• dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
  contained.contained.empty()
• dom-1: If the resource is contained in another resource, it SHALL NOT contain any narrative
  contained.text.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-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
  contained.where(('#'+id in %resource.descendants().reference).not()).empty()

• rim: Entity. Role, or Act
• v2: MSH / MSA / ERR
• rim: Message
• w5: infrastructure.exchange

The only time that a resource does not have an id is when it is being submitted to the server using a create operation.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• rim: N/A

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.

This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a

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).

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a

Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• rim: N/A
• rim: Act.text?

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.

• rim: Entity. Role, or Act
• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

Drives the behavior associated with this message.

Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
• rim: CV
• orim: fhir:Coding rdfs:subClassOf dt:CDCoding
• v2: MSH-9.2
• rim: ./payload[classCode="CACT" and moodCode="EVN" and isNormalAct()]/code[isNormalDatatype()]/code
• w5: what

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

Need to be unambiguous about the source of the definition of the symbol.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should de-reference to some definition that establish the system clearly and unambiguously.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: C*E.3
• rim: ./codeSystem
• orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
• ACSPIX2FHIR: http://roche.com/fhir/rdc/message-type
• GREENDOT: http://roche.com/fhir/rdc/message-type

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: C*E.7
• rim: ./codeSystemVersion
• orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion

Need to refer to a particular code in the system.

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: C*E.1
• rim: ./code
• orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
• ACSPIX2FHIR: new-bundle
• GREENDOT: new-bundle

Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: C*E.2 - but note this is not well followed
• rim: CV.displayName
• orim: fhir:Coding.display rdfs:subPropertyOf dt:CDCoding.displayName
• ACSPIX2FHIR: New bundle generated
• GREENDOT: New bundle generated

This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: Sometimes implied by being first
• rim: CD.codingRationale
• orim: fhir:Coding.userSelected fhir:mapsTo dt:CDCoding.codingRationale. fhir:Coding.userSelected fhir:hasMap fhir:Coding.userSelected.map. fhir:Coding.userSelected.map a fhir:Map; fhir:target dt:CDCoding.codingRationale. fhir:Coding.userSelected\#true a [ fhir:source "true"; fhir:target dt:CDCoding.codingRationale\#O ]

Indicates where message is to be sent for routing purposes. Allows verification of "am I the intended recipient".

There SHOULD be at least one destination, but in some circumstances, the source system is unaware of any particular destination system.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• rim: ./communicationFunction[typeCode="RCV"]
• w5: who.focus

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

May be used for routing of response and/or to support audit.

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: MSH-5
• rim: unique(./entity[determinerCode="INST" and (classCode=("DEV", "PSN", "ORG"]/name[type='ST' and isNormalDatatype()])

Supports multi-hop routing.

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (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 %resource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• rim: unique(./entity[determinerCode="INST" and (classCode=("DEV", "PSN", "ORG"]

Identifies where to route the message.

The id may be a non-resolvable URI for systems that do not use standard network-based addresses.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: MSH-25 (or MSH-6)
• rim: ./telecom

Allows routing beyond just the application level.

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (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 %resource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• v2: PRT-5:PRT-4='WAYR' / PRT-8:PRT-4='WAYR'
• rim: Not directly supported. Could be shared using attentionLine.value with an appropriate keyWordText
• w5: who.focus

Allows routing beyond just the application level.

Use case is for where a (trusted) sending system is responsible for multiple organizations, and therefore cannot differentiate based on source endpoint / authentication alone.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (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 %resource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• v2: PRT-5:PRT-4='WAYR' / PRT-8:PRT-4='WAYR'
• rim: Not directly supported. Could be shared using attentionLine.value with an appropriate keyWordText
• w5: who.focus

Allows limited detection of out-of-order and delayed transmission. Also supports audit.

Note: This is intended for precisely observed times, typically system logs etc., and not human-reported times - for them, see date and dateTime below. Time zone is always required

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: MSH-7
• rim: ./creationTime[isNormalDatatype()]
• w5: when.init
• ACSPIX2FHIR: CurrentDateTime
• GREENDOT: CurrentDateTime

Need to know for audit/traceback requirements and possibly for authorization.

Usually only for the request, but can be used in a response.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (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 %resource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• v2: EVN-5 / ORC-10 / PRT-5:PRT-4='EP' / ROL where ROL.3 is EP or ORC.10
• rim: unique(./controlAct[classCode="CACT" and classCode="EVN" and isNormalAct()]/participation[typeCode="ENT" and isNormalParticipation]/role[classCode="ASSIGNED" and isNormalRole()]/player[isNormalEntity() and classCode=("DEV", "PSN") and determinerCode="INST"])
• w5: who.author

Need to know for audit/traceback requirements and possibly for authorization.

Usually only for the request, but can be used in a response.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (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 %resource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• v2: ORC-19 / PRT-5:PRT-4='AUT' / ROL where ROL.3 is IP or ORC.12
• rim: unique(./controlAct[classCode="CACT" and classCode="EVN" and isNormalAct()]/participation[isHighest(priorityCode) and typeCode="AUT" and isNormalParticipation]/role[classCode="ASSIGNED" and isNormalRole()]/player[isNormalEntity() and classCode=("DEV", "PSN") and determinerCode="INST"])
• w5: who.author

Allows replies, supports audit.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• rim: unique(./communicationFunction[typeCode="SND"])
• w5: who.actor

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

May be used to support audit.

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: MSH-3
• rim: unique(./entity[determinerCode="INST" and classCode="DEV"]/name[type='ST' and isNormalDatatype()])
• ACSPIX2FHIR: metadata.source
• GREENDOT: GreenDot

Supports audit and possibly interface engine behavior.

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: SFT-3 ( +SFT-1)
• rim: unique(./entity[determinerCode="INST" and classCode="DEV"]/softwareName[isNormalDatatype()])
• ACSPIX2FHIR: metadata.software
• GREENDOT: GreenDot

Supports audit and possibly interface engine behavior.

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: SFT-2
• rim: (Not supported)
• ACSPIX2FHIR: metadata.version
• GREENDOT: metadata.version

Allows escalation of technical issues.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• cpt-2: A system is required if a value is provided.
  value.empty() or system.exists()

• rim: n/a
• v2: XTN
• rim: TEL
• servd: ContactPoint
• v2: (MSH-22?)
• rim: unique(./entity[determinerCode="INST" and classCode="DEV"]/scopesRole[normalRole() and classCode="CON" and layer[classCode="PSN"]/telecom[isNormalDatatype()])

Identifies where to send responses, may influence security permissions.

The id may be a non-resolvable URI for systems that do not use standard network-based addresses.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: MSH-24
• rim: ./telecom[isNormalDatatype()]
• ACSPIX2FHIR: https://uudev-internal.rochedc.accentureanalytics.com/fhirmsg/rdc/v1.0.0/$process-message
• GREENDOT: https://uuxxx-internal.rochedc.accentureanalytics.com/fhirmsg/rdc/v1.0.0/$process-message

Need to know for audit/traceback requirements and possibly for authorization.

Usually only for the request, but can be used in a response.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (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 %resource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• v2: ORC-12 / PRT-5:PRT-4='OP' / PRT-8:PRT-4='OP' / ROL where ROL.3 is RO or ORC.11
• rim: unique(./controlAct[classCode="CACT" and classCode="EVN" and isNormalAct()]/participation[isHighest(priorityCode) and typeCode="RESP" and isNormalParticipation]/role[classCode="ASSIGNED" and isNormalRole()]/player[isNormalEntity() and classCode="PSN" and determinerCode="INST"] or ./controlAct[classCode="CACT" and classCode="EVN" and isNormalAct()]/participation[isHighest(priorityCode) and typeCode="RESP" and isNormalParticipation]/role[classCode="ASSIGNED" and isNormalRole()]/scoper[isNormalEntity() and classCode="ORG" and determinerCode="INST"])
• w5: who.witness

Need to be able to track why resources are being changed and report in the audit log/history of the resource. May affect authorization.

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: CE/CNE/CWE
• rim: CD
• orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
• v2: EVN.4 / ORC.16 / OBR-31-reason for study / BPO-13-BP indication for use / RXO-20-indication / RXE-27-give indication / RXD-21-indication / RXG-22-indication / RXA-19-indication
• rim: unique(./controlAct[classCode="CACT" and classCode="EVN" and isNormalAct()]/reasonCode[isNormalDatatype()])
• w5: why

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: MSA
• rim: ./conveyedAcknowledgement

Note that FHIR strings may not exceed 1MB in size

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

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.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())
• ext-1: Must have either extensions or value[x], not both
  extension.exists() != value.exists()

• rim: n/a
• rim: N/A

Allows receiver to know what message is being responded to.

RFC 4122

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: MSA-2
• rim: ./acknowledges.id[isNormalDatatype()]

Allows the sender of the acknowledge message to know if the request was successful or if action is needed.

This is a generic response to the request message. Specific data for the response will be found in MessageHeader.focus.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (children().count() > id.count())

• rim: n/a
• v2: MSA-1
• rim: ./typeCode[isNormalDatatype()]

Allows the sender of the message to determine what the specific issues are.

This SHALL be contained in the bundle. If any of the issues are errors, the response code SHALL be an error.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (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 %resource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• v2: ERR
• rim: AcknowledgementDetail or Observation[classCode="ALRT" and moodCode="EVN"]

Every message event is about actual data, a single resource, that is identified in the definition of the event, and perhaps some or all linked resources.

The data is defined where the transaction type is defined. The transaction data is always included in the bundle that is the full message. Only the root resource is specified. The resources it references should be contained in the bundle but are not also listed here. Multiple repetitions are allowed to cater for merges and other situations with multiple focal targets.

• ele-1: All FHIR elements must have a @value or children
  hasValue() | (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 %resource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• rim: unique(./controlAct[classCode="CACT" and classCode="EVN" and isNormalAct()]/participation[typeCode="SUBJ" and isNormalParticipation]/role or ./controlAct[classCode="CACT" and classCode="EVN" and isNormalAct()]/outboundRelationship[typeCode="SBJ" and isNormalActRelatoinship]/target)