	There are no (further) constraints on this element Element id Patient.extension:patientInterpreterRequired.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.extension:patientInterpreterRequired.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired Mappings rim: N/A
value[x]		1..1		Element id Patient.extension:patientInterpreterRequired.value[x] Short description Indicator showing whether the patient needs an interpreter Definition Indicator showing if this Patient requires an interpreter to communicate healthcare information to the practitioner. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueBoolean			boolean	There are no (further) constraints on this element Data type boolean
nhsNumberUnavailableReason	I	0..1	Extension(CodeableConcept)	Element id Patient.extension:nhsNumberUnavailableReason Short description Reason why this Patient does not include an NHS Number identifier. Alternate names extensions, user content Definition The reason why a patient does not have an NHS Number. For example if this patient is an overseas patient. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberUnavailableReason Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A rim: n/a
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Patient.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	S Σ	0..*	Identifier	Element id Patient.identifier Short description An identifier for this patient. Definition An identifier for this patient. Requirements Patients are almost always assigned specific numerical identifiers. Data type Identifier Sliced: Unordered, Open, by system(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.identifier v2: PID-3 rim: id cda: .id
nhsNumber	Σ	0..1	Identifier	Element id Patient.identifier:nhsNumber Short description The patient's NHS number. Definition An identifier for this patient. Requirements Patients are almost always assigned specific numerical identifiers. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.identifier v2: PID-3 rim: id cda: .id
id		0..1	string	There are no (further) constraints on this element Element id Patient.identifier:nhsNumber.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.identifier:nhsNumber.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
nhsNumberVerificationStatus	I	0..1	Extension(CodeableConcept)	Element id Patient.identifier:nhsNumber.extension:nhsNumberVerificationStatus Short description NHS number verification status Alternate names extensions, user content Definition The verification/tracing status of the NHS number. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id Patient.identifier:nhsNumber.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: N/A rim: Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Patient.identifier:nhsNumber.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type. Data type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CX.5 rim: Role.code or implied by context
system	Σ	1..1	uriFixed Value	Element id Patient.identifier:nhsNumber.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers. Comments Identifier.system is always case sensitive. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed value https://fhir.nhs.uk/Id/nhs-number Mappings v2: CX.4 / EI-2-4 rim: II.root or Role.id.root servd: ./IdentifierType
value	Σ	1..1	string	There are no (further) constraints on this element Element id Patient.identifier:nhsNumber.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings v2: CX.1 / EI.1 rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd: ./Value
period	Σ	0..1	Period	There are no (further) constraints on this element Element id Patient.identifier:nhsNumber.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CX.7 + CX.8 rim: Role.effectiveTime or implied by context servd: ./StartDate and ./EndDate
assigner	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element id Patient.identifier:nhsNumber.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: CX.4 / (CX.4,CX.9,CX.10) rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd: ./IdentifierIssuingAuthority
active	S Σ ?!	0..1	boolean	Element id Patient.active Short description Whether this patient's record is in active use. Definition Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death. Requirements Need to be able to mark a patient record as not to be used because it was created in error. Comments If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient. Meaning when missing This resource is generally assumed to be active if no value is provided for the active element Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.status rim: statusCode cda: n/a
name	S Σ	0..*	HumanName	Element id Patient.name Short description A name associated with the patient. Definition A name associated with the individual. Requirements Need to be able to track the patient by multiple names. Examples are your official name and a partner name. Comments A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns. Data type HumanName Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-5, PID-9 rim: name cda: .patient.name
telecom	S Σ	0..*	ContactPoint	Element id Patient.telecom Short description A contact detail for the individual. Definition A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted. Requirements People have (primary) ways to contact them in some way such as phone, email. Comments A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone). Data type ContactPoint Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-13, PID-14, PID-40 rim: telecom cda: .telecom
id		0..1	string	There are no (further) constraints on this element Element id Patient.telecom.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.telecom.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	Σ I	0..1	codeBinding	There are no (further) constraints on this element Element id Patient.telecom.system Short description phone \| fax \| email \| pager \| url \| sms \| other Definition Telecommunications form for contact point - what communications system is required to make use of the contact. Data type code Binding Telecommunications form for contact point. ContactPointSystem (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: XTN.3 rim: ./scheme servd: ./ContactPointType
id		0..1	string	There are no (further) constraints on this element Element id Patient.telecom.system.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references) Data type string
extension	I	0..*	Extension	Element id Patient.telecom.system.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
otherContactSystem	I	0..1	Extension(CodeableConcept)	Element id Patient.telecom.system.extension:otherContactSystem Short description Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`. Alternate names extensions, user content Definition Other contact system value which extends the system element in the ContactPoint datatype. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OtherContactSystem Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
value		0..1	System.String	There are no (further) constraints on this element Element id Patient.telecom.system.value Short description Primitive value for code Definition Primitive value for code Data type System.String
value	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.telecom.value Short description The actual contact point details Definition The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address). Requirements Need to support legacy numbers that are not in a tightly controlled format. Comments Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: XTN.1 (or XTN.12) rim: ./url servd: ./Value
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id Patient.telecom.use Short description home \| work \| temp \| old \| mobile - purpose of this contact point Definition Identifies the purpose for the contact point. Requirements Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose. Comments Applications can assume that a contact is current unless it explicitly says that it is temporary or old. Data type code Binding Use of contact point. ContactPointUse (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: XTN.2 - but often indicated by field rim: unique(./use) servd: ./ContactPointPurpose
rank	Σ	0..1	positiveInt	There are no (further) constraints on this element Element id Patient.telecom.rank Short description Specify preferred order of use (1 = highest) Definition Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values. Comments Note that rank does not necessarily follow the order in which the contacts are represented in the instance. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: n/a rim: n/a
period	Σ	0..1	Period	There are no (further) constraints on this element Element id Patient.telecom.period Short description Time period when the contact point was/is in use Definition Time period when the contact point was/is in use. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: N/A rim: ./usablePeriod[type="IVL<TS>"] servd: ./StartDate and ./EndDate
gender	S Σ	0..1	codeBinding	Element id Patient.gender Short description The gender that the patient is considered to have for administration and record keeping purposes. Definition Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes. Requirements Needed for identification of the individual, in combination with (at least) name and birth date. Comments The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex. Data type code Binding The gender of a person used for administrative purposes. AdministrativeGender (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-8 rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/administrativeGender cda: .patient.administrativeGenderCode
birthDate	S Σ	0..1	date	Element id Patient.birthDate Short description The date of birth for the individual. Definition The date of birth for the individual. Requirements Age of the individual drives many clinical processes. Comments At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems). Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-7 rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/birthTime cda: .patient.birthTime loinc: 21112-8
id		0..1	string	There are no (further) constraints on this element Element id Patient.birthDate.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references) Data type string
extension	I	0..*	Extension	Element id Patient.birthDate.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
birthTime	I	0..1	Extension(dateTime)	Element id Patient.birthDate.extension:birthTime Short description The time of day that the patient was born. This SHOULD be included when the birth time is relevant. Alternate names extensions, user content Definition The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively. Comments 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. Data type Extension(dateTime) Extension URL http://hl7.org/fhir/StructureDefinition/patient-birthTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
id		0..1	string	There are no (further) constraints on this element Element id Patient.birthDate.extension:birthTime.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..0	Extension	There are no (further) constraints on this element Element id Patient.birthDate.extension:birthTime.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.birthDate.extension:birthTime.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://hl7.org/fhir/StructureDefinition/patient-birthTime Mappings rim: N/A
value[x]		1..1		Element id Patient.birthDate.extension:birthTime.value[x] Short description Time of day of birth. Definition The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
value		0..1	System.Date	There are no (further) constraints on this element Element id Patient.birthDate.value Short description Primitive value for date Definition The actual value Data type System.Date
deceased[x]	Σ ?!	0..1		There are no (further) constraints on this element Element id Patient.deceased[x] Short description Indicates if the individual is deceased or not Definition Indicates if the individual is deceased or not. Requirements The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive. Comments If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-30 (bool) and PID-29 (datetime) rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN\|ANM and determinerCode=INSTANCE]/deceasedTime cda: n/a
deceasedBoolean			boolean	There are no (further) constraints on this element Data type boolean
deceasedDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
address	S Σ	0..*	Address	There are no (further) constraints on this element Element id Patient.address Short description An address for the individual Definition An address for the individual. Requirements May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification. Comments Patient may have multiple addresses with different uses or applicable periods. Data type Address Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-11 rim: addr cda: .addr
id		0..1	string	There are no (further) constraints on this element Element id Patient.address.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.address.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
addressKey	I	0..*	Extension(Complex)	Element id Patient.address.extension:addressKey Short description A patient's address key and type Alternate names extensions, user content Definition A patient's address key and type. Comments 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. Data type Extension(Complex) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AddressKey Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id Patient.address.use Short description home \| work \| temp \| old \| billing - purpose of this address Definition The purpose of this address. Requirements Allows an appropriate address to be chosen from a list of many. Comments Applications can assume that an address is current unless it explicitly says that it is temporary or old. Data type code Binding The use of an address. AddressUse (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General home Mappings v2: XAD.7 rim: unique(./use) servd: ./AddressPurpose
type	Σ	0..1	codeBinding	There are no (further) constraints on this element Element id Patient.address.type Short description postal \| physical \| both Definition Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both. Comments The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource). Data type code Binding The type of an address (physical / postal). AddressType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General both Mappings v2: XAD.18 rim: unique(./use) vcard: address type parameter
text	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.address.text Short description Text representation of the address Definition Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts. Requirements A renderable, unencoded form. Comments Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 137 Nowhere Street, Erewhon 9132 Mappings v2: XAD.1 + XAD.2 + XAD.3 + XAD.4 + XAD.5 + XAD.6 rim: ./formatted vcard: address label parameter
line	Σ	0..*	string	There are no (further) constraints on this element Element id Patient.address.line Short description Street name, number, direction & P.O. Box etc. Definition This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 137 Nowhere Street Mappings v2: XAD.1 + XAD.2 (note: XAD.1 and XAD.2 have different meanings for a company address than for a person address) rim: AD.part[parttype = AL] vcard: street servd: ./StreetAddress (newline delimitted)
city	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.address.city Short description Name of city, town etc. Alternate names Municpality Definition The name of the city, town, suburb, village or other community or delivery center. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General Erewhon Mappings v2: XAD.3 rim: AD.part[parttype = CTY] vcard: locality servd: ./Jurisdiction
district	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.address.district Short description District name (aka county) Alternate names County Definition The name of the administrative area (county). Comments District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General Madison Mappings v2: XAD.9 rim: AD.part[parttype = CNT \| CPA]
state	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.address.state Short description Sub-unit of country (abbreviations ok) Alternate names Province, Territory Definition Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes). Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: XAD.4 rim: AD.part[parttype = STA] vcard: region servd: ./Region
postalCode	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.address.postalCode Short description Postal code for area Alternate names Zip Definition A postal code designating a region defined by the postal service. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 9132 Mappings v2: XAD.5 rim: AD.part[parttype = ZIP] vcard: code servd: ./PostalIdentificationCode
country	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.address.country Short description Country (e.g. can be ISO 3166 2 or 3 letter code) Definition Country - a nation as commonly understood or generally accepted. Comments ISO 3166 3 letter codes can be used in place of a human readable country name. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: XAD.6 rim: AD.part[parttype = CNT] vcard: country servd: ./Country
period	Σ	0..1	Period	There are no (further) constraints on this element Element id Patient.address.period Short description Time period when address was/is in use Definition Time period when address was/is in use. Requirements Allows addresses to be placed in historical context. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General { "start": "2010-03-23", "end": "2010-07-01" } Mappings v2: XAD.12 / XAD.13 + XAD.14 rim: ./usablePeriod[type="IVL<TS>"] servd: ./StartDate and ./EndDate
maritalStatus		0..1	CodeableConceptBinding	Element id Patient.maritalStatus Short description Marital (civil) status of a patient Definition This field contains a patient's most recent marital (civil) status. Requirements Most, if not all systems capture it. Data type CodeableConcept Binding An indicator to identify the legal marital status of a person UKCorePersonMaritalStatusCode (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-16 rim: player[classCode=PSN]/maritalStatusCode cda: .patient.maritalStatusCode
multipleBirth[x]		0..1		There are no (further) constraints on this element Element id Patient.multipleBirth[x] Short description Whether patient is part of a multiple birth Definition Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer). Requirements For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs. Comments Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-24 (bool), PID-25 (integer) rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN\|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber cda: n/a
multipleBirthBoolean			boolean	There are no (further) constraints on this element Data type boolean
multipleBirthInteger			integer	There are no (further) constraints on this element Data type integer
photo		0..*	Attachment	There are no (further) constraints on this element Element id Patient.photo Short description Image of the patient Definition Image of the patient. Requirements Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too. Comments Guidelines: Use id photos, not clinical photos. Limit dimensions to thumbnail. Keep byte count low to ease resource updates. Data type Attachment Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-5 - needs a profile rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/desc cda: n/a
contact	I	0..*	BackboneElement	There are no (further) constraints on this element Element id Patient.contact Short description A contact party (e.g. guardian, partner, friend) for the patient Definition A contact party (e.g. guardian, partner, friend) for the patient. Requirements Need to track people you can contact about the patient. Comments Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` pat-1: SHALL at least contain a contact's details or a reference to an organization `name.exists() or telecom.exists() or address.exists() or organization.exists()` Mappings rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON] cda: n/a
id		0..1	string	There are no (further) constraints on this element Element id Patient.contact.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	Element id Patient.contact.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
contactRank	I	0..1	Extension(positiveInt)	Element id Patient.contact.extension:contactRank Short description The preferred ranking or order of contact applied to a contact on a Patient's contact list. Alternate names extensions, user content Definition The preferred ranking or order of contact applied to a contact on a patient's contact list. Comments 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. Data type Extension(positiveInt) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ContactRank Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
copyCorrespondenceIndicator	I	0..1	Extension(boolean)	Element id Patient.contact.extension:copyCorrespondenceIndicator Short description Indicates that a must be copied in to all related correspondence. Alternate names extensions, user content Definition Extension carrying a boolean indicator showing that a patient's contact or related person SHALL be copied in to patient correspondence. Comments 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. Data type Extension(boolean) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-CopyCorrespondenceIndicator Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Patient.contact.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
relationship		0..*	CodeableConceptBinding	Element id Patient.contact.relationship Short description The kind of relationship Definition The nature of the relationship between the patient and the contact person. Requirements Used to determine which contact person is the most relevant to approach, depending on circumstances. Data type CodeableConcept Binding The nature of the relationship between a patient and a contact person for that patient. UKCorePersonRelationshipType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NK1-7, NK1-3 rim: code cda: n/a
name		0..1	HumanName	There are no (further) constraints on this element Element id Patient.contact.name Short description A name associated with the contact person Definition A name associated with the contact person. Requirements Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person. Data type HumanName Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NK1-2 rim: name cda: n/a
telecom		0..*	ContactPoint	There are no (further) constraints on this element Element id Patient.contact.telecom Short description A contact detail for the person Definition A contact detail for the person, e.g. a telephone number or an email address. Requirements People have (primary) ways to contact them in some way such as phone, email. Comments Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification. Data type ContactPoint Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NK1-5, NK1-6, NK1-40 rim: telecom cda: n/a
id		0..1	string	There are no (further) constraints on this element Element id Patient.contact.telecom.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.contact.telecom.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
system	Σ I	0..1	codeBinding	There are no (further) constraints on this element Element id Patient.contact.telecom.system Short description phone \| fax \| email \| pager \| url \| sms \| other Definition Telecommunications form for contact point - what communications system is required to make use of the contact. Data type code Binding Telecommunications form for contact point. ContactPointSystem (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: XTN.3 rim: ./scheme servd: ./ContactPointType
id		0..1	string	There are no (further) constraints on this element Element id Patient.contact.telecom.system.id Short description xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references) Data type string
extension	I	0..*	Extension	Element id Patient.contact.telecom.system.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
otherContactSystem	I	0..1	Extension(CodeableConcept)	Element id Patient.contact.telecom.system.extension:otherContactSystem Short description Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`. Alternate names extensions, user content Definition Other contact system value which extends the system element in the ContactPoint datatype. Comments 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. Data type Extension(CodeableConcept) Extension URL https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OtherContactSystem Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
value		0..1	System.String	There are no (further) constraints on this element Element id Patient.contact.telecom.system.value Short description Primitive value for code Definition Primitive value for code Data type System.String
value	Σ	0..1	string	There are no (further) constraints on this element Element id Patient.contact.telecom.value Short description The actual contact point details Definition The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address). Requirements Need to support legacy numbers that are not in a tightly controlled format. Comments Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: XTN.1 (or XTN.12) rim: ./url servd: ./Value
use	Σ ?!	0..1	codeBinding	There are no (further) constraints on this element Element id Patient.contact.telecom.use Short description home \| work \| temp \| old \| mobile - purpose of this contact point Definition Identifies the purpose for the contact point. Requirements Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose. Comments Applications can assume that a contact is current unless it explicitly says that it is temporary or old. Data type code Binding Use of contact point. ContactPointUse (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: XTN.2 - but often indicated by field rim: unique(./use) servd: ./ContactPointPurpose
rank	Σ	0..1	positiveInt	There are no (further) constraints on this element Element id Patient.contact.telecom.rank Short description Specify preferred order of use (1 = highest) Definition Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values. Comments Note that rank does not necessarily follow the order in which the contacts are represented in the instance. Data type positiveInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: n/a rim: n/a
period	Σ	0..1	Period	There are no (further) constraints on this element Element id Patient.contact.telecom.period Short description Time period when the contact point was/is in use Definition Time period when the contact point was/is in use. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: N/A rim: ./usablePeriod[type="IVL<TS>"] servd: ./StartDate and ./EndDate
address		0..1	Address	There are no (further) constraints on this element Element id Patient.contact.address Short description Address for the contact person Definition Address for the contact person. Requirements Need to keep track where the contact person can be contacted per postal mail or visited. Data type Address Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NK1-4 rim: addr cda: n/a
gender		0..1	codeBinding	There are no (further) constraints on this element Element id Patient.contact.gender Short description male \| female \| other \| unknown Definition Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes. Requirements Needed to address the person correctly. Data type code Binding The gender of a person used for administrative purposes. AdministrativeGender (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NK1-15 rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/administrativeGender cda: n/a
organization	I	0..1	Reference(Organization)	There are no (further) constraints on this element Element id Patient.contact.organization Short description Organization that is associated with the contact Definition Organization on behalf of which the contact is acting or for which the contact is working. Requirements For guardians or business related contacts, the organization is relevant. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: NK1-13, NK1-30, NK1-31, NK1-32, NK1-41 rim: scoper cda: n/a
period		0..1	Period	There are no (further) constraints on this element Element id Patient.contact.period Short description The period during which this contact person or organization is valid to be contacted relating to this patient Definition The period during which this contact person or organization is valid to be contacted relating to this patient. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: effectiveTime cda: n/a
communication		0..*	BackboneElement	There are no (further) constraints on this element Element id Patient.communication Short description A language which may be used to communicate with the patient about his or her health Definition A language which may be used to communicate with the patient about his or her health. Requirements If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest. Comments If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: LanguageCommunication cda: patient.languageCommunication
id		0..1	string	There are no (further) constraints on this element Element id Patient.communication.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	Element id Patient.communication.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
proficiency	I	0..1	Extension(Complex)	Element id Patient.communication.extension:proficiency Short description The patient's proficiency level of the communication method. Alternate names extensions, user content Definition Proficiency level of the communication. Comments 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. Data type Extension(Complex) Extension URL http://hl7.org/fhir/StructureDefinition/patient-proficiency Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
id		0..1	string	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
level	I	0..1	Extension	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension:level Short description The proficiency level of the communication Definition How well the patient can communicate this communication (good, poor, etc.). Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
id		0..1	string	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension:level.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..0	Extension	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension:level.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension:level.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value level Mappings rim: N/A
value[x]		1..1	Binding	Element id Patient.communication.extension:proficiency.extension:level.value[x] Short description The proficiency level for the communication Definition The proficiency level for the communication. Binding The proficiency level for the communication. v3.LanguageAbilityProficiency (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueCoding			Coding	There are no (further) constraints on this element Data type Coding
type	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension:type Short description The proficiency type of the communication Definition What type of communication for the proficiency (spoken, written, etc.). Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
id		0..1	string	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension:type.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..0	Extension	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension:type.extension Short description Extension Definition An Extension Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.extension:type.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value type Mappings rim: N/A
value[x]		1..1	Binding	Element id Patient.communication.extension:proficiency.extension:type.value[x] Short description The proficiency type for the communication Definition The proficiency type for the communication. Binding The proficiency type for the communication. v3.LanguageAbilityMode (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueCoding			Coding	There are no (further) constraints on this element Data type Coding
url		1..1	uriFixed Value	There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://hl7.org/fhir/StructureDefinition/patient-proficiency Mappings rim: N/A
value[x]		0..0		There are no (further) constraints on this element Element id Patient.communication.extension:proficiency.value[x] Short description Value of extension Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Patient.communication.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
language		1..1	CodeableConceptBinding	Element id Patient.communication.language Short description A ValueSet that identifies the language used by a person. Definition A ValueSet that identifies the language used by a person. Requirements Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect. Comments The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type. Data type CodeableConcept Binding A ValueSet that identifies the language used by a person. AllLanguages (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-15, LAN-2 rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/languageCommunication/code cda: .languageCode
preferred		0..1	boolean	There are no (further) constraints on this element Element id Patient.communication.preferred Short description Language preference indicator Definition Indicates whether or not the patient prefers this language (over other languages he masters up a certain level). Requirements People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method. Comments This language is specifically identified for communicating healthcare information. Data type boolean Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-15 rim: preferenceInd cda: .preferenceInd
generalPractitioner		0..*	Reference(Organization \| Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id Patient.generalPractitioner Short description Patient's nominated primary care provider Alternate names careProvider Definition Patient's nominated care provider. Comments This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues. Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type. Data type Reference(Organization \| Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PD1-4 rim: subjectOf.CareEvent.performer.AssignedEntity cda: n/a
managingOrganization	Σ	0..1	Reference(Organization)	There are no (further) constraints on this element Element id Patient.managingOrganization Short description Organization that is the custodian of the patient record Definition Organization that is the custodian of the patient record. Requirements Need to know who recognizes this patient record, manages and updates it. Comments There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association). Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: scoper cda: .providerOrganization
link	Σ ?!	0..*	BackboneElement	There are no (further) constraints on this element Element id Patient.link Short description Link to another patient resource that concerns the same actual person Definition Link to another patient resource that concerns the same actual patient. Requirements There are multiple use cases: Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and Distribution of patient information across multiple servers. Comments There is no assumption that linked patient records have mutual links. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: outboundLink cda: n/a
id		0..1	string	There are no (further) constraints on this element Element id Patient.link.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Patient.link.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Patient.link.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
other	Σ	1..1	Reference(Patient \| RelatedPerson)	There are no (further) constraints on this element Element id Patient.link.other Short description The other patient or related person resource that the link refers to Definition The other patient resource that the link refers to. Comments Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual. Data type Reference(Patient \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: PID-3, MRG-1 rim: id cda: n/a
type	Σ	1..1	codeBinding	There are no (further) constraints on this element Element id Patient.link.type Short description replaced-by \| replaces \| refer \| seealso Definition The type of link between this patient resource and another patient resource. Data type code Binding The type of link between this patient resource and another patient resource. LinkType (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: typeCode cda: n/a

Patient
Definition	Demographics and other administrative information about an individual or animal receiving care or other health-related services.
Cardinality	0...*
Alias	SubjectOfCare Client Resident
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings	rim: Entity. Role, or Act rim: Patient[classCode=PAT] cda: ClinicalDocument.recordTarget.patientRole
Patient.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Patient.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Patient.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Patient.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Patient.text
Definition	A human-readable narrative that contains a summary of the resource and can 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: Act.text?
Patient.contained
Definition	These 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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: N/A
Patient.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Patient.extension:birthPlace
Definition	The registered place of birth of the patient.
Cardinality	0...1
Type	Extension(Address)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Patient.extension:birthPlace.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.extension:birthPlace.extension
Definition	An Extension
Cardinality	0...0
Type	Extension
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.extension:birthPlace.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	http://hl7.org/fhir/StructureDefinition/patient-birthPlace
Mappings	rim: N/A
Patient.extension:birthPlace.value[x]
Definition	Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/extensibility.html) for a list).
Cardinality	1...1
Type	Address
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.extension:birthSex
Definition	The patient's phenotypic sex at birth.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Patient.extension:cadavericDonor
Definition	Flag indicating whether the patient authorized the donation of body parts after death.
Cardinality	0...1
Type	Extension(boolean)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Patient.extension:cadavericDonor.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.extension:cadavericDonor.extension
Definition	An Extension
Cardinality	0...0
Type	Extension
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.extension:cadavericDonor.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	http://hl7.org/fhir/StructureDefinition/patient-cadavericDonor
Mappings	rim: N/A
Patient.extension:cadavericDonor.value[x]
Definition	Flag indicating whether the patient authorized the donation of body parts after death.
Cardinality	1...1
Type	boolean
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.extension:contactPreference
Definition	The preferred method of contact, contact times and written communication format given by a Patient or Related Person.
Cardinality	0...1
Type	Extension(Complex)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Patient.extension:deathNotificationStatus
Definition	The patient's death notification status.
Cardinality	0...1
Type	Extension(Complex)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Patient.extension:deathNotificationStatus.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.extension:deathNotificationStatus.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	1...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.extension:deathNotificationStatus.extension:deathNotificationStatus
Definition	The patient's death notification status.
Cardinality	1...1
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.extension:deathNotificationStatus.extension:deathNotificationStatus.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.extension:deathNotificationStatus.extension:deathNotificationStatus.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.extension:deathNotificationStatus.extension:deathNotificationStatus.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	deathNotificationStatus
Mappings	rim: N/A
Patient.extension:deathNotificationStatus.extension:deathNotificationStatus.value[x]
Definition	The patient's death notification status.
Cardinality	1...1
Type	CodeableConcept
Binding	UKCoreDeathNotificationStatus (extensible)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.extension:deathNotificationStatus.extension:systemEffectiveDate
Definition	System effective date for patient's death notification status.
Cardinality	0...1
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.extension:deathNotificationStatus.extension:systemEffectiveDate.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.extension:deathNotificationStatus.extension:systemEffectiveDate.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.extension:deathNotificationStatus.extension:systemEffectiveDate.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	systemEffectiveDate
Mappings	rim: N/A
Patient.extension:deathNotificationStatus.extension:systemEffectiveDate.value[x]
Definition	System effective date for patient's death notification status.
Cardinality	1...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.extension:deathNotificationStatus.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeathNotificationStatus
Mappings	rim: N/A
Patient.extension:deathNotificationStatus.value[x]
Definition	Value of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality	0...0
Type	base64Binary
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.extension:ethnicCategory
Definition	The ethnicity of the subject.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Patient.extension:residentialStatus
Definition	The residential status of the patient. For example if this patient is a UK resident.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Patient.extension:patientInterpreterRequired
Definition	This Patient requires an interpreter to communicate healthcare information to the practitioner.
Cardinality	0...1
Type	Extension(boolean)
Alias	extensions, user content
Comments	The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Patient.extension:patientInterpreterRequired.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.extension:patientInterpreterRequired.extension
Definition	An Extension
Cardinality	0...0
Type	Extension
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.extension:patientInterpreterRequired.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired
Mappings	rim: N/A
Patient.extension:patientInterpreterRequired.value[x]
Definition	Indicator showing if this Patient requires an interpreter to communicate healthcare information to the practitioner.
Cardinality	1...1
Type	boolean
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.extension:nhsNumberUnavailableReason
Definition	The reason why a patient does not have an NHS Number. For example if this patient is an overseas patient.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A rim: n/a
Patient.modifierExtension
Definition	May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Patient.identifier
Definition	An identifier for this patient.
Cardinality	0...*
Type	Identifier
Must Support	True
Summary	True
Requirements	Patients are almost always assigned specific numerical identifiers.
Slicing	Unordered, Open, by system(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.identifier v2: PID-3 rim: id cda: .id
Patient.identifier:nhsNumber
Definition	An identifier for this patient.
Cardinality	0...1
Type	Identifier
Summary	True
Requirements	Patients are almost always assigned specific numerical identifiers.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.identifier v2: PID-3 rim: id cda: .id
Patient.identifier:nhsNumber.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.identifier:nhsNumber.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.identifier:nhsNumber.extension:nhsNumberVerificationStatus
Definition	The verification/tracing status of the NHS number.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Patient.identifier:nhsNumber.use
Definition	The purpose of this identifier.
Cardinality	0...1
Type	code
Binding	Identifies the purpose for this identifier, if known . IdentifierUse (required)
Modifier	True
Summary	True
Requirements	Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
Comments	Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: N/A rim: Role.code or implied by context
Patient.identifier:nhsNumber.type
Definition	A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Cardinality	0...1
Type	CodeableConcept
Binding	A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible)
Summary	True
Requirements	Allows users to make use of identifiers when the identifier system is not known.
Comments	This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: CX.5 rim: Role.code or implied by context
Patient.identifier:nhsNumber.system
Definition	Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Cardinality	1...1
Type	uri
Summary	True
Requirements	There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.
Comments	Identifier.system is always case sensitive.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Fixed Value	https://fhir.nhs.uk/Id/nhs-number
Mappings	v2: CX.4 / EI-2-4 rim: II.root or Role.id.root servd: ./IdentifierType
Patient.identifier:nhsNumber.value
Definition	The portion of the identifier typically relevant to the user and which is unique within the context of the system.
Cardinality	1...1
Type	string
Summary	True
Comments	If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General 123456
Mappings	v2: CX.1 / EI.1 rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd: ./Value
Patient.identifier:nhsNumber.period
Definition	Time period during which identifier is/was valid for use.
Cardinality	0...1
Type	Period
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: CX.7 + CX.8 rim: Role.effectiveTime or implied by context servd: ./StartDate and ./EndDate
Patient.identifier:nhsNumber.assigner
Definition	Organization that issued/manages the identifier.
Cardinality	0...1
Type	Reference(Organization)
Summary	True
Comments	The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: CX.4 / (CX.4,CX.9,CX.10) rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd: ./IdentifierIssuingAuthority
Patient.active
Definition	Whether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
Cardinality	0...1
Type	boolean
Must Support	True
Modifier	True
Summary	True
Requirements	Need to be able to mark a patient record as not to be used because it was created in error.
Comments	If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.status rim: statusCode cda: n/a
Patient.name
Definition	A name associated with the individual.
Cardinality	0...*
Type	HumanName
Must Support	True
Summary	True
Requirements	Need to be able to track the patient by multiple names. Examples are your official name and a partner name.
Comments	A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-5, PID-9 rim: name cda: .patient.name
Patient.telecom
Definition	A contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Cardinality	0...*
Type	ContactPoint
Must Support	True
Summary	True
Requirements	People have (primary) ways to contact them in some way such as phone, email.
Comments	A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-13, PID-14, PID-40 rim: telecom cda: .telecom
Patient.telecom.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.telecom.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.telecom.system
Definition	Telecommunications form for contact point - what communications system is required to make use of the contact.
Cardinality	0...1
Type	code
Binding	Telecommunications form for contact point. ContactPointSystem (required)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: XTN.3 rim: ./scheme servd: ./ContactPointType
Patient.telecom.system.id
Definition	unique id for the element within a resource (for internal references)
Cardinality	0...1
Type	string
Patient.telecom.system.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.telecom.system.extension:otherContactSystem
Definition	Other contact system value which extends the system element in the ContactPoint datatype.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Patient.telecom.system.value
Definition	Primitive value for code
Cardinality	0...1
Type	System.String
Patient.telecom.value
Definition	The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).
Cardinality	0...1
Type	string
Summary	True
Requirements	Need to support legacy numbers that are not in a tightly controlled format.
Comments	Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: XTN.1 (or XTN.12) rim: ./url servd: ./Value
Patient.telecom.use
Definition	Identifies the purpose for the contact point.
Cardinality	0...1
Type	code
Binding	Use of contact point. ContactPointUse (required)
Modifier	True
Summary	True
Requirements	Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.
Comments	Applications can assume that a contact is current unless it explicitly says that it is temporary or old.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: XTN.2 - but often indicated by field rim: unique(./use) servd: ./ContactPointPurpose
Patient.telecom.rank
Definition	Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Cardinality	0...1
Type	positiveInt
Summary	True
Comments	Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: n/a rim: n/a
Patient.telecom.period
Definition	Time period when the contact point was/is in use.
Cardinality	0...1
Type	Period
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: N/A rim: ./usablePeriod[type="IVL<TS>"] servd: ./StartDate and ./EndDate
Patient.gender
Definition	Administrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Cardinality	0...1
Type	code
Binding	The gender of a person used for administrative purposes. AdministrativeGender (required)
Must Support	True
Summary	True
Requirements	Needed for identification of the individual, in combination with (at least) name and birth date.
Comments	The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-8 rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/administrativeGender cda: .patient.administrativeGenderCode
Patient.birthDate
Definition	The date of birth for the individual.
Cardinality	0...1
Type	date
Must Support	True
Summary	True
Requirements	Age of the individual drives many clinical processes.
Comments	At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-7 rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/birthTime cda: .patient.birthTime loinc: 21112-8
Patient.birthDate.id
Definition	unique id for the element within a resource (for internal references)
Cardinality	0...1
Type	string
Patient.birthDate.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.birthDate.extension:birthTime
Definition	The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively.
Cardinality	0...1
Type	Extension(dateTime)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.birthDate.extension:birthTime.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.birthDate.extension:birthTime.extension
Definition	An Extension
Cardinality	0...0
Type	Extension
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.birthDate.extension:birthTime.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	http://hl7.org/fhir/StructureDefinition/patient-birthTime
Mappings	rim: N/A
Patient.birthDate.extension:birthTime.value[x]
Definition	The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively.
Cardinality	1...1
Type	dateTime
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.birthDate.value
Definition	The actual value
Cardinality	0...1
Type	System.Date
Patient.deceased[x]
Definition	Indicates if the individual is deceased or not.
Cardinality	0...1
Type	boolean
Modifier	True
Summary	True
Requirements	The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.
Comments	If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-30 (bool) and PID-29 (datetime) rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN\|ANM and determinerCode=INSTANCE]/deceasedTime cda: n/a
Patient.address
Definition	An address for the individual.
Cardinality	0...*
Type	Address
Must Support	True
Summary	True
Requirements	May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.
Comments	Patient may have multiple addresses with different uses or applicable periods.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-11 rim: addr cda: .addr
Patient.address.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.address.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.address.extension:addressKey
Definition	A patient's address key and type.
Cardinality	0...*
Type	Extension(Complex)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Patient.address.use
Definition	The purpose of this address.
Cardinality	0...1
Type	code
Binding	The use of an address. AddressUse (required)
Modifier	True
Summary	True
Requirements	Allows an appropriate address to be chosen from a list of many.
Comments	Applications can assume that an address is current unless it explicitly says that it is temporary or old.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General home
Mappings	v2: XAD.7 rim: unique(./use) servd: ./AddressPurpose
Patient.address.type
Definition	Distinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
Cardinality	0...1
Type	code
Binding	The type of an address (physical / postal). AddressType (required)
Summary	True
Comments	The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General both
Mappings	v2: XAD.18 rim: unique(./use) vcard: address type parameter
Patient.address.text
Definition	Specifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
Cardinality	0...1
Type	string
Summary	True
Requirements	A renderable, unencoded form.
Comments	Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General 137 Nowhere Street, Erewhon 9132
Mappings	v2: XAD.1 + XAD.2 + XAD.3 + XAD.4 + XAD.5 + XAD.6 rim: ./formatted vcard: address label parameter
Patient.address.line
Definition	This component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.
Cardinality	0...*
Type	string
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General 137 Nowhere Street
Mappings	v2: XAD.1 + XAD.2 (note: XAD.1 and XAD.2 have different meanings for a company address than for a person address) rim: AD.part[parttype = AL] vcard: street servd: ./StreetAddress (newline delimitted)
Patient.address.city
Definition	The name of the city, town, suburb, village or other community or delivery center.
Cardinality	0...1
Type	string
Summary	True
Alias	Municpality
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General Erewhon
Mappings	v2: XAD.3 rim: AD.part[parttype = CTY] vcard: locality servd: ./Jurisdiction
Patient.address.district
Definition	The name of the administrative area (county).
Cardinality	0...1
Type	string
Summary	True
Alias	County
Comments	District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General Madison
Mappings	v2: XAD.9 rim: AD.part[parttype = CNT \| CPA]
Patient.address.state
Definition	Sub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).
Cardinality	0...1
Type	string
Summary	True
Alias	Province, Territory
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: XAD.4 rim: AD.part[parttype = STA] vcard: region servd: ./Region
Patient.address.postalCode
Definition	A postal code designating a region defined by the postal service.
Cardinality	0...1
Type	string
Summary	True
Alias	Zip
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General 9132
Mappings	v2: XAD.5 rim: AD.part[parttype = ZIP] vcard: code servd: ./PostalIdentificationCode
Patient.address.country
Definition	Country - a nation as commonly understood or generally accepted.
Cardinality	0...1
Type	string
Summary	True
Comments	ISO 3166 3 letter codes can be used in place of a human readable country name.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: XAD.6 rim: AD.part[parttype = CNT] vcard: country servd: ./Country
Patient.address.period
Definition	Time period when address was/is in use.
Cardinality	0...1
Type	Period
Summary	True
Requirements	Allows addresses to be placed in historical context.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Examples	General { "start": "2010-03-23", "end": "2010-07-01" }
Mappings	v2: XAD.12 / XAD.13 + XAD.14 rim: ./usablePeriod[type="IVL<TS>"] servd: ./StartDate and ./EndDate
Patient.maritalStatus
Definition	This field contains a patient's most recent marital (civil) status.
Cardinality	0...1
Type	CodeableConcept
Binding	An indicator to identify the legal marital status of a person UKCorePersonMaritalStatusCode (extensible)
Requirements	Most, if not all systems capture it.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-16 rim: player[classCode=PSN]/maritalStatusCode cda: .patient.maritalStatusCode
Patient.multipleBirth[x]
Definition	Indicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Cardinality	0...1
Type	boolean
Requirements	For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.
Comments	Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-24 (bool), PID-25 (integer) rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN\|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber cda: n/a
Patient.photo
Definition	Image of the patient.
Cardinality	0...*
Type	Attachment
Requirements	Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.
Comments	Guidelines: Use id photos, not clinical photos. Limit dimensions to thumbnail. Keep byte count low to ease resource updates.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: OBX-5 - needs a profile rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/desc cda: n/a
Patient.contact
Definition	A contact party (e.g. guardian, partner, friend) for the patient.
Cardinality	0...*
Type	BackboneElement
Requirements	Need to track people you can contact about the patient.
Comments	Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` pat-1: SHALL at least contain a contact's details or a reference to an organization `name.exists() or telecom.exists() or address.exists() or organization.exists()`
Mappings	rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON] cda: n/a
Patient.contact.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.contact.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.contact.extension:contactRank
Definition	The preferred ranking or order of contact applied to a contact on a patient's contact list.
Cardinality	0...1
Type	Extension(positiveInt)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Patient.contact.extension:copyCorrespondenceIndicator
Definition	Extension carrying a boolean indicator showing that a patient's contact or related person SHALL be copied in to patient correspondence.
Cardinality	0...1
Type	Extension(boolean)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Patient.contact.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Patient.contact.relationship
Definition	The nature of the relationship between the patient and the contact person.
Cardinality	0...*
Type	CodeableConcept
Binding	The nature of the relationship between a patient and a contact person for that patient. UKCorePersonRelationshipType (extensible)
Requirements	Used to determine which contact person is the most relevant to approach, depending on circumstances.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NK1-7, NK1-3 rim: code cda: n/a
Patient.contact.name
Definition	A name associated with the contact person.
Cardinality	0...1
Type	HumanName
Requirements	Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NK1-2 rim: name cda: n/a
Patient.contact.telecom
Definition	A contact detail for the person, e.g. a telephone number or an email address.
Cardinality	0...*
Type	ContactPoint
Requirements	People have (primary) ways to contact them in some way such as phone, email.
Comments	Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NK1-5, NK1-6, NK1-40 rim: telecom cda: n/a
Patient.contact.telecom.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.contact.telecom.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.contact.telecom.system
Definition	Telecommunications form for contact point - what communications system is required to make use of the contact.
Cardinality	0...1
Type	code
Binding	Telecommunications form for contact point. ContactPointSystem (required)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: XTN.3 rim: ./scheme servd: ./ContactPointType
Patient.contact.telecom.system.id
Definition	unique id for the element within a resource (for internal references)
Cardinality	0...1
Type	string
Patient.contact.telecom.system.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.contact.telecom.system.extension:otherContactSystem
Definition	Other contact system value which extends the system element in the ContactPoint datatype.
Cardinality	0...1
Type	Extension(CodeableConcept)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a rim: N/A
Patient.contact.telecom.system.value
Definition	Primitive value for code
Cardinality	0...1
Type	System.String
Patient.contact.telecom.value
Definition	The actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).
Cardinality	0...1
Type	string
Summary	True
Requirements	Need to support legacy numbers that are not in a tightly controlled format.
Comments	Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: XTN.1 (or XTN.12) rim: ./url servd: ./Value
Patient.contact.telecom.use
Definition	Identifies the purpose for the contact point.
Cardinality	0...1
Type	code
Binding	Use of contact point. ContactPointUse (required)
Modifier	True
Summary	True
Requirements	Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.
Comments	Applications can assume that a contact is current unless it explicitly says that it is temporary or old.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: XTN.2 - but often indicated by field rim: unique(./use) servd: ./ContactPointPurpose
Patient.contact.telecom.rank
Definition	Specifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Cardinality	0...1
Type	positiveInt
Summary	True
Comments	Note that rank does not necessarily follow the order in which the contacts are represented in the instance.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: n/a rim: n/a
Patient.contact.telecom.period
Definition	Time period when the contact point was/is in use.
Cardinality	0...1
Type	Period
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: N/A rim: ./usablePeriod[type="IVL<TS>"] servd: ./StartDate and ./EndDate
Patient.contact.address
Definition	Address for the contact person.
Cardinality	0...1
Type	Address
Requirements	Need to keep track where the contact person can be contacted per postal mail or visited.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NK1-4 rim: addr cda: n/a
Patient.contact.gender
Definition	Administrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
Cardinality	0...1
Type	code
Binding	The gender of a person used for administrative purposes. AdministrativeGender (required)
Requirements	Needed to address the person correctly.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NK1-15 rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/administrativeGender cda: n/a
Patient.contact.organization
Definition	Organization on behalf of which the contact is acting or for which the contact is working.
Cardinality	0...1
Type	Reference(Organization)
Requirements	For guardians or business related contacts, the organization is relevant.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: NK1-13, NK1-30, NK1-31, NK1-32, NK1-41 rim: scoper cda: n/a
Patient.contact.period
Definition	The period during which this contact person or organization is valid to be contacted relating to this patient.
Cardinality	0...1
Type	Period
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: effectiveTime cda: n/a
Patient.communication
Definition	A language which may be used to communicate with the patient about his or her health.
Cardinality	0...*
Type	BackboneElement
Requirements	If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.
Comments	If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: LanguageCommunication cda: patient.languageCommunication
Patient.communication.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.communication.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.communication.extension:proficiency
Definition	Proficiency level of the communication.
Cardinality	0...1
Type	Extension(Complex)
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.communication.extension:proficiency.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.communication.extension:proficiency.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.communication.extension:proficiency.extension:level
Definition	How well the patient can communicate this communication (good, poor, etc.).
Cardinality	0...1
Type	Extension
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.communication.extension:proficiency.extension:level.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.communication.extension:proficiency.extension:level.extension
Definition	An Extension
Cardinality	0...0
Type	Extension
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.communication.extension:proficiency.extension:level.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	level
Mappings	rim: N/A
Patient.communication.extension:proficiency.extension:level.value[x]
Definition	The proficiency level for the communication.
Cardinality	1...1
Type	Coding
Binding	The proficiency level for the communication. v3.LanguageAbilityProficiency (preferred)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.communication.extension:proficiency.extension:type
Definition	What type of communication for the proficiency (spoken, written, etc.).
Cardinality	0...*
Type	Extension
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.communication.extension:proficiency.extension:type.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.communication.extension:proficiency.extension:type.extension
Definition	An Extension
Cardinality	0...0
Type	Extension
Slicing	Unordered, Open, by url(Value)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Patient.communication.extension:proficiency.extension:type.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	type
Mappings	rim: N/A
Patient.communication.extension:proficiency.extension:type.value[x]
Definition	The proficiency type for the communication.
Cardinality	1...1
Type	Coding
Binding	The proficiency type for the communication. v3.LanguageAbilityMode (preferred)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.communication.extension:proficiency.url
Definition	Source of the definition for the extension code - a logical name or a URL.
Cardinality	1...1
Type	uri
Comments	The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.
Fixed Value	http://hl7.org/fhir/StructureDefinition/patient-proficiency
Mappings	rim: N/A
Patient.communication.extension:proficiency.value[x]
Definition	Value of extension - must be one of a constrained set of the data types (see [Extensibility](http://hl7.org/fhir/extensibility.html) for a list).
Cardinality	0...0
Type	base64Binary
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: N/A
Patient.communication.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Patient.communication.language
Definition	A ValueSet that identifies the language used by a person.
Cardinality	1...1
Type	CodeableConcept
Binding	A ValueSet that identifies the language used by a person. AllLanguages (required)
Requirements	Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.
Comments	The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-15, LAN-2 rim: player[classCode=PSN\|ANM and determinerCode=INSTANCE]/languageCommunication/code cda: .languageCode
Patient.communication.preferred
Definition	Indicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Cardinality	0...1
Type	boolean
Requirements	People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.
Comments	This language is specifically identified for communicating healthcare information.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-15 rim: preferenceInd cda: .preferenceInd
Patient.generalPractitioner
Definition	Patient's nominated care provider.
Cardinality	0...*
Type	Reference(Organization \| Practitioner \| PractitionerRole)
Alias	careProvider
Comments	This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues. Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PD1-4 rim: subjectOf.CareEvent.performer.AssignedEntity cda: n/a
Patient.managingOrganization
Definition	Organization that is the custodian of the patient record.
Cardinality	0...1
Type	Reference(Organization)
Summary	True
Requirements	Need to know who recognizes this patient record, manages and updates it.
Comments	There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: scoper cda: .providerOrganization
Patient.link
Definition	Link to another patient resource that concerns the same actual patient.
Cardinality	0...*
Type	BackboneElement
Modifier	True
Summary	True
Requirements	There are multiple use cases: Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and Distribution of patient information across multiple servers.
Comments	There is no assumption that linked patient records have mutual links.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: outboundLink cda: n/a
Patient.link.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Patient.link.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Patient.link.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Patient.link.other
Definition	The other patient resource that the link refers to.
Cardinality	1...1
Type	Reference(Patient \| RelatedPerson)
Summary	True
Comments	Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: PID-3, MRG-1 rim: id cda: n/a
Patient.link.type
Definition	The type of link between this patient resource and another patient resource.
Cardinality	1...1
Type	code
Binding	The type of link between this patient resource and another patient resource. LinkType (required)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: typeCode cda: n/a

Patient		..
Patient.extension	Extension	..
Patient.extension.value[x]		..
Patient.extension	Extension	..
Patient.extension	Extension	..
Patient.extension.value[x]		..
Patient.extension	Extension	..
Patient.extension	Extension	..
Patient.extension.extension		1..
Patient.extension	Extension	..1
Patient.extension	Extension	..
Patient.extension	Extension	..
Patient.extension.value[x]		..
Patient.extension	Extension	..
Patient.identifier		..
Patient.identifier		..1
Patient.identifier.extension	Extension	..1
Patient.identifier.system		1..
Patient.identifier.value		1..
Patient.active		..
Patient.name		..
Patient.telecom		..
Patient.telecom.system		..
Patient.telecom.system.extension	Extension	..
Patient.gender		..
Patient.birthDate		..
Patient.birthDate.extension	Extension	..
Patient.birthDate.extension.value[x]		..
Patient.address		..
Patient.address.extension	Extension	..
Patient.maritalStatus		..
Patient.contact		..
Patient.contact.extension	Extension	..
Patient.contact.extension	Extension	..
Patient.contact.relationship		..
Patient.contact.telecom		..
Patient.contact.telecom.system		..
Patient.contact.telecom.system.extension	Extension	..
Patient.communication		..
Patient.communication.extension	Extension	..1
Patient.communication.extension.extension		..
Patient.communication.extension.extension.value[x]		..
Patient.communication.extension.extension		..
Patient.communication.extension.extension.value[x]		..
Patient.communication.language		..

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Patient" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient" />
    <version value="2.5.0" />
    <name value="UKCorePatient" />
    <title value="UK Core Patient" />
    <status value="active" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Patient](https://hl7.org/fhir/R4/Patient.html)." />
    <purpose value="This profile allows exchange of demographics and other administrative information about an individual receiving care or other health-related services." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Patient" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Patient" />
    <derivation value="constraint" />
    <differential>
        <element id="Patient.extension:birthPlace">
            <path value="Patient.extension" />
            <sliceName value="birthPlace" />
            <short value="The registered place of birth of the patient." />
            <definition value="The registered place of birth of the patient." />
            <type>
                <code value="Extension" />
                <profile value="http://hl7.org/fhir/StructureDefinition/patient-birthPlace" />
            </type>
        </element>
        <element id="Patient.extension:birthPlace.value[x]">
            <path value="Patient.extension.value[x]" />
            <short value="The registered place of birth of the patient." />
        </element>
        <element id="Patient.extension:birthSex">
            <path value="Patient.extension" />
            <sliceName value="birthSex" />
            <short value="The patient&#39;s phenotypic sex at birth." />
            <definition value="The patient&#39;s phenotypic sex at birth." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BirthSex" />
            </type>
        </element>
        <element id="Patient.extension:cadavericDonor">
            <path value="Patient.extension" />
            <sliceName value="cadavericDonor" />
            <short value="Post-mortem donor status." />
            <type>
                <code value="Extension" />
                <profile value="http://hl7.org/fhir/StructureDefinition/patient-cadavericDonor" />
            </type>
        </element>
        <element id="Patient.extension:cadavericDonor.value[x]">
            <path value="Patient.extension.value[x]" />
            <short value="Post-mortem donor status." />
            <definition value="Flag indicating whether the patient authorized the donation of body parts after death." />
        </element>
        <element id="Patient.extension:contactPreference">
            <path value="Patient.extension" />
            <sliceName value="contactPreference" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ContactPreference" />
            </type>
        </element>
        <element id="Patient.extension:deathNotificationStatus">
            <path value="Patient.extension" />
            <sliceName value="deathNotificationStatus" />
            <short value="The patient&#39;s death notification status." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeathNotificationStatus" />
            </type>
        </element>
        <element id="Patient.extension:deathNotificationStatus.extension">
            <path value="Patient.extension.extension" />
            <min value="1" />
        </element>
        <element id="Patient.extension:ethnicCategory">
            <path value="Patient.extension" />
            <sliceName value="ethnicCategory" />
            <short value="The ethnicity of the subject." />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-EthnicCategory" />
            </type>
        </element>
        <element id="Patient.extension:residentialStatus">
            <path value="Patient.extension" />
            <sliceName value="residentialStatus" />
            <short value="The residential status of the patient." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ResidentialStatus" />
            </type>
        </element>
        <element id="Patient.extension:patientInterpreterRequired">
            <path value="Patient.extension" />
            <sliceName value="patientInterpreterRequired" />
            <short value="Indicator showing whether the patient needs an interpreter." />
            <type>
                <code value="Extension" />
                <profile value="http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired" />
            </type>
        </element>
        <element id="Patient.extension:patientInterpreterRequired.value[x]">
            <path value="Patient.extension.value[x]" />
            <short value="Indicator showing whether the patient needs an interpreter" />
            <definition value="Indicator showing if this Patient requires an interpreter to communicate healthcare information to the practitioner." />
        </element>
        <element id="Patient.extension:nhsNumberUnavailableReason">
            <path value="Patient.extension" />
            <sliceName value="nhsNumberUnavailableReason" />
            <short value="Reason why this Patient does not include an NHS Number identifier." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberUnavailableReason" />
            </type>
            <isModifier value="false" />
        </element>
        <element id="Patient.identifier">
            <path value="Patient.identifier" />
            <slicing>
                <discriminator>
                    <type value="value" />
                    <path value="system" />
                </discriminator>
                <ordered value="false" />
                <rules value="open" />
            </slicing>
            <short value="An identifier for this patient." />
            <mustSupport value="true" />
        </element>
        <element id="Patient.identifier:nhsNumber">
            <path value="Patient.identifier" />
            <sliceName value="nhsNumber" />
            <short value="The patient&#39;s NHS number." />
            <max value="1" />
            <mustSupport value="false" />
        </element>
        <element id="Patient.identifier:nhsNumber.extension:nhsNumberVerificationStatus">
            <path value="Patient.identifier.extension" />
            <sliceName value="nhsNumberVerificationStatus" />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus" />
            </type>
            <mustSupport value="false" />
        </element>
        <element id="Patient.identifier:nhsNumber.system">
            <path value="Patient.identifier.system" />
            <min value="1" />
            <fixedUri value="https://fhir.nhs.uk/Id/nhs-number" />
        </element>
        <element id="Patient.identifier:nhsNumber.value">
            <path value="Patient.identifier.value" />
            <min value="1" />
        </element>
        <element id="Patient.active">
            <path value="Patient.active" />
            <short value="Whether this patient&#39;s record is in active use." />
            <mustSupport value="true" />
        </element>
        <element id="Patient.name">
            <path value="Patient.name" />
            <short value="A name associated with the patient." />
            <mustSupport value="true" />
        </element>
        <element id="Patient.telecom">
            <path value="Patient.telecom" />
            <short value="A contact detail for the individual." />
            <mustSupport value="true" />
        </element>
        <element id="Patient.telecom.system.extension:otherContactSystem">
            <path value="Patient.telecom.system.extension" />
            <sliceName value="otherContactSystem" />
            <short value="Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OtherContactSystem" />
            </type>
        </element>
        <element id="Patient.gender">
            <path value="Patient.gender" />
            <short value="The gender that the patient is considered to have for administration and record keeping purposes." />
            <mustSupport value="true" />
        </element>
        <element id="Patient.birthDate">
            <path value="Patient.birthDate" />
            <short value="The date of birth for the individual." />
            <mustSupport value="true" />
        </element>
        <element id="Patient.birthDate.extension:birthTime">
            <path value="Patient.birthDate.extension" />
            <sliceName value="birthTime" />
            <short value="The time of day that the patient was born. This SHOULD be included when the birth time is relevant." />
            <definition value="The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively." />
            <type>
                <code value="Extension" />
                <profile value="http://hl7.org/fhir/StructureDefinition/patient-birthTime" />
            </type>
        </element>
        <element id="Patient.birthDate.extension:birthTime.value[x]">
            <path value="Patient.birthDate.extension.value[x]" />
            <short value="Time of day of birth." />
            <definition value="The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively." />
        </element>
        <element id="Patient.address">
            <path value="Patient.address" />
            <definition value="An address for the individual." />
            <mustSupport value="true" />
        </element>
        <element id="Patient.address.extension:addressKey">
            <path value="Patient.address.extension" />
            <sliceName value="addressKey" />
            <short value="A patient&#39;s address key and type" />
            <definition value="A patient&#39;s address key and type." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AddressKey" />
            </type>
            <mustSupport value="false" />
        </element>
        <element id="Patient.maritalStatus">
            <path value="Patient.maritalStatus" />
            <binding>
                <strength value="extensible" />
                <description value="An indicator to identify the legal marital status of a person" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-PersonMaritalStatusCode" />
            </binding>
        </element>
        <element id="Patient.contact.extension:contactRank">
            <path value="Patient.contact.extension" />
            <sliceName value="contactRank" />
            <short value="The preferred ranking or order of contact applied to a contact on a Patient&#39;s contact list." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ContactRank" />
            </type>
        </element>
        <element id="Patient.contact.extension:copyCorrespondenceIndicator">
            <path value="Patient.contact.extension" />
            <sliceName value="copyCorrespondenceIndicator" />
            <short value="Indicates that a must be copied in to all related correspondence." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-CopyCorrespondenceIndicator" />
            </type>
        </element>
        <element id="Patient.contact.relationship">
            <path value="Patient.contact.relationship" />
            <binding>
                <strength value="extensible" />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-PersonRelationshipType" />
            </binding>
        </element>
        <element id="Patient.contact.telecom.system.extension:otherContactSystem">
            <path value="Patient.contact.telecom.system.extension" />
            <sliceName value="otherContactSystem" />
            <short value="Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`." />
            <type>
                <code value="Extension" />
                <profile value="https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OtherContactSystem" />
            </type>
        </element>
        <element id="Patient.communication.extension:proficiency">
            <path value="Patient.communication.extension" />
            <sliceName value="proficiency" />
            <short value="The patient&#39;s proficiency level of the communication method." />
            <max value="1" />
            <type>
                <code value="Extension" />
                <profile value="http://hl7.org/fhir/StructureDefinition/patient-proficiency" />
            </type>
        </element>
        <element id="Patient.communication.extension:proficiency.extension:level">
            <path value="Patient.communication.extension.extension" />
            <sliceName value="level" />
        </element>
        <element id="Patient.communication.extension:proficiency.extension:level.value[x]">
            <path value="Patient.communication.extension.extension.value[x]" />
            <short value="The proficiency level for the communication" />
            <definition value="The proficiency level for the communication." />
        </element>
        <element id="Patient.communication.extension:proficiency.extension:type">
            <path value="Patient.communication.extension.extension" />
            <sliceName value="type" />
        </element>
        <element id="Patient.communication.extension:proficiency.extension:type.value[x]">
            <path value="Patient.communication.extension.extension.value[x]" />
            <short value="The proficiency type for the communication" />
            <definition value="The proficiency type for the communication." />
        </element>
        <element id="Patient.communication.language">
            <path value="Patient.communication.language" />
            <short value="A ValueSet that identifies the language used by a person." />
            <definition value="A ValueSet that identifies the language used by a person." />
            <binding>
                <strength value="required" />
                <description value="A ValueSet that identifies the language used by a person." />
                <valueSet value="http://hl7.org/fhir/ValueSet/all-languages" />
            </binding>
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Patient",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient",
    "version": "2.5.0",
    "name": "UKCorePatient",
    "title": "UK Core Patient",
    "status": "active",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Patient](https://hl7.org/fhir/R4/Patient.html).",
    "purpose": "This profile allows exchange of demographics and other administrative information about an individual receiving care or other health-related services.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Patient",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Patient",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Patient.extension:birthPlace",
                "path": "Patient.extension",
                "sliceName": "birthPlace",
                "short": "The registered place of birth of the patient.",
                "definition": "The registered place of birth of the patient.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/StructureDefinition/patient-birthPlace"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.extension:birthPlace.value[x]",
                "path": "Patient.extension.value[x]",
                "short": "The registered place of birth of the patient."
            },
            {
                "id": "Patient.extension:birthSex",
                "path": "Patient.extension",
                "sliceName": "birthSex",
                "short": "The patient's phenotypic sex at birth.",
                "definition": "The patient's phenotypic sex at birth.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BirthSex"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.extension:cadavericDonor",
                "path": "Patient.extension",
                "sliceName": "cadavericDonor",
                "short": "Post-mortem donor status.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/StructureDefinition/patient-cadavericDonor"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.extension:cadavericDonor.value[x]",
                "path": "Patient.extension.value[x]",
                "short": "Post-mortem donor status.",
                "definition": "Flag indicating whether the patient authorized the donation of body parts after death."
            },
            {
                "id": "Patient.extension:contactPreference",
                "path": "Patient.extension",
                "sliceName": "contactPreference",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ContactPreference"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.extension:deathNotificationStatus",
                "path": "Patient.extension",
                "sliceName": "deathNotificationStatus",
                "short": "The patient's death notification status.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-DeathNotificationStatus"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.extension:deathNotificationStatus.extension",
                "path": "Patient.extension.extension",
                "min": 1
            },
            {
                "id": "Patient.extension:ethnicCategory",
                "path": "Patient.extension",
                "sliceName": "ethnicCategory",
                "short": "The ethnicity of the subject.",
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-EthnicCategory"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.extension:residentialStatus",
                "path": "Patient.extension",
                "sliceName": "residentialStatus",
                "short": "The residential status of the patient.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ResidentialStatus"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.extension:patientInterpreterRequired",
                "path": "Patient.extension",
                "sliceName": "patientInterpreterRequired",
                "short": "Indicator showing whether the patient needs an interpreter.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.extension:patientInterpreterRequired.value[x]",
                "path": "Patient.extension.value[x]",
                "short": "Indicator showing whether the patient needs an interpreter",
                "definition": "Indicator showing if this Patient requires an interpreter to communicate healthcare information to the practitioner."
            },
            {
                "id": "Patient.extension:nhsNumberUnavailableReason",
                "path": "Patient.extension",
                "sliceName": "nhsNumberUnavailableReason",
                "short": "Reason why this Patient does not include an NHS Number identifier.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberUnavailableReason"
                        ]
                    }
                ],
                "isModifier": false
            },
            {
                "id": "Patient.identifier",
                "path": "Patient.identifier",
                "short": "An identifier for this patient.",
                "slicing": {
                    "discriminator":  [
                        {
                            "type": "value",
                            "path": "system"
                        }
                    ],
                    "ordered": false,
                    "rules": "open"
                },
                "mustSupport": true
            },
            {
                "id": "Patient.identifier:nhsNumber",
                "path": "Patient.identifier",
                "sliceName": "nhsNumber",
                "short": "The patient's NHS number.",
                "max": "1",
                "mustSupport": false
            },
            {
                "id": "Patient.identifier:nhsNumber.extension:nhsNumberVerificationStatus",
                "path": "Patient.identifier.extension",
                "sliceName": "nhsNumberVerificationStatus",
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus"
                        ]
                    }
                ],
                "mustSupport": false
            },
            {
                "id": "Patient.identifier:nhsNumber.system",
                "path": "Patient.identifier.system",
                "min": 1,
                "fixedUri": "https://fhir.nhs.uk/Id/nhs-number"
            },
            {
                "id": "Patient.identifier:nhsNumber.value",
                "path": "Patient.identifier.value",
                "min": 1
            },
            {
                "id": "Patient.active",
                "path": "Patient.active",
                "short": "Whether this patient's record is in active use.",
                "mustSupport": true
            },
            {
                "id": "Patient.name",
                "path": "Patient.name",
                "short": "A name associated with the patient.",
                "mustSupport": true
            },
            {
                "id": "Patient.telecom",
                "path": "Patient.telecom",
                "short": "A contact detail for the individual.",
                "mustSupport": true
            },
            {
                "id": "Patient.telecom.system.extension:otherContactSystem",
                "path": "Patient.telecom.system.extension",
                "sliceName": "otherContactSystem",
                "short": "Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OtherContactSystem"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.gender",
                "path": "Patient.gender",
                "short": "The gender that the patient is considered to have for administration and record keeping purposes.",
                "mustSupport": true
            },
            {
                "id": "Patient.birthDate",
                "path": "Patient.birthDate",
                "short": "The date of birth for the individual.",
                "mustSupport": true
            },
            {
                "id": "Patient.birthDate.extension:birthTime",
                "path": "Patient.birthDate.extension",
                "sliceName": "birthTime",
                "short": "The time of day that the patient was born. This SHOULD be included when the birth time is relevant.",
                "definition": "The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/StructureDefinition/patient-birthTime"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.birthDate.extension:birthTime.value[x]",
                "path": "Patient.birthDate.extension.value[x]",
                "short": "Time of day of birth.",
                "definition": "The time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively."
            },
            {
                "id": "Patient.address",
                "path": "Patient.address",
                "definition": "An address for the individual.",
                "mustSupport": true
            },
            {
                "id": "Patient.address.extension:addressKey",
                "path": "Patient.address.extension",
                "sliceName": "addressKey",
                "short": "A patient's address key and type",
                "definition": "A patient's address key and type.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AddressKey"
                        ]
                    }
                ],
                "mustSupport": false
            },
            {
                "id": "Patient.maritalStatus",
                "path": "Patient.maritalStatus",
                "binding": {
                    "strength": "extensible",
                    "description": "An indicator to identify the legal marital status of a person",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-PersonMaritalStatusCode"
                }
            },
            {
                "id": "Patient.contact.extension:contactRank",
                "path": "Patient.contact.extension",
                "sliceName": "contactRank",
                "short": "The preferred ranking or order of contact applied to a contact on a Patient's contact list.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-ContactRank"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.contact.extension:copyCorrespondenceIndicator",
                "path": "Patient.contact.extension",
                "sliceName": "copyCorrespondenceIndicator",
                "short": "Indicates that a must be copied in to all related correspondence.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-CopyCorrespondenceIndicator"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.contact.relationship",
                "path": "Patient.contact.relationship",
                "binding": {
                    "strength": "extensible",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-PersonRelationshipType"
                }
            },
            {
                "id": "Patient.contact.telecom.system.extension:otherContactSystem",
                "path": "Patient.contact.telecom.system.extension",
                "sliceName": "otherContactSystem",
                "short": "Information about other contact methods which could be used in addition to those listed in `ContactPoint.system`.",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-OtherContactSystem"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.communication.extension:proficiency",
                "path": "Patient.communication.extension",
                "sliceName": "proficiency",
                "short": "The patient's proficiency level of the communication method.",
                "max": "1",
                "type":  [
                    {
                        "code": "Extension",
                        "profile":  [
                            "http://hl7.org/fhir/StructureDefinition/patient-proficiency"
                        ]
                    }
                ]
            },
            {
                "id": "Patient.communication.extension:proficiency.extension:level",
                "path": "Patient.communication.extension.extension",
                "sliceName": "level"
            },
            {
                "id": "Patient.communication.extension:proficiency.extension:level.value[x]",
                "path": "Patient.communication.extension.extension.value[x]",
                "short": "The proficiency level for the communication",
                "definition": "The proficiency level for the communication."
            },
            {
                "id": "Patient.communication.extension:proficiency.extension:type",
                "path": "Patient.communication.extension.extension",
                "sliceName": "type"
            },
            {
                "id": "Patient.communication.extension:proficiency.extension:type.value[x]",
                "path": "Patient.communication.extension.extension.value[x]",
                "short": "The proficiency type for the communication",
                "definition": "The proficiency type for the communication."
            },
            {
                "id": "Patient.communication.language",
                "path": "Patient.communication.language",
                "short": "A ValueSet that identifies the language used by a person.",
                "definition": "A ValueSet that identifies the language used by a person.",
                "binding": {
                    "strength": "required",
                    "description": "A ValueSet that identifies the language used by a person.",
                    "valueSet": "http://hl7.org/fhir/ValueSet/all-languages"
                }
            }
        ]
    }
}

Propose a change to UKCore-Patient

StructureDefinition UKCore-Procedure

UKCoreProcedure (Procedure)	I		Procedure	There are no (further) constraints on this element Element id Procedure Short description An action that is being or was performed on a patient Definition An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy. Data type Procedure Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() Mappings rim: Entity. Role, or Act workflow: Event rim: Procedure[moodCode=EVN]
id	Σ	0..1	string	There are no (further) constraints on this element Element id Procedure.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id Procedure.meta Short description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id Procedure.implicitRules Short description A set of rules under which this content was created Definition A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Comments 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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
language		0..1	codeBinding	There are no (further) constraints on this element Element id Procedure.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
text		0..1	Narrative	There are no (further) constraints on this element Element id Procedure.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition A human-readable narrative that contains a summary of the resource and can 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. Comments 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 information is added later. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id Procedure.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition These 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. Comments 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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. Data type Resource Mappings rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Procedure.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id Procedure.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
identifier	Σ	0..*	Identifier	There are no (further) constraints on this element Element id Procedure.identifier Short description External Identifiers for this procedure Definition Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server. Requirements Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers. Comments This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.identifier w5: FiveWs.identifier v2: Some combination of ORC-2 / ORC-3 / OBR-2 / OBR-3 / IPC-1 / IPC-2 / IPC-3 / IPC-4 rim: .id
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition \| ActivityDefinition \| Measure \| OperationDefinition \| Questionnaire)	There are no (further) constraints on this element Element id Procedure.instantiatesCanonical Short description Instantiates FHIR protocol or definition Definition The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure. Data type canonical(PlanDefinition \| ActivityDefinition \| Measure \| OperationDefinition \| Questionnaire) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.instantiatesCanonical rim: .outboundRelationship[typeCode=DEFN].target
instantiatesUri	Σ	0..*	uri	There are no (further) constraints on this element Element id Procedure.instantiatesUri Short description Instantiates external protocol or definition Definition The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure. Comments This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.instantiatesUri rim: .outboundRelationship[typeCode=DEFN].target
basedOn	Σ	0..*	Reference(CarePlan \| ServiceRequest)	There are no (further) constraints on this element Element id Procedure.basedOn Short description A request for this procedure Alternate names fulfills Definition A reference to a resource that contains details of the request for this procedure. Data type Reference(CarePlan \| ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.basedOn rim: .outboundRelationship[typeCode=FLFS].target[classCode=(various e.g. PROC, OBS, PCPR, ACT, moodCode=RQO].code
partOf	Σ	0..*	Reference(Procedure \| Observation \| MedicationAdministration)	There are no (further) constraints on this element Element id Procedure.partOf Short description Part of referenced event Alternate names container Definition A larger event of which this particular procedure is a component or step. Comments The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration). Data type Reference(Procedure \| Observation \| MedicationAdministration) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.partOf rim: .inboundRelationship[typeCode=COMP].source[classCode=SBADM or PROC or OBS, moodCode=EVN]
status	S Σ ?!	1..1	codeBinding	Element id Procedure.status Short description A code specifying the state of the procedure. Definition A code specifying the state of the procedure. Generally, this will be the in-progress or completed state. Comments 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 procedure. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid. Data type code Binding A code specifying the state of the procedure. EventStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.status w5: FiveWs.status rim: statusCode
statusReason	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element id Procedure.statusReason Short description Reason for current status Alternate names Suspended Reason, Cancelled Reason Definition Captures the reason for the current state of the procedure. Comments This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here. Data type CodeableConcept Binding A code that identifies the reason a procedure was not performed. ProcedureNotPerformedReason(SNOMED-CT) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.statusReason rim: .reason.Observation.value
category	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element id Procedure.category Short description Classification of the procedure Definition A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure"). Data type CodeableConcept Binding A code that classifies a procedure for searching, sorting and display purposes. ProcedureCategoryCodes(SNOMEDCT) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.class rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
code	S Σ	0..1	CodeableConceptBinding	Element id Procedure.code Short description A code identifying the procedure performed. Alternate names type Definition The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy"). Requirements 0..1 to account for primarily narrative only resources. Data type CodeableConcept Binding A code from the SNOMED Clinical Terminology UK. UKCoreProcedureCode (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.code w5: FiveWs.what[x] v2: OBR-44/OBR-45 rim: .code
subject	S Σ	1..1	Reference(Patient \| Group)	Element id Procedure.subject Short description Who the procedure was performed on. Alternate names patient Definition The person, animal or group on which the procedure was performed. Data type Reference(Patient \| Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 rim: .participation[typeCode=SBJ].role w5: FiveWs.subject
encounter	Σ	0..1	Reference(Encounter)	There are no (further) constraints on this element Element id Procedure.encounter Short description Encounter created as part of Definition The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated. Comments This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.context w5: FiveWs.context v2: PV1-19 rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
performed[x]	S Σ	0..1		Element id Procedure.performed[x] Short description When the procedure was performed. Definition Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured. Comments Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone. Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: OBR-7 rim: .effectiveTime
performedDateTime			dateTime	There are no (further) constraints on this element Data type dateTime
performedPeriod			Period	There are no (further) constraints on this element Data type Period
performedString			string	There are no (further) constraints on this element Data type string
performedAge			Age	There are no (further) constraints on this element Data type Age
performedRange			Range	There are no (further) constraints on this element Data type Range
recorder	Σ	0..1	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id Procedure.recorder Short description Who recorded the procedure Definition Individual who recorded the record and takes responsibility for its content. Data type Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.author rim: .participation[typeCode=AUT].role
asserter	Σ	0..1	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id Procedure.asserter Short description Person who asserts this procedure Definition Individual who is making the procedure statement. Data type Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.source rim: .participation[typeCode=INF].role
performer	Σ	0..*	BackboneElement	There are no (further) constraints on this element Element id Procedure.performer Short description The people who performed the procedure Definition Limited to "real" people rather than equipment. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer rim: .participation[typeCode=PRF]
id		0..1	string	There are no (further) constraints on this element Element id Procedure.performer.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Procedure.performer.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Procedure.performer.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
function	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element id Procedure.performer.function Short description Type of performance Definition Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist. Requirements Allows disambiguation of the types of involvement of different performers. Data type CodeableConcept Binding A code that identifies the role of a performer of the procedure. ProcedurePerformerRoleCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.function v2: Some combination of STF-18 / PRA-3 / PRT-4 / ROL-3 / ORC-12 / OBR-16 / PV1-7 / PV1-8 / PV1-9 / PV1-17 / OBX-25 rim: .functionCode
actor	Σ	1..1	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson \| Device)	There are no (further) constraints on this element Element id Procedure.performer.actor Short description The reference to the practitioner Definition The practitioner who was involved in the procedure. Requirements A reference to Device supports use cases, such as pacemakers. Data type Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson \| Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.performer.actor w5: FiveWs.actor v2: ORC-19/PRT-5 rim: .role
onBehalfOf		0..1	Reference(Organization)	There are no (further) constraints on this element Element id Procedure.performer.onBehalfOf Short description Organization the device or practitioner was acting for Definition The organization the device or practitioner was acting on behalf of. Requirements Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .scoper
location	Σ	0..1	Reference(Location)	There are no (further) constraints on this element Element id Procedure.location Short description Where the procedure happened Definition The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant. Requirements Ties a procedure to where the records are likely kept. Data type Reference(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings w5: FiveWs.where[x] rim: .participation[typeCode=LOC].role[classCode=SDLOC]
reasonCode	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id Procedure.reasonCode Short description Coded reason procedure performed Definition The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text. Comments Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition \| Observation \| Procedure \| DiagnosticReport \| DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure. Data type CodeableConcept Binding A code that identifies the reason a procedure is required. ProcedureReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.reasonCode w5: FiveWs.why[x] rim: .reasonCode
reasonReference	Σ	0..*	Reference(Condition \| Observation \| Procedure \| DiagnosticReport \| DocumentReference)	There are no (further) constraints on this element Element id Procedure.reasonReference Short description The justification that the procedure was performed Definition The justification of why the procedure was performed. Comments It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition \| Observation \| Procedure \| DiagnosticReport \| DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure. Data type Reference(Condition \| Observation \| Procedure \| DiagnosticReport \| DocumentReference) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.reasonReference w5: FiveWs.why[x] rim: .reasonCode
bodySite	Σ	0..*	CodeableConceptBinding	Element id Procedure.bodySite Short description Target body sites Definition Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion. Comments If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure. Data type CodeableConcept Binding Codes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings v2: OBX-20 rim: .targetSiteCode
outcome	Σ	0..1	CodeableConcept	There are no (further) constraints on this element Element id Procedure.outcome Short description The result of procedure Definition The outcome of the procedure - did it resolve the reasons for the procedure being performed? Comments If outcome contains narrative text only, it can be captured using the CodeableConcept.text. Data type CodeableConcept Binding An outcome of a procedure - whether it was resolved or otherwise. ProcedureOutcomeCodes(SNOMEDCT) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode=OUT].target.text
report		0..*	Reference(DiagnosticReport \| DocumentReference \| Composition)	There are no (further) constraints on this element Element id Procedure.report Short description Any report resulting from the procedure Definition This could be a histology result, pathology report, surgical report, etc. Comments There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports. Data type Reference(DiagnosticReport \| DocumentReference \| Composition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN]
complication		0..*	CodeableConceptBinding	Element id Procedure.complication Short description Complication following the procedure Definition Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues. Comments If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text. Data type CodeableConcept Binding A code from the SNOMED Clinical Terminology UK with the expression (<404684003 \|Clinical finding\| OR <413350009 \|Finding with explicit context\| OR <272379006 \|Event\|). UKCoreConditionCode (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode=OUTC].target[classCode=OBS, code="complication", moodCode=EVN].value
complicationDetail		0..*	Reference(Condition)	There are no (further) constraints on this element Element id Procedure.complicationDetail Short description A condition that is a result of the procedure Definition Any complications that occurred during the procedure, or in the immediate post-performance period. Requirements This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure. Data type Reference(Condition) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode=OUTC].target[classCode=OBS, code="complication", moodCode=EVN].value
followUp		0..*	CodeableConcept	There are no (further) constraints on this element Element id Procedure.followUp Short description Instructions for follow up Definition If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used. Data type CodeableConcept Binding Specific follow up required for a procedure e.g. removal of sutures. ProcedureFollowUpCodes(SNOMEDCT) (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .outboundRelationship[typeCode=COMP].target[classCode=ACT, moodCode=INT].code
note		0..*	Annotation	There are no (further) constraints on this element Element id Procedure.note Short description Additional information about the procedure Definition Any other notes and comments about the procedure. Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings workflow: Event.note v2: NTE rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
focalDevice		0..*	BackboneElement	There are no (further) constraints on this element Element id Procedure.focalDevice Short description Manipulated, implanted, or removed device Definition A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .participation[typeCode=DEV].role[classCode=MANU]
id		0..1	string	There are no (further) constraints on this element Element id Procedure.focalDevice.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Procedure.focalDevice.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
modifierExtension	Σ ?! I	0..*	Extension	There are no (further) constraints on this element Element id Procedure.focalDevice.modifierExtension Short description Extensions that cannot be ignored even if unrecognized Alternate names extensions, user content, modifiers Definition May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Requirements Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. Comments 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. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: N/A
action		0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id Procedure.focalDevice.action Short description Kind of change to device Definition The kind of change that happened to the device during the procedure. Data type CodeableConcept Binding A kind of change that happened to the device during the procedure. ProcedureDeviceActionCodes (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="procedure device action"].value=:procedure device action codes
manipulated		1..1	Reference(Device)	There are no (further) constraints on this element Element id Procedure.focalDevice.manipulated Short description Device that was changed Definition The device that was manipulated (changed) during the procedure. Data type Reference(Device) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .participation[typeCode=DEV].role[classCode=SDLOC]
usedReference		0..*	Reference(Device \| Medication \| Substance)	There are no (further) constraints on this element Element id Procedure.usedReference Short description Items used during procedure Definition Identifies medications, devices and any other substance used as part of the procedure. Requirements Used for tracking contamination, etc. Comments For devices actually implanted or removed, use Procedure.device. Data type Reference(Device \| Medication \| Substance) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: .participation[typeCode=DEV].role[classCode=MANU] or .participation[typeCode=CSM].role[classCode=ADMM] (for Medication or Substance)
usedCode		0..*	CodeableConcept	There are no (further) constraints on this element Element id Procedure.usedCode Short description Coded items used during the procedure Definition Identifies coded items that were used as part of the procedure. Comments For devices actually implanted or removed, use Procedure.device. Data type CodeableConcept Binding Codes describing items used during a procedure. FHIRDeviceTypes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: participation[typeCode=Dev].role[classCode=MANU]

Procedure
Definition	An action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.
Cardinality	0...*
Invariants	dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` dom-6: A resource should have narrative for robust management text.`div`.exists()
Mappings	rim: Entity. Role, or Act workflow: Event rim: Procedure[moodCode=EVN]
Procedure.id
Definition	The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality	0...1
Type	string
Summary	True
Comments	The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
Procedure.meta
Definition	The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality	0...1
Type	Meta
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Procedure.implicitRules
Definition	A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality	0...1
Type	uri
Modifier	True
Summary	True
Comments	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. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Procedure.language
Definition	The base language in which the resource is written.
Cardinality	0...1
Type	code
Binding	A human language. CommonLanguages (preferred)
Comments	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).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Procedure.text
Definition	A human-readable narrative that contains a summary of the resource and can 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.
Cardinality	0...1
Type	Narrative
Alias	narrative, html, xhtml, display
Comments	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 information is added later.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: Act.text?
Procedure.contained
Definition	These 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.
Cardinality	0...*
Type	Resource
Alias	inline resources, anonymous resources, contained resources
Comments	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. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
Mappings	rim: N/A
Procedure.extension
Definition	May be used to represent additional information that is not part of the basic definition of the resource. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Procedure.modifierExtension
Definition	May 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 and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Alias	extensions, user content
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Procedure.identifier
Definition	Business identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.
Cardinality	0...*
Type	Identifier
Summary	True
Requirements	Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.
Comments	This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.identifier w5: FiveWs.identifier v2: Some combination of ORC-2 / ORC-3 / OBR-2 / OBR-3 / IPC-1 / IPC-2 / IPC-3 / IPC-4 rim: .id
Procedure.instantiatesCanonical
Definition	The URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.
Cardinality	0...*
Type	canonical(PlanDefinition \| ActivityDefinition \| Measure \| OperationDefinition \| Questionnaire)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.instantiatesCanonical rim: .outboundRelationship[typeCode=DEFN].target
Procedure.instantiatesUri
Definition	The URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.
Cardinality	0...*
Type	uri
Summary	True
Comments	This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.instantiatesUri rim: .outboundRelationship[typeCode=DEFN].target
Procedure.basedOn
Definition	A reference to a resource that contains details of the request for this procedure.
Cardinality	0...*
Type	Reference(CarePlan \| ServiceRequest)
Summary	True
Alias	fulfills
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.basedOn rim: .outboundRelationship[typeCode=FLFS].target[classCode=(various e.g. PROC, OBS, PCPR, ACT, moodCode=RQO].code
Procedure.partOf
Definition	A larger event of which this particular procedure is a component or step.
Cardinality	0...*
Type	Reference(Procedure \| Observation \| MedicationAdministration)
Summary	True
Alias	container
Comments	The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.partOf rim: .inboundRelationship[typeCode=COMP].source[classCode=SBADM or PROC or OBS, moodCode=EVN]
Procedure.status
Definition	A code specifying the state of the procedure. Generally, this will be the in-progress or completed state.
Cardinality	1...1
Type	code
Binding	A code specifying the state of the procedure. EventStatus (required)
Must Support	True
Modifier	True
Summary	True
Comments	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 procedure. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.status w5: FiveWs.status rim: statusCode
Procedure.statusReason
Definition	Captures the reason for the current state of the procedure.
Cardinality	0...1
Type	CodeableConcept
Binding	A code that identifies the reason a procedure was not performed. ProcedureNotPerformedReason(SNOMED-CT) (example)
Summary	True
Alias	Suspended Reason, Cancelled Reason
Comments	This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.statusReason rim: .reason.Observation.value
Procedure.category
Definition	A code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").
Cardinality	0...1
Type	CodeableConcept
Binding	A code that classifies a procedure for searching, sorting and display purposes. ProcedureCategoryCodes(SNOMEDCT) (example)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.class rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
Procedure.code
Definition	The specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").
Cardinality	0...1
Type	CodeableConcept
Binding	A code from the SNOMED Clinical Terminology UK. UKCoreProcedureCode (preferred)
Must Support	True
Summary	True
Alias	type
Requirements	0..1 to account for primarily narrative only resources.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.code w5: FiveWs.what[x] v2: OBR-44/OBR-45 rim: .code
Procedure.subject
Definition	The person, animal or group on which the procedure was performed.
Cardinality	1...1
Type	Reference(Patient \| Group)
Must Support	True
Summary	True
Alias	patient
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.subject w5: FiveWs.subject[x] v2: PID-3 rim: .participation[typeCode=SBJ].role w5: FiveWs.subject
Procedure.encounter
Definition	The Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.
Cardinality	0...1
Type	Reference(Encounter)
Summary	True
Comments	This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.context w5: FiveWs.context v2: PV1-19 rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Procedure.performed[x]
Definition	Estimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.
Cardinality	0...1
Type	dateTime
Must Support	True
Summary	True
Comments	Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.occurrence[x] w5: FiveWs.done[x] v2: OBR-7 rim: .effectiveTime
Procedure.recorder
Definition	Individual who recorded the record and takes responsibility for its content.
Cardinality	0...1
Type	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.author rim: .participation[typeCode=AUT].role
Procedure.asserter
Definition	Individual who is making the procedure statement.
Cardinality	0...1
Type	Reference(Patient \| RelatedPerson \| Practitioner \| PractitionerRole)
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.source rim: .participation[typeCode=INF].role
Procedure.performer
Definition	Limited to "real" people rather than equipment.
Cardinality	0...*
Type	BackboneElement
Summary	True
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.performer rim: .participation[typeCode=PRF]
Procedure.performer.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Procedure.performer.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Procedure.performer.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Procedure.performer.function
Definition	Distinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.
Cardinality	0...1
Type	CodeableConcept
Binding	A code that identifies the role of a performer of the procedure. ProcedurePerformerRoleCodes (example)
Summary	True
Requirements	Allows disambiguation of the types of involvement of different performers.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.performer.function v2: Some combination of STF-18 / PRA-3 / PRT-4 / ROL-3 / ORC-12 / OBR-16 / PV1-7 / PV1-8 / PV1-9 / PV1-17 / OBX-25 rim: .functionCode
Procedure.performer.actor
Definition	The practitioner who was involved in the procedure.
Cardinality	1...1
Type	Reference(Practitioner \| PractitionerRole \| Organization \| Patient \| RelatedPerson \| Device)
Summary	True
Requirements	A reference to Device supports use cases, such as pacemakers.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.performer.actor w5: FiveWs.actor v2: ORC-19/PRT-5 rim: .role
Procedure.performer.onBehalfOf
Definition	The organization the device or practitioner was acting on behalf of.
Cardinality	0...1
Type	Reference(Organization)
Requirements	Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .scoper
Procedure.location
Definition	The location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.
Cardinality	0...1
Type	Reference(Location)
Summary	True
Requirements	Ties a procedure to where the records are likely kept.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	w5: FiveWs.where[x] rim: .participation[typeCode=LOC].role[classCode=SDLOC]
Procedure.reasonCode
Definition	The coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.
Cardinality	0...*
Type	CodeableConcept
Binding	A code that identifies the reason a procedure is required. ProcedureReasonCodes (example)
Summary	True
Comments	Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition \| Observation \| Procedure \| DiagnosticReport \| DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.reasonCode w5: FiveWs.why[x] rim: .reasonCode
Procedure.reasonReference
Definition	The justification of why the procedure was performed.
Cardinality	0...*
Type	Reference(Condition \| Observation \| Procedure \| DiagnosticReport \| DocumentReference)
Summary	True
Comments	It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition \| Observation \| Procedure \| DiagnosticReport \| DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.reasonReference w5: FiveWs.why[x] rim: .reasonCode
Procedure.bodySite
Definition	Detailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.
Cardinality	0...*
Type	CodeableConcept
Binding	Codes describing anatomical locations. May include laterality. SNOMEDCTBodyStructures (preferred)
Summary	True
Comments	If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	v2: OBX-20 rim: .targetSiteCode
Procedure.outcome
Definition	The outcome of the procedure - did it resolve the reasons for the procedure being performed?
Cardinality	0...1
Type	CodeableConcept
Binding	An outcome of a procedure - whether it was resolved or otherwise. ProcedureOutcomeCodes(SNOMEDCT) (example)
Summary	True
Comments	If outcome contains narrative text only, it can be captured using the CodeableConcept.text.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode=OUT].target.text
Procedure.report
Definition	This could be a histology result, pathology report, surgical report, etc.
Cardinality	0...*
Type	Reference(DiagnosticReport \| DocumentReference \| Composition)
Comments	There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN]
Procedure.complication
Definition	Any complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.
Cardinality	0...*
Type	CodeableConcept
Binding	A code from the SNOMED Clinical Terminology UK with the expression (<404684003 \|Clinical finding\| OR <413350009 \|Finding with explicit context\| OR <272379006 \|Event\|). UKCoreConditionCode (preferred)
Comments	If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode=OUTC].target[classCode=OBS, code="complication", moodCode=EVN].value
Procedure.complicationDetail
Definition	Any complications that occurred during the procedure, or in the immediate post-performance period.
Cardinality	0...*
Type	Reference(Condition)
Requirements	This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode=OUTC].target[classCode=OBS, code="complication", moodCode=EVN].value
Procedure.followUp
Definition	If the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.
Cardinality	0...*
Type	CodeableConcept
Binding	Specific follow up required for a procedure e.g. removal of sutures. ProcedureFollowUpCodes(SNOMEDCT) (example)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .outboundRelationship[typeCode=COMP].target[classCode=ACT, moodCode=INT].code
Procedure.note
Definition	Any other notes and comments about the procedure.
Cardinality	0...*
Type	Annotation
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	workflow: Event.note v2: NTE rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
Procedure.focalDevice
Definition	A device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.
Cardinality	0...*
Type	BackboneElement
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .participation[typeCode=DEV].role[classCode=MANU]
Procedure.focalDevice.id
Definition	Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality	0...1
Type	string
Mappings	rim: n/a
Procedure.focalDevice.extension
Definition	May be used to represent additional information that is not part of the basic definition of the element. 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 can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality	0...*
Type	Extension
Alias	extensions, user content
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: n/a
Procedure.focalDevice.modifierExtension
Definition	May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. 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 can 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. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality	0...*
Type	Extension
Modifier	True
Summary	True
Alias	extensions, user content, modifiers
Requirements	Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.
Comments	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.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()`
Mappings	rim: N/A
Procedure.focalDevice.action
Definition	The kind of change that happened to the device during the procedure.
Cardinality	0...1
Type	CodeableConcept
Binding	A kind of change that happened to the device during the procedure. ProcedureDeviceActionCodes (preferred)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="procedure device action"].value=:procedure device action codes
Procedure.focalDevice.manipulated
Definition	The device that was manipulated (changed) during the procedure.
Cardinality	1...1
Type	Reference(Device)
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .participation[typeCode=DEV].role[classCode=SDLOC]
Procedure.usedReference
Definition	Identifies medications, devices and any other substance used as part of the procedure.
Cardinality	0...*
Type	Reference(Device \| Medication \| Substance)
Requirements	Used for tracking contamination, etc.
Comments	For devices actually implanted or removed, use Procedure.device.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: .participation[typeCode=DEV].role[classCode=MANU] or .participation[typeCode=CSM].role[classCode=ADMM] (for Medication or Substance)
Procedure.usedCode
Definition	Identifies coded items that were used as part of the procedure.
Cardinality	0...*
Type	CodeableConcept
Binding	Codes describing items used during a procedure. FHIRDeviceTypes (example)
Comments	For devices actually implanted or removed, use Procedure.device.
Invariants	ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())`
Mappings	rim: participation[typeCode=Dev].role[classCode=MANU]

Procedure		..
Procedure.status		..
Procedure.code		..
Procedure.subject		..
Procedure.performed[x]		..
Procedure.bodySite		..
Procedure.complication		..

<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="UKCore-Procedure" />
    <url value="https://fhir.hl7.org.uk/StructureDefinition/UKCore-Procedure" />
    <version value="2.5.0" />
    <name value="UKCoreProcedure" />
    <title value="UK Core Procedure" />
    <status value="active" />
    <date value="2023-12-12" />
    <publisher value="HL7 UK" />
    <contact>
        <name value="HL7 UK" />
        <telecom>
            <system value="email" />
            <value value="ukcore@hl7.org.uk" />
            <use value="work" />
            <rank value="1" />
        </telecom>
    </contact>
    <description value="This profile defines the UK constraints and extensions on the International FHIR resource [Procedure](https://hl7.org/fhir/R4/Procedure.html)." />
    <purpose value="This profile allows exchange of details of current and historical procedures performed on or for an individual. A procedure is an activity that is performed on, with, or for an individual as part of the provision of care. Examples include surgical procedures, diagnostic procedures, endoscopic procedures, biopsies, counselling, physiotherapy, personal support services, adult day care services, non-emergency transportation, home modification, exercise, etc. Procedures may be performed by a healthcare professional, a service provider, a friend or relative or in some cases by themselves." />
    <copyright value="Copyright &#169; 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the &quot;License&quot;); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an &quot;AS IS&quot; BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7&#174; FHIR&#174; standard Copyright &#169; 2011+ HL7 The HL7&#174; FHIR&#174; standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html." />
    <fhirVersion value="4.0.1" />
    <kind value="resource" />
    <abstract value="false" />
    <type value="Procedure" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Procedure" />
    <derivation value="constraint" />
    <differential>
        <element id="Procedure.status">
            <path value="Procedure.status" />
            <short value="A code specifying the state of the procedure." />
            <mustSupport value="true" />
        </element>
        <element id="Procedure.code">
            <path value="Procedure.code" />
            <short value="A code identifying the procedure performed." />
            <mustSupport value="true" />
            <binding>
                <strength value="preferred" />
                <description value="A code from the SNOMED Clinical Terminology UK." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode" />
            </binding>
        </element>
        <element id="Procedure.subject">
            <path value="Procedure.subject" />
            <short value="Who the procedure was performed on." />
            <mustSupport value="true" />
        </element>
        <element id="Procedure.performed[x]">
            <path value="Procedure.performed[x]" />
            <short value="When the procedure was performed." />
            <mustSupport value="true" />
        </element>
        <element id="Procedure.bodySite">
            <path value="Procedure.bodySite" />
            <binding>
                <strength value="preferred" />
            </binding>
        </element>
        <element id="Procedure.complication">
            <path value="Procedure.complication" />
            <binding>
                <strength value="preferred" />
                <description value="A code from the SNOMED Clinical Terminology UK with the expression (&lt;404684003 |Clinical finding| OR &lt;413350009 |Finding with explicit context| OR &lt;272379006 |Event|)." />
                <valueSet value="https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode" />
            </binding>
        </element>
    </differential>
</StructureDefinition>

{
    "resourceType": "StructureDefinition",
    "id": "UKCore-Procedure",
    "url": "https://fhir.hl7.org.uk/StructureDefinition/UKCore-Procedure",
    "version": "2.5.0",
    "name": "UKCoreProcedure",
    "title": "UK Core Procedure",
    "status": "active",
    "date": "2023-12-12",
    "publisher": "HL7 UK",
    "contact":  [
        {
            "name": "HL7 UK",
            "telecom":  [
                {
                    "system": "email",
                    "value": "ukcore@hl7.org.uk",
                    "use": "work",
                    "rank": 1
                }
            ]
        }
    ],
    "description": "This profile defines the UK constraints and extensions on the International FHIR resource [Procedure](https://hl7.org/fhir/R4/Procedure.html).",
    "purpose": "This profile allows exchange of details of current and historical procedures performed on or for an individual. A procedure is an activity that is performed on, with, or for an individual as part of the provision of care. Examples include surgical procedures, diagnostic procedures, endoscopic procedures, biopsies, counselling, physiotherapy, personal support services, adult day care services, non-emergency transportation, home modification, exercise, etc. Procedures may be performed by a healthcare professional, a service provider, a friend or relative or in some cases by themselves.",
    "copyright": "Copyright © 2021+ HL7 UK Licensed under the Apache License, Version 2.0 (the \"License\"); you may not use this file except in compliance with the License. You may obtain a copy of the License at  http://www.apache.org/licenses/LICENSE-2.0 Unless required by applicable law or agreed to in writing, software distributed under the License is distributed on an \"AS IS\" BASIS, WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied. See the License for the specific language governing permissions and limitations under the License. HL7® FHIR® standard Copyright © 2011+ HL7 The HL7® FHIR® standard is used under the FHIR license. You may obtain a copy of the FHIR license at  https://www.hl7.org/fhir/license.html.",
    "fhirVersion": "4.0.1",
    "kind": "resource",
    "abstract": false,
    "type": "Procedure",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Procedure",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Procedure.status",
                "path": "Procedure.status",
                "short": "A code specifying the state of the procedure.",
                "mustSupport": true
            },
            {
                "id": "Procedure.code",
                "path": "Procedure.code",
                "short": "A code identifying the procedure performed.",
                "mustSupport": true,
                "binding": {
                    "strength": "preferred",
                    "description": "A code from the SNOMED Clinical Terminology UK.",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ProcedureCode"
                }
            },
            {
                "id": "Procedure.subject",
                "path": "Procedure.subject",
                "short": "Who the procedure was performed on.",
                "mustSupport": true
            },
            {
                "id": "Procedure.performed[x]",
                "path": "Procedure.performed[x]",
                "short": "When the procedure was performed.",
                "mustSupport": true
            },
            {
                "id": "Procedure.bodySite",
                "path": "Procedure.bodySite",
                "binding": {
                    "strength": "preferred"
                }
            },
            {
                "id": "Procedure.complication",
                "path": "Procedure.complication",
                "binding": {
                    "strength": "preferred",
                    "description": "A code from the SNOMED Clinical Terminology UK with the expression (<404684003 |Clinical finding| OR <413350009 |Finding with explicit context| OR <272379006 |Event|).",
                    "valueSet": "https://fhir.hl7.org.uk/ValueSet/UKCore-ConditionCode"
                }
            }
        ]
    }
}