| EpisodeOfCare | I | | EpisodeOfCare | There are no (further) constraints on this element Element idShort description An association of a Patient with an Organization and Healthcare Provider(s) for a period of time that the Organization assumes some level of responsibility Alternate names Case Program Problem Definition An association between a patient and an organization / healthcare provider(s) during which time encounters may occur. The managing organization assumes a level of responsibility for the patient during this time.
EpisodeOfCare Constraints- 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
- rim: n/a
- w5: workflow.encounter
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| id | Σ | 0..1 | id | There are no (further) constraints on this element Element idShort 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.
The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
id Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idShort description Metadata about the resource Definition The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content may not always be associated with version changes to the resource.
Meta Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idEpisodeOfCare.implicitRules 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.
Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element.
This element is labelled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation.
uri Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| language | | 0..1 | codeBinding | There are no (further) constraints on this element Element idShort description Language of the resource content Definition The base language in which the resource is written.
Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
code Binding A human language. ?? (extensible)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| text | I | 0..1 | Narrative | There are no (further) constraints on this element Element idShort 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 may be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded in formation is added later.
Narrative Constraints- 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?
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| contained | | 0..* | Resource | There are no (further) constraints on this element Element idShort 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.
This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again.
Resource Mappings- rim: Entity. Role, or Act
- rim: N/A
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idShort 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. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
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| modifierExtension | ?! I | 0..* | Extension | There are no (further) constraints on this element Element idEpisodeOfCare.modifierExtension 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. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
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| identifier | | 0..* | Identifier | There are no (further) constraints on this element Element idShort description Business Identifier(s) relevant for this EpisodeOfCare Definition The EpisodeOfCare may be known by different identifiers for different contexts of use, such as when an external agency is tracking the Episode for funding purposes.
Identifier Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
- rim: n/a
- v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
- rim: II - see see identifier pattern at http://wiki.hl7.org/index.php?title=Common_Design_Patterns#Identifier_Pattern for relevant discussion. 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: id
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| status | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idShort description planned | waitlist | active | onhold | finished | cancelled | entered-in-error Definition planned | waitlist | active | onhold | finished | cancelled.
This element is labeled as a modifier because the status contains codes that mark the episode as not currently valid.
code Binding The status of the episode of care. ?? (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| statusHistory | | 0..* | BackboneElement | There are no (further) constraints on this element Element idEpisodeOfCare.statusHistory Past list of status codes (the current status may be included to cover the start date of the status) Definition The history of statuses that the EpisodeOfCare has been through (without requiring processing the history of the resource).
BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| id | | 0..1 | string | There are no (further) constraints on this element Element idEpisodeOfCare.statusHistory.id xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idEpisodeOfCare.statusHistory.extension 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. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idEpisodeOfCare.statusHistory.modifierExtension Extensions that cannot be ignored 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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- 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()
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| status | | 1..1 | codeBinding | There are no (further) constraints on this element Element idEpisodeOfCare.statusHistory.status planned | waitlist | active | onhold | finished | cancelled | entered-in-error Definition planned | waitlist | active | onhold | finished | cancelled.
Note that FHIR strings may not exceed 1MB in size
code Binding The status of the episode of care. ?? (required)Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| period | I | 1..1 | Period | There are no (further) constraints on this element Element idEpisodeOfCare.statusHistory.period Duration the EpisodeOfCare was in the specified status Definition The period during this EpisodeOfCare that the specific status applied.
This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. 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"). If duration is required, specify the type as Interval|Duration.
Period Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count()) - per-1: If present, start SHALL have a lower value than end
start.empty() or end.empty() or (start <= end)
- rim: n/a
- v2: DR
- rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
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| type | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idShort description Type/class - e.g. specialist referral, disease management Definition A classification of the type of episode of care; e.g. specialist referral, disease management, type of funded care.
The type can be very important in processing as this could be used in determining if the EpisodeOfCare is relevant to specific government reporting, or other types of classifications.
CodeableConcept Binding The type of the episode of care ?? (example)Constraints- 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
- w5: class
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| diagnosis | Σ | 0..* | BackboneElement | There are no (further) constraints on this element Element idShort description The list of diagnosis relevant to this episode of care Definition The list of diagnosis relevant to this episode of care.
BackboneElement Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| id | | 0..1 | string | There are no (further) constraints on this element Element idEpisodeOfCare.diagnosis.id xml:id (or equivalent in JSON) Definition unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Note that FHIR strings may not exceed 1MB in size
string Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| extension | I | 0..* | Extension | There are no (further) constraints on this element Element idEpisodeOfCare.diagnosis.extension 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. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints- 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()
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| modifierExtension | Σ ?! I | 0..* | Extension | There are no (further) constraints on this element Element idEpisodeOfCare.diagnosis.modifierExtension Extensions that cannot be ignored 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 that contains it. Usually modifier elements provide negation or qualification. In order to make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.
There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
Extension Constraints- 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()
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| condition | Σ I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Condition) | There are no (further) constraints on this element Element idEpisodeOfCare.diagnosis.condition Conditions/problems/diagnoses this episode of care is for Definition A list of conditions/problems/diagnoses that this episode of care is intended to be providing care for.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(http://hl7.org/fhir/StructureDefinition/Condition) Constraints- 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)
- w5: what
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| role | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idEpisodeOfCare.diagnosis.role Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …) Definition Role that this diagnosis has within the episode of care (e.g. admission, billing, discharge …).
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.
CodeableConcept Binding The type of diagnosis this condition represents ?? (preferred)Constraints- 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
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| rank | Σ | 0..1 | positiveInt | There are no (further) constraints on this element Element idEpisodeOfCare.diagnosis.rank Ranking of the diagnosis (for each role type) Definition Ranking of the diagnosis (for each role type).
32 bit number; for values larger than this, use decimal
positiveInt Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count())
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| patient | Σ I | 1..1 | Reference(http://hl7.org/fhir/StructureDefinition/Patient) | There are no (further) constraints on this element Element idShort description The patient who is the focus of this episode of care Definition The patient who is the focus of this episode of care.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(http://hl7.org/fhir/StructureDefinition/Patient) Constraints- 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)
- w5: who.focus
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| managingOrganization | Σ I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Organization) | There are no (further) constraints on this element Element idEpisodeOfCare.managingOrganization Organization that assumes care Definition The organization that has assumed the specific responsibilities for the specified duration.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(http://hl7.org/fhir/StructureDefinition/Organization) Constraints- 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)
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| period | Σ I | 0..1 | Period | There are no (further) constraints on this element Element idShort description Interval during responsibility is assumed Definition The interval during which the managing organization assumes the defined responsibility.
This is not a duration - that's a measure of time (a separate type), but a duration that occurs at a fixed value of time. 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"). If duration is required, specify the type as Interval|Duration.
Period Constraints- ele-1: All FHIR elements must have a @value or children
hasValue() | (children().count() > id.count()) - per-1: If present, start SHALL have a lower value than end
start.empty() or end.empty() or (start <= end)
- rim: n/a
- v2: DR
- rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
- w5: when.init
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| referralRequest | I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/ReferralRequest) | There are no (further) constraints on this element Element idEpisodeOfCare.referralRequest Originating Referral Request(s) Definition Referral Request(s) that are fulfilled by this EpisodeOfCare, incoming referrals.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(http://hl7.org/fhir/StructureDefinition/ReferralRequest) Constraints- 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)
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| careManager | I | 0..1 | Reference(http://hl7.org/fhir/StructureDefinition/Practitioner) | There are no (further) constraints on this element Element idEpisodeOfCare.careManager Care manager/care co-ordinator for the patient Definition The practitioner that is the care manager/care co-ordinator for this patient.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(http://hl7.org/fhir/StructureDefinition/Practitioner) Constraints- 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)
|
| team | I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/CareTeam) | There are no (further) constraints on this element Element idShort description Other practitioners facilitating this episode of care Alternate names CareTeam Definition The list of practitioners that may be facilitating this episode of care for specific purposes.
References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.
Reference(http://hl7.org/fhir/StructureDefinition/CareTeam) Constraints- 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)
|
| account | I | 0..* | Reference(http://hl7.org/fhir/StructureDefinition/Account) | There are no (further) constraints on this element Element idShort description The set of accounts that may be used for billing for this EpisodeOfCare Definition The set of accounts that may be used for billing for this EpisodeOfCare.
The billing system may choose to allocate billable items associated with the EpisodeOfCare to different referenced Accounts based on internal business rules.
Reference(http://hl7.org/fhir/StructureDefinition/Account) Constraints- 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)
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