CarePlan
This resource represents the treatment plan used to describe the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.
| CarePlan | C | CarePlan | There are no (further) constraints on this element Element idCarePlanShort description Healthcare plan for patient or group Alternate namesCare Team DefinitionDescribes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.
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| id | Σ | 0..1 | id | There are no (further) constraints on this element Element idCarePlan.idShort description Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case. |
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idCarePlan.metaShort description Metadata about the resource DefinitionThe 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.
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idCarePlan.implicitRulesShort description A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. 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 its narrative along with other profiles, value sets, etc.
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.languageShort description Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). IETF language tag for a human language
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| text | C | 0..1 | Narrative | There are no (further) constraints on this element Element idCarePlan.textShort description Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and 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. Contained resources do not have a 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. The cardinality or value of this element may be affected by these constraints: dom-6 Constraints
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| contained | C | 0..* | Goal | Element idCarePlan.containedShort description Information about an individual or animal receiving health care services Alternate namesinline resources, anonymous resources, contained resources, SubjectOfCare Client Resident DefinitionDemographics and other administrative information about an individual or animal receiving care or other health-related services. 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. The cardinality or value of this element may be affected by these constraints: dom-2, dom-4, dom-3, dom-5 Mappings
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, 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. 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.
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.modifierExtensionShort description Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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 managable, 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). 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. 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.
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| identifier | Σ | 1..1 | Identifier | There are no (further) constraints on this element Element idCarePlan.identifierShort description External Ids for this plan DefinitionBusiness 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. Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers. 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.
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| instantiatesCanonical | Σ | 0..0 | canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) | There are no (further) constraints on this element Element idCarePlan.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) Constraints
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| instantiatesUri | Σ | 0..0 | uri | There are no (further) constraints on this element Element idCarePlan.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
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| basedOn | Σ | 0..0 | Reference(CarePlan | ServiceRequest | RequestOrchestration | NutritionOrder) | There are no (further) constraints on this element Element idCarePlan.basedOnShort description Fulfills plan, proposal or order Alternate namesfulfills DefinitionA higher-level request resource (i.e. a plan, proposal or order) that is fulfilled in whole or in part by this care plan. Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon. Reference(CarePlan | ServiceRequest | RequestOrchestration | NutritionOrder) Constraints
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| replaces | Σ | 0..0 | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.replacesShort description CarePlan replaced by this CarePlan Alternate namessupersedes DefinitionCompleted or terminated care plan whose function is taken by this new care plan. Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans. The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing.
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| partOf | Σ | 0..0 | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.partOfShort description Part of referenced CarePlan DefinitionA larger care plan of which this particular care plan is a component or step. Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed.
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| status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.statusShort description draft | active | on-hold | revoked | completed | entered-in-error | unknown DefinitionIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. Allows clinicians to determine whether the plan is actionable or not. The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan. This element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid. Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
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| intent | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.intentShort description proposal | plan | order | option | directive DefinitionIndicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain. Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. This element is expected to be immutable. E.g. A "proposal" instance should never change to be a "plan" instance or "order" instance. Instead, a new instance 'basedOn' the prior instance should be created with the new 'intent' value. Codes indicating the degree of authority/intentionality associated with a care plan.
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| category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.categoryShort description Type of plan DefinitionIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.addresses. Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
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| title | Σ | 0..0 | string | There are no (further) constraints on this element Element idCarePlan.titleShort description Human-friendly name for the care plan DefinitionHuman-friendly name for the care plan.
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| description | Σ | 0..0 | string | There are no (further) constraints on this element Element idCarePlan.descriptionShort description Summary of nature of plan DefinitionA description of the scope and nature of the plan. Provides more detail than conveyed by category.
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| subject | Σ | 1..1 | Reference(Patient) | Element idCarePlan.subjectShort description Who the care plan is for Alternate namespatient DefinitionIdentifies the patient or group whose intended care is described by the plan.
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| encounter | Σ | 1..1 | Reference(Encounter) | Element idCarePlan.encounterShort description The Encounter during which this CarePlan was created DefinitionThe Encounter during which this CarePlan was created or to which the creation of this record is tightly associated. 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.
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| period | Σ | 0..1 | Period | There are no (further) constraints on this element Element idCarePlan.periodShort description Time period plan covers Alternate namestiming DefinitionIndicates when the plan did (or is intended to) come into effect and end. Allows tracking what plan(s) are in effect at a particular time. Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition).
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| created | Σ | 0..0 | dateTime | There are no (further) constraints on this element Element idCarePlan.createdShort description Date record was first recorded Alternate namesauthoredOn DefinitionRepresents when this particular CarePlan record was created in the system, which is often a system-generated date.
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| custodian | Σ | 0..0 | Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) | There are no (further) constraints on this element Element idCarePlan.custodianShort description Who is the designated responsible party DefinitionWhen populated, the custodian is responsible for the care plan. The care plan is attributed to the custodian. The custodian might or might not be a contributor. Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) Constraints
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| contributor | 0..1 | Reference(Practitioner) | Element idCarePlan.contributorShort description Who provided the content of the care plan DefinitionIdentifies the individual(s), organization or device who provided the contents of the care plan. Collaborative care plans may have multiple contributors.
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| careTeam | 1..1 | Reference(CareTeam) | There are no (further) constraints on this element Element idCarePlan.careTeamShort description Who's involved in plan? DefinitionIdentifies all people and organizations who are expected to be involved in the care envisioned by this plan. Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.
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| addresses | Σ | 0..* | CodeableReference(Condition) | Element idCarePlan.addressesShort description Health issues this plan addresses DefinitionIdentifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. The element can identify risks addressed by the plan as well as concerns. Also scopes plans - multiple plans may exist addressing different concerns. Use CarePlan.addresses.concept when a code sufficiently describes the concern (e.g. condition, problem, diagnosis, risk). Use CarePlan.addresses.reference when referencing a resource, which allows more information to be conveyed, such as onset date. CarePlan.addresses.concept and CarePlan.addresses.reference are not meant to be duplicative. For a single concern, either CarePlan.addresses.concept or CarePlan.addresses.reference can be used. CarePlan.addresses.concept may be a summary code, or CarePlan.addresses.reference may be used to reference a very precise definition of the concern using Condition. Both CarePlan.addresses.concept and CarePlan.addresses.reference can be used if they are describing different concerns for the care plan. Codes that describe the health issues this plan addresses. SNOMEDCTClinicalFindings (example) Constraints
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| id | 0..0 | id | There are no (further) constraints on this element Element idCarePlan.addresses.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. The cardinality or value of this element may be affected by these constraints: ele-1 Mappings
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| extension | C | 0..0 | Extension | There are no (further) constraints on this element Element idCarePlan.addresses.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| concept | Σ | 0..0 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.addresses.conceptShort description Reference to a concept (by class) DefinitionA reference to a concept - e.g. the information is identified by its general class to the degree of precision found in the terminology.
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| reference | Σ | 1..1 | Reference() | There are no (further) constraints on this element Element idCarePlan.addresses.referenceShort description Reference to a resource (by instance) DefinitionA reference to a resource the provides exact details about the information being referenced.
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| supportingInfo | 0..0 | Reference(Resource) | There are no (further) constraints on this element Element idCarePlan.supportingInfoShort description Information considered as part of plan DefinitionIdentifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc. Identifies barriers and other considerations associated with the care plan. Use "concern" to identify specific conditions addressed by the care plan. supportingInfo can be used to convey one or more Advance Directives or Medical Treatment Consent Directives by referencing Consent or any other request resource with intent = directive.
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| goal | 0..* | Reference(Goal) | Element idCarePlan.goalShort description Desired outcome of plan DefinitionDescribes the intended objective(s) of carrying out the care plan. Provides context for plan. Allows plan effectiveness to be evaluated by clinicians. Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline. Allowed aggregation:contained Constraints
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| activity | 0..* | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activityShort description Action to occur or has occurred as part of plan DefinitionIdentifies an action that has occurred or is a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring that has occurred, education etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice.
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| id | 0..0 | string | There are no (further) constraints on this element Element idCarePlan.activity.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. The cardinality or value of this element may be affected by these constraints: ele-1 Mappings
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| extension | C | 0..0 | Extension | There are no (further) constraints on this element Element idCarePlan.activity.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, 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. 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.
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| modifierExtension | Σ ?! C | 0..0 | Extension | There are no (further) constraints on this element Element idCarePlan.activity.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay 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 managable, 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). 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. 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.
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| performedActivity | 0..* | CodeableReference(Location | Organization) | Element idCarePlan.activity.performedActivityShort description Results of the activity (concept, or Appointment, Encounter, Procedure, etc.) DefinitionIdentifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource). Links plan to resulting actions. Note that this should not duplicate the activity status (e.g. completed or in progress). The activity performed 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 exercise, then the activity performed could be amount and intensity of exercise performed whereas the goal outcome is an observation for the actual body weight measured. CodeableReference(Location | Organization) BindingIdentifies the results of the activity. CarePlanActivityPerformed (example) Constraints
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| id | 0..0 | id | There are no (further) constraints on this element Element idCarePlan.activity.performedActivity.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. The cardinality or value of this element may be affected by these constraints: ele-1 Mappings
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| extension | C | 0..0 | Extension | There are no (further) constraints on this element Element idCarePlan.activity.performedActivity.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| concept | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.performedActivity.conceptShort description Reference to a concept (by class) DefinitionA reference to a concept - e.g. the information is identified by its general class to the degree of precision found in the terminology.
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| reference | Σ | 0..1 | Reference() | There are no (further) constraints on this element Element idCarePlan.activity.performedActivity.referenceShort description Reference to a resource (by instance) DefinitionA reference to a resource the provides exact details about the information being referenced.
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| progress | 1..1 | Annotation | There are no (further) constraints on this element Element idCarePlan.activity.progressShort description Comments about the activity status/progress DefinitionNotes about the adherence/status/progress of the activity. Can be used to capture information about adherence, progress, concerns, etc. 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.
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| id | 0..0 | id | There are no (further) constraints on this element Element idCarePlan.activity.progress.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. The cardinality or value of this element may be affected by these constraints: ele-1 Mappings
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| extension | C | 0..0 | Extension | There are no (further) constraints on this element Element idCarePlan.activity.progress.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, 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. 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. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints
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| author[x] | Σ | 1..1 | There are no (further) constraints on this element Element idCarePlan.activity.progress.author[x]Short description Individual responsible for the annotation DefinitionThe individual responsible for making the annotation. Organization is used when there's no need for specific attribution as to who made the comment.
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| authorReference | Reference(Patient | Practitioner | Organization) | Data type | ||
| time | Σ | 1..1 | dateTime | There are no (further) constraints on this element Element idCarePlan.activity.progress.timeShort description When the annotation was made DefinitionIndicates when this particular annotation was made.
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| text | Σ | 1..1 | markdown | There are no (further) constraints on this element Element idCarePlan.activity.progress.textShort description The annotation - text content (as markdown) DefinitionThe text of the annotation in markdown format.
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| plannedActivityReference | 0..1 | Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestOrchestration | ImmunizationRecommendation | SupplyRequest) | There are no (further) constraints on this element Element idCarePlan.activity.plannedActivityReferenceShort description Activity that is intended to be part of the care plan DefinitionThe details of the proposed activity represented in a specific resource. Details in a form consistent with other applications and contexts of use. Standard extension exists (http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.plannedActivityReference. Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestOrchestration | ImmunizationRecommendation | SupplyRequest) Constraints
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| note | 0..* | Annotation | There are no (further) constraints on this element Element idCarePlan.noteShort description Comments about the plan DefinitionGeneral notes about the care plan not covered elsewhere. Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.
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