Genomics-AuditEvent

Created by the central GMS infrastructure on any CRUD event.

Can be searched on for auditability and obtaining status history for Tasks (as an alternative to the Task _history option).

It is not expected or permitted that a client system would update or post AuditEvents to the central service.

AuditEvents are expected to be created for any CRUD events which affect resources on the server. Where resources do not exist on the server, e.g. empty SearchSets or failed POSTs, no AuditEvents will be created. Failed updates may still trigger creation of AuditEvent resources but the outcome.code will record that the event was unsuccessful.

AuditEvents for resources created by the server will record the server identity within the who element.

The below profile is therefore provided to support parsing for clients if returned through a GET request.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/AuditEvent HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
typeΣ1..1CodingBinding
subtypeΣ0..*CodingBinding
actionΣ0..1codeBinding
periodI0..1Period
recordedΣ1..1instant
outcomeΣ0..1codeBinding
outcomeDescΣ0..1string
purposeOfEventΣ0..*CodeableConceptBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
type0..1CodeableConceptBinding
role0..*CodeableConcept
whoΣ I0..1Reference(PractitionerRole | Practitioner | Organization | Device | Patient | RelatedPerson)
altId0..1string
name0..1string
requestorΣ1..1boolean
locationI0..1Reference(Location)
policy0..*uri
media0..1CodingBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
address0..1string
type0..1codeBinding
purposeOfUse0..*CodeableConceptBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
site0..1string
observerΣ I1..1Reference(PractitionerRole | Practitioner | Organization | Device | Patient | RelatedPerson)
type0..*CodingBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
whatΣ I0..1Reference(Resource)
type0..1CodingBinding
role0..1CodingBinding
lifecycle0..1CodingBinding
securityLabel0..*CodingBinding
nameΣ I0..1string
description0..1string
queryΣ I0..1base64Binary
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
type1..1string
valueStringstring
valueBase64Binarybase64Binary

Differential from AuditEvent

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
typeΣ1..1CodingBinding
subtypeΣ0..*CodingBinding
actionΣ0..1codeBinding
periodI0..1Period
recordedΣ1..1instant
outcomeΣ0..1codeBinding
outcomeDescΣ0..1string
purposeOfEventΣ0..*CodeableConceptBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
type0..1CodeableConceptBinding
role0..*CodeableConcept
whoΣ I0..1Reference(PractitionerRole | Practitioner | Organization | Device | Patient | RelatedPerson)
altId0..1string
name0..1string
requestorΣ1..1boolean
locationI0..1Reference(Location)
policy0..*uri
media0..1CodingBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
address0..1string
type0..1codeBinding
purposeOfUse0..*CodeableConceptBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
site0..1string
observerΣ I1..1Reference(PractitionerRole | Practitioner | Organization | Device | Patient | RelatedPerson)
type0..*CodingBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
whatΣ I0..1Reference(Resource)
type0..1CodingBinding
role0..1CodingBinding
lifecycle0..1CodingBinding
securityLabel0..*CodingBinding
nameΣ I0..1string
description0..1string
queryΣ I0..1base64Binary
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
type1..1string
valueStringstring
valueBase64Binarybase64Binary

AuditEvent
DefinitionA record of an event made for purposes of maintaining a security log. Typical uses include detection of intrusion attempts and monitoring for inappropriate usage.
Cardinality0...*
Comments

Based on IHE-ATNA.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • rim: ControlAct[moodCode=EVN]
  • dicom: Message
AuditEvent.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

AuditEvent.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
AuditEvent.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
AuditEvent.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
AuditEvent.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
AuditEvent.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.type
DefinitionIdentifier for a family of the event. For example, a menu item, program, rule, policy, function code, application name or URL. It identifies the performed function.
Cardinality1...1
TypeCoding
Binding

Type of event.

AuditEventID (extensible)
SummaryTrue
Requirements

This identifies the performed function. For "Execute" Event Action Code audit records, this identifies the application function performed.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • workflow: Event.code
  • w5: FiveWs.what[x]
  • rim: .code (type, subtype and action are pre-coordinated or sent as translations)
  • dicom: EventId
  • w3c.prov: Activity
AuditEvent.subtype
DefinitionIdentifier for the category of event.
Cardinality0...*
TypeCoding
Binding

Sub-type of event.

AuditEventSub-Type (extensible)
SummaryTrue
Requirements

This field enables queries of messages by implementation-defined event categories.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • w5: FiveWs.what[x]
  • rim: .code (type, subtype and action are pre-coordinated or sent as translations)
  • dicom: EventTypeCode
AuditEvent.action
DefinitionIndicator for type of action performed during the event that generated the audit.
Cardinality0...1
Typecode
Binding

Indicator for type of action performed during the event that generated the event.

AuditEventAction (required)
SummaryTrue
Requirements

This broadly indicates what kind of action was done on the AuditEvent.entity by the AuditEvent.agent.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.what[x]
  • rim: .code (type, subtype and action are pre-coordinated or sent as translations)
  • dicom: EventActionCode
AuditEvent.period
DefinitionThe period during which the activity occurred.
Cardinality0...1
TypePeriod
Comments

The period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • workflow: Event.occurred[x]
  • w5: FiveWs.done[x]
  • rim: ./effectiveTime[type=IVL_TS]
  • dicom: EventDateTime
  • w3c.prov: Activity.startTime & Activity.endTime
  • fhirprovenance: Provenance.occurred[x]
AuditEvent.recorded
DefinitionThe time when the event was recorded.
Cardinality1...1
Typeinstant
SummaryTrue
Requirements

This ties an event to a specific date and time. Security audits typically require a consistent time base (e.g. UTC), to eliminate time-zone issues arising from geographical distribution.

Comments

In a distributed system, some sort of common time base (e.g. an NTP [RFC1305] server) is a good implementation tactic.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.recorded
  • rim: .effectiveTime
  • w3c.prov: Activity.when
  • fhirprovenance: Provenance.recorded
AuditEvent.outcome
DefinitionIndicates whether the event succeeded or failed.
Cardinality0...1
Typecode
Binding

Indicates whether the event succeeded or failed.

AuditEventOutcome (required)
SummaryTrue
Comments

In some cases a "success" may be partial, for example, an incomplete or interrupted transfer of a radiological study. For the purpose of establishing accountability, these distinctions are not relevant.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.what[x]
  • rim: .actionNegationInd
  • dicom: EventOutcomeIndicator
AuditEvent.outcomeDesc
DefinitionA free text description of the outcome of the event.
Cardinality0...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.what[x]
  • rim: .outboundRelationship[typeCode=OUT].target.text
  • dicom: EventOutcomeDescription
AuditEvent.purposeOfEvent
DefinitionThe purposeOfUse (reason) that was used during the event being recorded.
Cardinality0...*
TypeCodeableConcept
Binding

The reason the activity took place.

v3.PurposeOfUse (extensible)
SummaryTrue
Comments

Use AuditEvent.agent.purposeOfUse when you know that it is specific to the agent, otherwise use AuditEvent.purposeOfEvent. For example, during a machine-to-machine transfer it might not be obvious to the audit system who caused the event, but it does know why.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.reasonCode
  • w5: FiveWs.why[x]
  • rim: * .reasonCode [ControlActReason when Act.class = CACT Control Act] *.outboundRelationship[typeCode=RSON].target
  • dicom: EventPurposeOfUse
  • w3c.prov: Activity.Activity
  • fhirprovenance: Provenance.reason, Provenance.activity
AuditEvent.agent
DefinitionAn actor taking an active role in the event or activity that is logged.
Cardinality1...*
TypeBackboneElement
AliasActiveParticipant
Requirements

An agent can be a person, an organization, software, device, or other actors that may be ascribed responsibility.

Comments

Several agents may be associated (i.e. have some responsibility for an activity) with an event or activity.

For example, an activity may be initiated by one user for other users or involve more than one user. However, only one user may be the initiator/requestor for the activity.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.performer
  • w5: FiveWs.who
  • rim: .participation
  • dicom: ActiveParticipant
  • w3c.prov: Agent
  • fhirprovenance: Provenance.agent
AuditEvent.agent.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
AuditEvent.agent.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.agent.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.agent.type
DefinitionSpecification of the participation type the user plays when performing the event.
Cardinality0...1
TypeCodeableConcept
Binding

The Participation type of the agent to the event.

ParticipationRoleType (extensible)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.performer.function
  • w5: FiveWs.who
  • rim: .typeCode and/or .functionCode
  • dicom: RoleIdCode
  • w3c.prov: Agent.Attribution
  • fhirprovenance: Provenance.agent.type
AuditEvent.agent.role
DefinitionThe security role that the user was acting under, that come from local codes defined by the access control security system (e.g. RBAC, ABAC) used in the local context.
Cardinality0...*
TypeCodeableConcept
Binding

What security role enabled the agent to participate in the event.

SecurityRoleType (example)
Requirements

This value ties an audited event to a user's role(s). It is an optional value that might be used to group events for analysis by user functional role categories.

Comments

Should be roles relevant to the event. Should not be an exhaustive list of roles.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.who
  • rim: .role
  • dicom: RoleIdCode
  • w3c.prov: Agent.Attribution
  • fhirprovenance: Provenance.agent.role
AuditEvent.agent.who
DefinitionReference to who this agent is that was involved in the event.
Cardinality0...1
TypeReference(PractitionerRole | Practitioner | Organization | Device | Patient | RelatedPerson)
SummaryTrue
AliasuserId
Requirements

This field ties an audit event to a specific resource or identifier.

Comments

Where a User ID is available it will go into who.identifier.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • w5: FiveWs.who
  • rim: .id
  • dicom: UserId
  • w3c.prov: Agent.Identity
  • fhirprovenance: Provenance.agent.who
AuditEvent.agent.altId
DefinitionAlternative agent Identifier. For a human, this should be a user identifier text string from authentication system. This identifier would be one known to a common authentication system (e.g. single sign-on), if available.
Cardinality0...1
Typestring
Requirements

In some situations, a human user may authenticate with one identity but, to access a specific application system, may use a synonymous identify. For example, some "single sign on" implementations will do this. The alternative identifier would then be the original identify used for authentication, and the User ID is the one known to and used by the application.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.who
  • rim: .id (distinguish id type by root)
  • dicom: AlternativeUserId
  • w3c.prov: Agent.Identity
AuditEvent.agent.name
DefinitionHuman-meaningful name for the agent.
Cardinality0...1
Typestring
Requirements

The User ID and Authorization User ID may be internal or otherwise obscure values. This field assists the auditor in identifying the actual user.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.who
  • rim: .name
  • dicom: UserName
  • w3c.prov: Agent.Identity
AuditEvent.agent.requestor
DefinitionIndicator that the user is or is not the requestor, or initiator, for the event being audited.
Cardinality1...1
Typeboolean
SummaryTrue
Requirements

This value is used to distinguish between requestor-users and recipient-users. For example, one person may initiate a report-output to be sent to another user.

Comments

There can only be one initiator. If the initiator is not clear, then do not choose any one agent as the initiator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.who
  • rim: If participation.typeCode was author, then true
  • dicom: UserIsRequestor
AuditEvent.agent.location
DefinitionWhere the event occurred.
Cardinality0...1
TypeReference(Location)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.location
  • w5: FiveWs.where[x]
  • rim: * Role.Class =SDLOC *Role.Code = ServiceDeliveryLocationRoleType *Entity.Code = PlaceEntityType = df.Types of places for Entity.Class = PLC *EntityClass = PLC = df.A physical place or site with its containing structure. May be natural or man-made. The geographic position of a place might or might not be constant.
  • w3c.prov: Activity.location
  • fhirprovenance: Provenance.location
AuditEvent.agent.policy
DefinitionThe policy or plan that authorized the activity being recorded. Typically, a single activity may have multiple applicable policies, such as patient consent, guarantor funding, etc. The policy would also indicate the security token used.
Cardinality0...*
Typeuri
Requirements

This value is used retrospectively to determine the authorization policies.

Comments

For example: Where an OAuth token authorizes, the unique identifier from the OAuth token is placed into the policy element Where a policy engine (e.g. XACML) holds policy logic, the unique policy identifier is placed into the policy element.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.why[x]
  • rim: ActPolicyType
  • dicom: ParticipantRoleIDCode
  • fhirprovenance: Provenance.policy
AuditEvent.agent.media
DefinitionType of media involved. Used when the event is about exporting/importing onto media.
Cardinality0...1
TypeCoding
Binding

Used when the event is about exporting/importing onto media.

MediaTypeCode (extensible)
Requirements

Usually, this is used instead of specifying a network address. This field is not used for Media Id (i.e. the serial number of a CD).

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • w5: FiveWs.where[x]
  • rim: .player.description.mediaType
  • dicom: MediaType
AuditEvent.agent.network
DefinitionLogical network location for application activity, if the activity has a network location.
Cardinality0...1
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.where[x]
  • rim: .player.description.reference
AuditEvent.agent.network.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
AuditEvent.agent.network.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.agent.network.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.agent.network.address
DefinitionAn identifier for the network access point of the user device for the audit event.
Cardinality0...1
Typestring
Requirements

This datum identifies the user's network access point, which may be distinct from the server that performed the action. It is an optional value that may be used to group events recorded on separate servers for analysis of a specific network access point's data access across all servers.

Comments

This could be a device id, IP address or some other identifier associated with a device.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.where[x]
  • rim: pre-coordinated into URL
  • dicom: NetworkAccessPointID
  • w3c.prov: Agent.Location
AuditEvent.agent.network.type
DefinitionAn identifier for the type of network access point that originated the audit event.
Cardinality0...1
Typecode
Binding

The type of network access point of this agent in the audit event.

AuditEventAgentNetworkType (required)
Requirements

This datum identifies the type of network access point identifier of the user device for the audit event. It is an optional value that may be used to group events recorded on separate servers for analysis of access according to a network access point's type.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.where[x]
  • rim: pre-coordinated into URL
  • dicom: NetworkAccessPointTypeCode
AuditEvent.agent.purposeOfUse
DefinitionThe reason (purpose of use), specific to this agent, that was used during the event being recorded.
Cardinality0...*
TypeCodeableConcept
Binding

The reason the activity took place.

v3.PurposeOfUse (extensible)
Comments

Use AuditEvent.agent.purposeOfUse when you know that is specific to the agent, otherwise use AuditEvent.purposeOfEvent. For example, during a machine-to-machine transfer it might not be obvious to the audit system who caused the event, but it does know why.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.why[x]
  • rim: *.reasonCode [ActHealthInformationPurposeOfUseReason codes/v:PurposeOfUse (2.16.840.1.113883.1.11.20448) * .outboundRelationship[typeCode=RSON or SUBJ].target
  • w3c.prov: Agent.Activity
AuditEvent.source
DefinitionThe system that is reporting the event.
Cardinality1...1
TypeBackboneElement
Requirements

The event is reported by one source.

Comments

Since multi-tier, distributed, or composite applications make source identification ambiguous, this collection of fields may repeat for each application or process actively involved in the event. For example, multiple value-sets can identify participating web servers, application processes, and database server threads in an n-tier distributed application. Passive event participants (e.g. low-level network transports) need not be identified.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.witness
  • rim: .participation[typeCode=INF].role[classCode=ASSIGN].player[classCode=DEV, determinerCode=INSTANCE]
  • dicom: AuditSourceIdentification
AuditEvent.source.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
AuditEvent.source.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.source.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.source.site
DefinitionLogical source location within the healthcare enterprise network. For example, a hospital or other provider location within a multi-entity provider group.
Cardinality0...1
Typestring
Requirements

This value differentiates among the sites in a multi-site enterprise health information system.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.witness
  • rim: .scopedRole[classCode=LOCE].player.desc
  • dicom: AuditEnterpriseSiteId
AuditEvent.source.observer
DefinitionIdentifier of the source where the event was detected.
Cardinality1...1
TypeReference(PractitionerRole | Practitioner | Organization | Device | Patient | RelatedPerson)
SummaryTrue
AliasSourceId
Requirements

This field ties the event to a specific source system. It may be used to group events for analysis according to where the event was detected.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.witness
  • rim: .id
  • dicom: AuditSourceId
AuditEvent.source.type
DefinitionCode specifying the type of source where event originated.
Cardinality0...*
TypeCoding
Binding

Code specifying the type of system that detected and recorded the event.

AuditEventSourceType (extensible)
Requirements

This field indicates which type of source is identified by the Audit Source ID. It is an optional value that may be used to group events for analysis according to the type of source where the event occurred.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • w5: FiveWs.witness
  • rim: .code
  • dicom: AuditSourceTypeCode
AuditEvent.entity
DefinitionSpecific instances of data or objects that have been accessed.
Cardinality0...*
TypeBackboneElement
AliasParticipantObject
Requirements

The event may have other entities involved.

Comments

Required unless the values for event identification, agent identification, and audit source identification are sufficient to document the entire auditable event. Because events may have more than one entity, this group can be a repeating set of values.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • sev-1: Either a name or a query (NOT both)
    name.empty() or query.empty()
Mappings
  • rim: n/a
  • w5: FiveWs.what[x]
  • rim: .outboundRelationship[typeCode=SUBJ].target or .participation[typeCode=SBJ].role
  • dicom: ParticipantObjectIdentification
  • w3c.prov: Entity
  • fhirprovenance: Provenance.target, Provenance.entity
AuditEvent.entity.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
AuditEvent.entity.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.entity.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.entity.what
DefinitionIdentifies a specific instance of the entity. The reference should be version specific.
Cardinality0...1
TypeReference(Resource)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.what[x]
  • rim: .id
  • dicom: ParticipantObjectID and ParticipantObjectIDTypeCode
  • fhirprovenance: Provenance.target, Provenance.entity.what
AuditEvent.entity.type
DefinitionThe type of the object that was involved in this audit event.
Cardinality0...1
TypeCoding
Binding

Code for the entity type involved in the audit event.

AuditEventEntityType (extensible)
Requirements

To describe the object being acted upon. In addition to queries on the subject of the action in an auditable event, it is also important to be able to query on the object type for the action.

Comments

This value is distinct from the user's role or any user relationship to the entity.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • w5: FiveWs.what[x]
  • rim: [self::Act].code or role.player.code
  • dicom: ParticipantObjectTypeCode
  • w3c.prov: Entity.type
  • fhirprovenance: Provenance.entity.type
AuditEvent.entity.role
DefinitionCode representing the role the entity played in the event being audited.
Cardinality0...1
TypeCoding
Binding

Code representing the role the entity played in the audit event.

AuditEventEntityRole (extensible)
Requirements

For some detailed audit analysis it may be necessary to indicate a more granular type of entity, based on the application role it serves.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • w5: FiveWs.context
  • rim: role.code (not sure what this would mean for an Act)
  • dicom: ParticipantObjectTypeCodeRole
  • w3c.prov: Entity.role
AuditEvent.entity.lifecycle
DefinitionIdentifier for the data life-cycle stage for the entity.
Cardinality0...1
TypeCoding
Binding

Identifier for the data life-cycle stage for the entity.

ObjectLifecycleEvents (extensible)
Requirements

Institutional policies for privacy and security may optionally fall under different accountability rules based on data life cycle. This provides a differentiating value for those cases.

Comments

This can be used to provide an audit trail for data, over time, as it passes through the system.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • w5: FiveWs.context
  • rim: target of ObservationEvent[code="lifecycle"].value
  • dicom: ParticipantObjectDataLifeCycle
  • w3c.prov: Entity.role
  • fhirprovenance: Provenance.entity.role
AuditEvent.entity.securityLabel
DefinitionSecurity labels for the identified entity.
Cardinality0...*
TypeCoding
Binding

Security Labels from the Healthcare Privacy and Security Classification System.

All Security Labels (extensible)
Requirements

This field identifies the security labels for a specific instance of an object, such as a patient, to detect/track privacy and security issues.

Comments

Copied from entity meta security tags.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • w5: FiveWs.context
  • rim: .confidentialityCode
  • dicom: ParticipantObjectSensitivity
AuditEvent.entity.name
DefinitionA name of the entity in the audit event.
Cardinality0...1
Typestring
SummaryTrue
Requirements

Use only where entity can't be identified with an identifier.

Comments

This field may be used in a query/report to identify audit events for a specific person. For example, where multiple synonymous entity identifiers (patient number, medical record number, encounter number, etc.) have been used.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.context
  • rim: .title
  • dicom: ParticipantObjectName
  • w3c.prov: Entity.Label
AuditEvent.entity.description
DefinitionText that describes the entity in more detail.
Cardinality0...1
Typestring
Requirements

Use only where entity can't be identified with an identifier.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.context
  • rim: .text
  • dicom: ParticipantObjectDescription
AuditEvent.entity.query
DefinitionThe query parameters for a query-type entities.
Cardinality0...1
Typebase64Binary
SummaryTrue
Requirements

For query events, it may be necessary to capture the actual query input to the query process in order to identify the specific event. Because of differences among query implementations and data encoding for them, this is a base 64 encoded data blob. It may be subsequently decoded or interpreted by downstream audit analysis processing.

Comments

The meaning and secondary-encoding of the content of base64 encoded blob is specific to the AuditEvent.type, AuditEvent.subtype, AuditEvent.entity.type, and AuditEvent.entity.role. The base64 is a general-use and safe container for event specific data blobs regardless of the encoding used by the transaction being recorded. An AuditEvent consuming application must understand the event it is consuming and the formats used by the event. For example, if auditing an Oracle network database access, the Oracle formats must be understood as they will be simply encoded in the base64binary blob.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.context
  • rim: No mapping
  • dicom: ParticipantObjectQuery
AuditEvent.entity.detail
DefinitionTagged value pairs for conveying additional information about the entity.
Cardinality0...*
TypeBackboneElement
Requirements

Implementation-defined data about specific details of the object accessed or used.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.context
  • rim: .inboundRelationship[typeCode=SUBJ].target[classCode=OBS, moodCode=EVN]
  • dicom: ParticipantObjectDetail
AuditEvent.entity.detail.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
AuditEvent.entity.detail.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.entity.detail.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
AuditEvent.entity.detail.type
DefinitionThe type of extra detail provided in the value.
Cardinality1...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.context
  • rim: .code
  • dicom: ParticipantObjectDetail.type
AuditEvent.entity.detail.value[x]
DefinitionThe value of the extra detail.
Cardinality1...1
Typestring
Requirements

Should not duplicate the entity value unless absolutely necessary.

Comments

The value can be string when known to be a string, else base64 encoding should be used to protect binary or undefined content. The meaning and secondary-encoding of the content of base64 encoded blob is specific to the AuditEvent.type, AuditEvent.subtype, AuditEvent.entity.type, and AuditEvent.entity.role. The base64 is a general-use and safe container for event specific data blobs regardless of the encoding used by the transaction being recorded. An AuditEvent consuming application must understand the event it is consuming and the formats used by the event. For example if auditing an Oracle network database access, the Oracle formats must be understood as they will be simply encoded in the base64binary blob.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.context
  • rim: .value
  • dicom: ParticipantObjectDetail.value


FHIRMDSHL7v2

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation


Additional Guidance

action

SHALL be present. Code from base HL7 resource, only C (create), R (read) and U (update) would usually be expected.

"action": "U",

agent

SHOULD be present for any user initiated actions. Reference to the user or system that triggered the creation/read/update. Identity SHOULD be determined through the appropriate authentication token within the request header, e.g. CIS2 auth token.

"agent":  [
        {
            "type": {
                "coding":  [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                        "code": "AUT",
                        "display": "author (originator)"
                    }
                ]
            },
            "who": {
                "reference": "PractitionerRole/PractitionerRole-TestClinicalScientist-Example",
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/sds-user-id",
                    "value": "9999999997"
                }
            },
            "name": "Test Clinical Scientist",
            "requestor": true
        }
    ],

entity

SHOULD be present where the resource exists on the server. Reference to the resource which was affected by the event.

"entity":  [
        {
            "what": {
                "reference": "Task/Task-NonWGSRareDiseaseTestOrderRejected-Example"
            },
            "type": {
                "system": "http://hl7.org/fhir/resource-types",
                "code": "Task",
                "display": "Task"
            },
            "role": {
                "system": "http://terminology.hl7.org/CodeSystem/object-role",
                "code": "20",
                "display": "Job"
            }
        }
    ]

Genomics-BodyStructure

The Genomics BodyStructure is currently based on the HL7 international version of the resource as a profile for BodyStructure does not exist in UKCore. Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.

The base BodyStructure resource is provided below for completeness.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/BodyStructure HL7 International trial-use

Use of this resource is meant to replace the Genomics extensions for topology and morphology on the Specimen profile

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
activeΣ ?!0..1boolean
morphologyΣ0..1CodeableConcept
locationΣ0..1CodeableConcept
locationQualifier0..*CodeableConcept
descriptionΣ0..1string
imageI0..*Attachment
patientΣ I1..1Reference(Patient)

Differential from BodyStructure

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
activeΣ ?!0..1boolean
morphologyΣ0..1CodeableConcept
locationΣ0..1CodeableConcept
locationQualifier0..*CodeableConcept
descriptionΣ0..1string
imageI0..*Attachment
patientΣ I1..1Reference(Patient)

BodyStructure
DefinitionRecord details about an anatomical structure. This resource may be used when a coded concept does not provide the necessary detail needed for the use case.
Cardinality0...*
Aliasanatomical location
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • rim: ActSIte
  • openehr: Archetype ID openEHR-EHR-CLUSTER.anatomical_location.v1 Concept name Anatomical Location Concept description Record details about an anatomical location. Keywords location, site, anatomical Copyright © openEHR Foundation Purpose To record details about anatomical location. Misuse Not for specifiying unilateral/bilateral occurrence - this is related to an evaluation which perhaps includes multiple locations. Author Author name: Heather Leslie Organization: Ocean Informatics Email: heather.leslie@oceaninformatics.com Date of Origination: 2008-11-10 Translator Norwegian Bokmål: Lars Bitsch-Larsen, Haukeland University Hospital of Bergen, Norway, MD, DEAA, MBA, spec in anesthesia, spec in tropical medicine. Arabic (Syria): Mona Saleh Other contributors Heather Leslie, Ocean Informatics, Australia (Editor) Ian McNicoll, freshEHR Clinical Informatics, United Kingdom (Editor) Dunmail Hodkinson, Black Pear Software Ltd, UK References Use cases: - 5LICS, midclavicular line - L forearm, 2cm anterior to the cubital fossa - Right iliac fossa - 5 cm below L tibial tuberosity - 2 cm medial to R nipple - 4 cm below R costal margin in midclavicular line - R femur - midline nose - medial aspect of R great toe nail.
BodyStructure.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

BodyStructure.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
BodyStructure.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
BodyStructure.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
BodyStructure.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
BodyStructure.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
BodyStructure.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
BodyStructure.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
BodyStructure.identifier
DefinitionIdentifier for this instance of the anatomical structure.
Cardinality0...*
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • rim: .id
  • openehr: Specific location Cluster Optional (0..1) Cardinality: Mandatory, repeating, unordered (1..*)
BodyStructure.active
DefinitionWhether this body site is in active use.
Cardinality0...1
Typeboolean
ModifierTrue
SummaryTrue
Requirements

Need to be able to mark a body site entry as not to be used because it was created in error.

Comments

This element is labeled as a modifier because it may be used to mark that the resource was created in error.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • rim: statusCode
BodyStructure.morphology
DefinitionThe kind of structure being represented by the body structure at `BodyStructure.location`. This can define both normal and abnormal morphologies.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing anatomic morphology.

SNOMEDCTMorphologicAbnormalities (example)
SummaryTrue
Comments

The minimum cardinality of 0 supports the use case of specifying a location without defining a morphology.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.what[x]
  • v2: SPM-4/SPM-5
BodyStructure.location
DefinitionThe anatomical location or region of the specimen, lesion, or body structure.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing anatomical locations. May include laterality.

SNOMEDCTBodyStructures (example)
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.what[x]
  • v2: OBX-20/SPM-8/SPM-10
  • rim: .targetSiteCode
  • openehr: Name of location
BodyStructure.locationQualifier
DefinitionQualifier to refine the anatomical location. These include qualifiers for laterality, relative location, directionality, number, and plane.
Cardinality0...*
TypeCodeableConcept
Binding

Concepts modifying the anatomic location.

BodystructureLocationQualifier (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.what[x]
  • v2: No distinct element defined in V2.x. The IHE Radiology Technical Framework directs the use of OBR-15-specimen source to contain laterality for imaging studies./SPM-9
  • rim: .targetSiteCode
  • openehr: Combines Side, Numerical identifier, Anatomical plane,and Aspect
BodyStructure.description
DefinitionA summary, characterization or explanation of the body structure.
Cardinality0...1
Typestring
SummaryTrue
Comments

This description could include any visual markings used to orientate the viewer e.g. external reference points, special sutures, ink markings.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.what[x]
  • v2: NTE
  • rim: .text
  • openehr: Description of anatomical location/Visual markings/orientation
BodyStructure.image
DefinitionImage or images used to identify a location.
Cardinality0...*
TypeAttachment
Comments

When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • att-1: If the Attachment has data, it SHALL have a contentType
    data.empty() or contentType.exists()
Mappings
  • rim: n/a
  • v2: ED/RP
  • rim: ED
  • w5: FiveWs.what[x]
  • v2: OBX
  • rim: outboundRelationship[typeCode=COMP].target
  • openehr: Image
BodyStructure.patient
DefinitionThe person to which the body site belongs.
Cardinality1...1
TypeReference(Patient)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.subject[x]
  • v2: PID-3
  • rim: .scoper or .scoper.playsRole
  • w5: FiveWs.subject


FHIRMDSHL7v2
BodyStructure.morphologyPrimary Sample - Solid tumour morphologyAdditional SPM-4/5 qualifiers
BodyStructure.locationPrimary Sample - Solid tumour histological type (topography)SPM-8

Genomics-Bundle

The Genomics Bundle is currently pending Clinical and Technical Assurance of the base UKCore resource. Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.

The profile for the UKCore-Bundle is provided below for completeness.

Bundles within Genomics will be limited to Transactions for Test orders and updates; Transaction-responses for responses to transactions (housing sets of OperationOutcomes); or Searchsets, returned in response to search queries.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/Bundle HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
identifierΣ0..1Identifier
typeΣ1..1codeBinding
timestampΣ0..1instant
totalΣ I0..1unsignedInt
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
relationΣ1..1string
urlΣ1..1uri
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
fullUrlΣ0..1uri
resourceΣ0..1Resource
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
modeΣ0..1codeBinding
scoreΣ0..1decimal
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
methodΣ1..1codeBinding
urlΣ1..1uri
ifNoneMatchΣ0..1string
ifModifiedSinceΣ0..1instant
ifMatchΣ0..1string
ifNoneExistΣ0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
statusΣ1..1string
locationΣ0..1uri
etagΣ0..1string
lastModifiedΣ0..1instant
outcomeΣ0..1Resource
signatureΣ0..1Signature

Differential from Bundle

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
identifierΣ0..1Identifier
typeΣ1..1codeBinding
timestampΣ0..1instant
totalΣ I0..1unsignedInt
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
relationΣ1..1string
urlΣ1..1uri
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
fullUrlΣ0..1uri
resourceΣ0..1Resource
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
modeΣ0..1codeBinding
scoreΣ0..1decimal
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
methodΣ1..1codeBinding
urlΣ1..1uri
ifNoneMatchΣ0..1string
ifModifiedSinceΣ0..1instant
ifMatchΣ0..1string
ifNoneExistΣ0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
statusΣ1..1string
locationΣ0..1uri
etagΣ0..1string
lastModifiedΣ0..1instant
outcomeΣ0..1Resource
signatureΣ0..1Signature

Bundle
DefinitionA container for a collection of resources.
Cardinality0...*
Invariants
  • bdl-7: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles)
    (type = 'history') or entry.where(fullUrl.exists()).select(fullUrl&resource.meta.versionId).isDistinct()
  • bdl-9: A document must have an identifier with a system and a value
    type = 'document' implies (identifier.system.exists() and identifier.value.exists())
  • bdl-3: entry.request mandatory for batch/transaction/history, otherwise prohibited
    entry.all(request.exists() = (%resource.type = 'batch' or %resource.type = 'transaction' or %resource.type = 'history'))
  • bdl-4: entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited
    entry.all(response.exists() = (%resource.type = 'batch-response' or %resource.type = 'transaction-response' or %resource.type = 'history'))
  • bdl-12: A message must have a MessageHeader as the first resource
    type = 'message' implies entry.first().resource.is(MessageHeader)
  • bdl-1: total only when a search or history
    total.empty() or (type = 'searchset') or (type = 'history')
  • bdl-2: entry.search only when a search
    entry.search.empty() or (type = 'searchset')
  • bdl-11: A document must have a Composition as the first resource
    type = 'document' implies entry.first().resource.is(Composition)
  • bdl-10: A document must have a date
    type = 'document' implies (timestamp.hasValue())
Mappings
  • rim: Entity. Role, or Act
  • v2: N/A
  • rim: N/A
  • cda: ClinicalDocument, if bundle.type = document
Bundle.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Bundle.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Bundle.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.identifier
DefinitionA persistent identifier for the bundle that won't change as a bundle is copied from server to server.
Cardinality0...1
TypeIdentifier
SummaryTrue
Comments

Persistent identity generally only matters for batches of type Document, Message, and Collection. It would not normally be populated for search and history results and servers ignore Bundle.identifier when processing batches and transactions. For Documents the .identifier SHALL be populated such that the .identifier is globally unique.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • cda: ClinicalDocument.id
Bundle.type
DefinitionIndicates the purpose of this bundle - how it is intended to be used.
Cardinality1...1
Typecode
Binding

Indicates the purpose of a bundle - how it is intended to be used.

BundleType (required)
SummaryTrue
Comments

It's possible to use a bundle for other purposes (e.g. a document can be accepted as a transaction). This is primarily defined so that there can be specific rules for some of the bundle types.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.class
Bundle.timestamp
DefinitionThe date/time that the bundle was assembled - i.e. when the resources were placed in the bundle.
Cardinality0...1
Typeinstant
SummaryTrue
Comments

For many bundles, the timestamp is equal to .meta.lastUpdated, because they are not stored (e.g. search results). When a bundle is placed in a persistent store, .meta.lastUpdated will be usually be changed by the server. When the bundle is a message, a middleware agent altering the message (even if not stored) SHOULD update .meta.lastUpdated. .timestamp is used to track the original time of the Bundle, and SHOULD be populated.

Usage:

  • document : the date the document was created. Note: the composition may predate the document, or be associated with multiple documents. The date of the composition - the authoring time - may be earlier than the document assembly time
  • message : the date that the content of the message was assembled. This date is not changed by middleware engines unless they add additional data that changes the meaning of the time of the message
  • history : the date that the history was assembled. This time would be used as the _since time to ask for subsequent updates
  • searchset : the time that the search set was assembled. Note that different pages MAY have different timestamps but need not. Having different timestamps does not imply that subsequent pages will represent or include changes made since the initial query
  • transaction | transaction-response | batch | batch-response | collection : no particular assigned meaning

The timestamp value should be greater than the lastUpdated and other timestamps in the resources in the bundle, and it should be equal or earlier than the .meta.lastUpdated on the Bundle itself.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.init
  • cda: ClinicalDocument.effectiveTime
Bundle.total
DefinitionIf a set of search matches, this is the total number of entries of type 'match' across all pages in the search. It does not include search.mode = 'include' or 'outcome' entries and it does not provide a count of the number of entries in the Bundle.
Cardinality0...1
TypeunsignedInt
SummaryTrue
Comments

Only used if the bundle is a search result set. The total does not include resources such as OperationOutcome and included resources, only the total number of matching resources.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.link
DefinitionA series of links that provide context to this bundle.
Cardinality0...*
TypeBackboneElement
SummaryTrue
Comments

Both Bundle.link and Bundle.entry.link are defined to support providing additional context when Bundles are used (e.g. HATEOAS).

Bundle.entry.link corresponds to links found in the HTTP header if the resource in the entry was read directly.

This specification defines some specific uses of Bundle.link for searching and paging, but no specific uses for Bundle.entry.link, and no defined function in a transaction - the meaning is implementation specific.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.link.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Bundle.link.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.link.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.link.relation
DefinitionA name which details the functional use for this link - see [http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1](http://www.iana.org/assignments/link-relations/link-relations.xhtml#link-relations-1).
Cardinality1...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.link.url
DefinitionThe reference details for the link.
Cardinality1...1
Typeuri
SummaryTrue
Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry
DefinitionAn entry in a bundle resource - will either contain a resource or information about a resource (transactions and history only).
Cardinality0...*
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • bdl-8: fullUrl cannot be a version specific reference
    fullUrl.contains('/_history/').not()
  • bdl-5: must be a resource unless there's a request or response
    resource.exists() or request.exists() or response.exists()
Mappings
  • rim: n/a
Bundle.entry.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Bundle.entry.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.entry.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.entry.link
DefinitionA series of links that provide context to this entry.
Cardinality0...*
Typesee (link)
SummaryTrue
Bundle.entry.fullUrl
DefinitionThe Absolute URL for the resource. The fullUrl SHALL NOT disagree with the id in the resource - i.e. if the fullUrl is not a urn:uuid, the URL shall be version-independent URL consistent with the Resource.id. The fullUrl is a version independent reference to the resource. The fullUrl element SHALL have a value except that: * fullUrl can be empty on a POST (although it does not need to when specifying a temporary id for reference in the bundle) * Results from operations might involve resources that are not identified.
Cardinality0...1
Typeuri
SummaryTrue
Comments

fullUrl might not be unique in the context of a resource. Note that since FHIR resources do not need to be served through the FHIR API, the fullURL might be a URN or an absolute URL that does not end with the logical id of the resource (Resource.id). However, but if the fullUrl does look like a RESTful server URL (e.g. meets the regex, then the 'id' portion of the fullUrl SHALL end with the Resource.id.

Note that the fullUrl is not the same as the canonical URL - it's an absolute url for an endpoint serving the resource (these will happen to have the same value on the canonical server for the resource with the canonical URL).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.resource
DefinitionThe Resource for the entry. The purpose/meaning of the resource is determined by the Bundle.type.
Cardinality0...1
TypeResource
SummaryTrue
Mappings
  • rim: Entity. Role, or Act
Bundle.entry.search
DefinitionInformation about the search process that lead to the creation of this entry.
Cardinality0...1
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.search.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Bundle.entry.search.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.entry.search.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.entry.search.mode
DefinitionWhy this entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.
Cardinality0...1
Typecode
Binding

Why an entry is in the result set - whether it's included as a match or because of an _include requirement, or to convey information or warning information about the search process.

SearchEntryMode (required)
SummaryTrue
Comments

There is only one mode. In some corner cases, a resource may be included because it is both a match and an include. In these circumstances, 'match' takes precedence.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.search.score
DefinitionWhen searching, the server's search ranking score for the entry.
Cardinality0...1
Typedecimal
SummaryTrue
Comments

Servers are not required to return a ranking score. 1 is most relevant, and 0 is least relevant. Often, search results are sorted by score, but the client may specify a different sort order.

See Patient Match for the EMPI search which relates to this element.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.request
DefinitionAdditional information about how this entry should be processed as part of a transaction or batch. For history, it shows how the entry was processed to create the version contained in the entry.
Cardinality0...1
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.request.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Bundle.entry.request.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.entry.request.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.entry.request.method
DefinitionIn a transaction or batch, this is the HTTP action to be executed for this entry. In a history bundle, this indicates the HTTP action that occurred.
Cardinality1...1
Typecode
Binding

HTTP verbs (in the HTTP command line). See HTTP rfc for details.

HTTPVerb (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.request.url
DefinitionThe URL for this entry, relative to the root (the address to which the request is posted).
Cardinality1...1
Typeuri
SummaryTrue
Comments

E.g. for a Patient Create, the method would be "POST" and the URL would be "Patient". For a Patient Update, the method would be PUT and the URL would be "Patient/[id]".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.request.ifNoneMatch
DefinitionIf the ETag values match, return a 304 Not Modified status. See the API documentation for ["Conditional Read"](http.html#cread).
Cardinality0...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.request.ifModifiedSince
DefinitionOnly perform the operation if the last updated date matches. See the API documentation for ["Conditional Read"](http.html#cread).
Cardinality0...1
Typeinstant
SummaryTrue
Comments

Note: This is intended for where precisely observed times are required, typically system logs etc., and not human-reported times - for them, see date and dateTime (which can be as precise as instant, but is not required to be) below. Time zone is always required

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.request.ifMatch
DefinitionOnly perform the operation if the Etag value matches. For more information, see the API section ["Managing Resource Contention"](http.html#concurrency).
Cardinality0...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.request.ifNoneExist
DefinitionInstruct the server not to perform the create if a specified resource already exists. For further information, see the API documentation for ["Conditional Create"](http.html#ccreate). This is just the query portion of the URL - what follows the "?" (not including the "?").
Cardinality0...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.response
DefinitionIndicates the results of processing the corresponding 'request' entry in the batch or transaction being responded to or what the results of an operation where when returning history.
Cardinality0...1
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.response.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Bundle.entry.response.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.entry.response.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Bundle.entry.response.status
DefinitionThe status code returned by processing this entry. The status SHALL start with a 3 digit HTTP code (e.g. 404) and may contain the standard HTTP description associated with the status code.
Cardinality1...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.response.location
DefinitionThe location header created by processing this operation, populated if the operation returns a location.
Cardinality0...1
Typeuri
SummaryTrue
Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.response.etag
DefinitionThe Etag for the resource, if the operation for the entry produced a versioned resource (see [Resource Metadata and Versioning](http.html#versioning) and [Managing Resource Contention](http.html#concurrency)).
Cardinality0...1
Typestring
SummaryTrue
Comments

Etags match the Resource.meta.versionId. The ETag has to match the version id in the header if a resource is included.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.response.lastModified
DefinitionThe date/time that the resource was modified on the server.
Cardinality0...1
Typeinstant
SummaryTrue
Comments

This has to match the same time in the meta header (meta.lastUpdated) if a resource is included.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Bundle.entry.response.outcome
DefinitionAn OperationOutcome containing hints and warnings produced as part of processing this entry in a batch or transaction.
Cardinality0...1
TypeResource
SummaryTrue
Comments

For a POST/PUT operation, this is the equivalent outcome that would be returned for prefer = operationoutcome - except that the resource is always returned whether or not the outcome is returned.

This outcome is not used for error responses in batch/transaction, only for hints and warnings. In a batch operation, the error will be in Bundle.entry.response, and for transaction, there will be a single OperationOutcome instead of a bundle in the case of an error.

Mappings
  • rim: Entity. Role, or Act
Bundle.signature
DefinitionDigital Signature - base64 encoded. XML-DSig or a JWT.
Cardinality0...1
TypeSignature
SummaryTrue
Requirements

A Signature holds an electronic representation of a signature and its supporting context in a FHIR accessible form. The signature may either be a cryptographic type (XML DigSig or a JWS), which is able to provide non-repudiation proof, or it may be a graphical image that represents a signature or a signature process. This element allows capturing signatures on documents, messages, transactions or even search responses, to support content-authentication, non-repudiation or other business cases. This is primarily relevant where the bundle may travel through multiple hops or via other mechanisms where HTTPS non-repudiation is insufficient.

Comments

The signature could be created by the "author" of the bundle or by the originating device. Requirements around inclusion of a signature, verification of signatures and treatment of signed/non-signed bundles is implementation-environment specific.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A


FHIRMDSHL7v2

Additional Guidance

type

SHALL be present. The type of Bundle. This is expected to be transaction for Bundles POSTed to the central broker, transaction-response for responses to transaction Bundles returned by the broker and searchset for collections of resources returned in response to search (GET) requests, as per standard HTTP FHIR rules.

"type": "transaction",

total

Only relevant for searchset Bundles. Details the number of resources in the bundle matching the search criteria, not including resources included via the _include criteria.

"total": 3,

Only relevant for searchset bundles. Details the query string that resulted in the searchset (to allow future queries using the same parameters). "relation": "self" will only ever be used.

Links related to response pagination such as next/prev are pending Non-Functional Requirements finalisation for the order management central broker.

"link": [
        {
            "relation": "self",
            "url": "https://api.service.nhs.uk/genomic-order-management-service/FHIR/R4/Specimen/?_include=Specimen%3Asubject&identifier=RGT03135"
        }
    ],

entry

Transactions

An entry in the bundle. For transaction Bundles, each entry SHOULD contain a fullURL to ensure resources in the Bundle can reference each other, these can be the locations within the source system or urn:uuids.

Resources are expected to contain ids to allow referencing within Bundles, though these will be replaced by server assigned ids when saved by the central broker. If additional identifiers need to be persisted e.g. NHS Number, these should be captured within the identifier field.

Transaction Bundle entries also SHALL contain a request object, specifying the method (either PUT for updates or POST for creates) and the url to send the resource to (equivalent to the resource type for the resource).

Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS

"entry": [
        {
			"fullUrl": "http://example.org/fhir/Specimen/Specimen-BloodEDTA-Example",
			"resource": {
				"resourceType": "Specimen",
				"id": "Specimen-BloodEDTA-Example",
				"identifier": [
					{
						"system": "https://fhir.add.nhs.uk/Id/specimenId",
						"value": "RGT03135"
					}
				],
				"status": "unavailable",
				"type": {
					"coding": [
						{
							"system": "http://snomed.info/sct",
							"code": "445295009",
							"display": "Blood specimen with EDTA"
						}
					]
				},
				"subject": {
					"reference": "Patient/Patient-MeirLieberman-Example",
					"identifier": {
						"system": "https://fhir.nhs.uk/Id/nhs-number",
						"value": "9449307873"
					}
				},
				"request": [
					{
						"reference": "ServiceRequest/ServiceRequest-NonWGSTestOrderForm-Example"
					}
				]
			},
            "request": {
                "method": "POST",
                "url": "Specimen"
            }
		}
	]

Transaction Responses

These Bundles are returned in response to transaction requests. These will only contain OperationOutcome resources (one for each recource contained in the transaction request). See Acknowledgements and responses for more information.

These entries will contain a response object detailing the response status of the individual resource operation and an OperationOutcome detailing any relevant diagnostics, such as validation messages.

Entries will also contain a location element, detailing the relative path of the resource, where the operation has resulted in a resource being created or updated. These URLs will be version specific (using the _history suffix to denote the version number of the resource) if the resource has been updated.

"entry": [
    {
      "response": {
        "status": "201 Created",
        "location": "ServiceRequest/4d70678c-81e4-4ff4-8c67-17596fd0aa46/",
        "lastModified": "2024-01-30T12:01:24Z",
        "outcome": {
          "resourceType": "OperationOutcome",
          "meta": {
            "lastUpdated": "2024-01-30T12:01:24Z"
          },
          "issue": [
            {
              "severity": "information",
              "code": "informational",
              "diagnostics": "No issues detected during validation."
            }
          ]
        }
      }
    }
  ]

Searchsets

These Bundles are returned in response to GET requests without an ID. entries within these bundles will depend on the endpoint queried and the search parameters included.

Each entry is expected to include a fullUrl identifying the URL that can be used to retrieve the resource on the server; the resource itself; and a search element detailing whether the resource was included in the search response due to it matching the query parameters, "mode": "match", or whether it was included via the _include parameter, "mode": "include".

"entry": [
        {
            "fullUrl": "https://api.service.nhs.uk/genomic-order-management-service/FHIR/R4/44707473",
            "resource": {
                "resourceType": "Specimen",
                "id": "44707473",
                "meta": {
                    "versionId": "1",
                    "lastUpdated": "2024-05-13T14:28:05.843+00:00",
                    "source": "#CJ6XJLTGD315XL2Z"
                },
                "identifier": [
                    {
                        "system": "https://fhir.add.nhs.uk/Id/specimenId",
                        "value": "RGT03135"
                    }
                ],
                "status": "unavailable",
                "type": {
                    "coding": [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "445295009",
                            "display": "Blood specimen with EDTA"
                        }
                    ]
                },
                "subject": {
                    "reference": "Patient/44707475",
                    "identifier": {
                        "system": "https://fhir.nhs.uk/Id/nhs-number",
                        "value": "9449307946"
                    }
                },
                "request": [
                    {
                        "reference": "ServiceRequest/ServiceRequest-NonWGSTestOrderForm-Example"
                    }
                ]
            },
            "search": {
                "mode": "match"
            }
        }
    ]

Genomics-Composition

The Genomics Composition is currently pending Clinical and Technical Assurance of the base UKCore resource. Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.

The profile for the UKCore-Bundle is provided below for completeness.

Compositions within Genomics will be limited to documents generated by the central broker for capturing snapshots of Test orders and results in order to maintain historical accuracy, as per the

Command 'pagelink' could not render: Page not found.
OperationDefinition. These will typically form the first entry of a Document Bundle and as such will not be exposed via their own endpoint, nor allow creates,reads or updates from client systems on the resource itself.

Usage of the Compostion resource and generation of documents is pending internal review

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/Composition HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..1Identifier
statusΣ ?!1..1codeBinding
typeΣ1..1CodeableConceptBinding
categoryΣ0..*CodeableConcept
subjectΣ I0..1Reference(Resource)
encounterΣ I0..1Reference(Encounter)
dateΣ1..1dateTime
authorΣ I1..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
titleΣ1..1string
confidentialityΣ0..1codeBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
mode1..1codeBinding
time0..1dateTime
partyI0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)
custodianΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
code1..1codeBinding
targetIdentifierIdentifier
targetReferenceReference(Composition)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ0..*CodeableConcept
periodΣ I0..1Period
detailΣ I0..*Reference(Resource)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
title0..1string
code0..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
entryI0..*Reference(Resource)
emptyReasonI0..1CodeableConceptBinding
sectionI0..*see (section)

Differential from Composition

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..1Identifier
statusΣ ?!1..1codeBinding
typeΣ1..1CodeableConceptBinding
categoryΣ0..*CodeableConcept
subjectΣ I0..1Reference(Resource)
encounterΣ I0..1Reference(Encounter)
dateΣ1..1dateTime
authorΣ I1..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
titleΣ1..1string
confidentialityΣ0..1codeBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
mode1..1codeBinding
time0..1dateTime
partyI0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)
custodianΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
code1..1codeBinding
targetIdentifierIdentifier
targetReferenceReference(Composition)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ0..*CodeableConcept
periodΣ I0..1Period
detailΣ I0..*Reference(Resource)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
title0..1string
code0..1CodeableConcept
authorI0..*Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
focusI0..1Reference(Resource)
textI0..1Narrative
mode0..1codeBinding
orderedBy0..1CodeableConceptBinding
entryI0..*Reference(Resource)
emptyReasonI0..1CodeableConceptBinding
sectionI0..*see (section)

Composition
DefinitionA set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).
Cardinality0...*
Comments

While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • rim: Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
  • cda: ClinicalDocument
  • fhirdocumentreference: when described by DocumentReference
Composition.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Composition.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Composition.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Composition.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Composition.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Composition.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Composition.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.identifier
DefinitionA version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time.
Cardinality0...1
TypeIdentifier
SummaryTrue
Comments

Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • rim: Document.id / Document.setId
  • cda: .setId
  • fhirdocumentreference: DocumentReference.masterIdentifier
Composition.status
DefinitionThe workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.
Cardinality1...1
Typecode
Binding

The workflow/clinical status of the composition.

CompositionStatus (required)
ModifierTrue
SummaryTrue
Requirements

Need to be able to mark interim, amended, or withdrawn compositions or documents.

Comments

If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements.

Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
  • rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"
  • cda: n/a
  • fhirdocumentreference: DocumentReference.status
Composition.type
DefinitionSpecifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.
Cardinality1...1
TypeCodeableConcept
Binding

Type of a composition.

FHIRDocumentTypeCodes (preferred)
SummaryTrue
Requirements

Key metadata element describing the composition, used in searching/filtering.

Comments

For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.code
  • w5: FiveWs.class
  • rim: ./code
  • cda: .code
  • fhirdocumentreference: DocumentReference.type
Composition.category
DefinitionA categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.
Cardinality0...*
TypeCodeableConcept
Binding

High-level kind of a clinical document at a macro level.

DocumentClassValueSet (example)
SummaryTrue
Requirements

Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.

Comments

This is a metadata field from XDS/MHD.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.subject
  • w5: FiveWs.class
  • rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
  • cda: n/a
  • fhirdocumentreference: DocumenttReference.category
Composition.subject
DefinitionWho or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).
Cardinality0...1
TypeReference(Resource)
SummaryTrue
Requirements

Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.

Comments

For clinical documents, this is usually the patient.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.subject[x]
  • rim: .participation[typeCode="SBJ"].role[typeCode="PAT"]
  • cda: .recordTarget
  • fhirdocumentreference: DocumentReference.subject
  • w5: FiveWs.subject
Composition.encounter
DefinitionDescribes the clinical encounter or type of care this documentation is associated with.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
Requirements

Provides context for the composition and supports searching.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.context
  • w5: FiveWs.context
  • rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
  • cda: .componentOf.encompassingEncounter
  • fhirdocumentreference: DocumentReference.context.encounter
Composition.date
DefinitionThe composition editing time, when the composition was last logically changed by the author.
Cardinality1...1
TypedateTime
SummaryTrue
Requirements

dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring. When packaged in a document, Bundle.timestamp is the date of packaging.

Comments

The Last Modified Date on the composition may be after the date of the document was attested without being changed.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • rim: .effectiveTime[type="TS"]
  • cda: .effectiveTime
  • fhirdocumentreference: DocumentReference.content.attachment.date, DocumentReference.created
Composition.author
DefinitionIdentifies who is responsible for the information in the composition, not necessarily who typed it in.
Cardinality1...*
TypeReference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
SummaryTrue
Requirements

Identifies who is responsible for the content.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer
  • w5: FiveWs.author
  • rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"]
  • cda: .author.assignedAuthor
  • fhirdocumentreference: DocumentReference.agent
Composition.title
DefinitionOfficial human-readable label for the composition.
Cardinality1...1
Typestring
SummaryTrue
Comments

For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ./title
  • cda: .title
  • fhirdocumentreference: DocumentReference.description, DocumentReference.content.attachment.title
Composition.confidentiality
DefinitionThe code specifying the level of confidentiality of the Composition.
Cardinality0...1
Typecode
Binding

Codes specifying the level of confidentiality of the composition.

v3.ConfidentialityClassification (required)
SummaryTrue
Comments

The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .confidentialityCode
  • cda: .confidentialityCode
  • fhirdocumentreference: DocumentReference.securityLabel
Composition.attester
DefinitionA participant who has attested to the accuracy of the composition/document.
Cardinality0...*
TypeBackboneElement
Requirements

Identifies responsibility for the accuracy of the composition content.

Comments

Only list each attester once.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"]
  • cda: .authenticator/.legalAuthenticator
  • fhirdocumentreference: DocumentReference.authenticator
Composition.attester.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Composition.attester.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.attester.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.attester.mode
DefinitionThe type of attestation the authenticator offers.
Cardinality1...1
Typecode
Binding

The way in which a person authenticated a composition.

CompositionAttestationMode (required)
Requirements

Indicates the level of authority of the attestation.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: unique(./modeCode)
  • cda: implied by .authenticator/.legalAuthenticator
Composition.attester.time
DefinitionWhen the composition was attested by the party.
Cardinality0...1
TypedateTime
Requirements

Identifies when the information in the composition was deemed accurate. (Things may have changed since then.).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ./time[type="TS" and isNormalDatatype()]
  • cda: .authenticator.time
Composition.attester.party
DefinitionWho attested the composition in the specified way.
Cardinality0...1
TypeReference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)
Requirements

Identifies who has taken on the responsibility for accuracy of the composition content.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.witness
  • rim: ./role[classCode="ASSIGNED" and isNormalRole]/player[determinerCode="INST" and classCode=("DEV", "PSN") and isNormalEntity()] or ./role[classCode="ASSIGNED" and isNormalRole and not(player)]/scoper[determinerCode="INST" and classCode="ORG" and isNormalEntity()]
  • cda: .authenticator.assignedEnttty
Composition.custodian
DefinitionIdentifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.
Cardinality0...1
TypeReference(Organization)
SummaryTrue
Requirements

Identifies where to go to find the current version, where to report issues, etc.

Comments

This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
  • cda: .custodian.assignedCustodian
  • fhirdocumentreference: DocumentReference.custodian
Composition.relatesTo
DefinitionRelationships that this composition has with other compositions or documents that already exist.
Cardinality0...*
TypeBackboneElement
Comments

A document is a version specific composition.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship
  • cda: .relatedDocument
  • fhirdocumentreference: DocumentReference.relatesTo
Composition.relatesTo.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Composition.relatesTo.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.relatesTo.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.relatesTo.code
DefinitionThe type of relationship that this composition has with anther composition or document.
Cardinality1...1
Typecode
Binding

The type of relationship between documents.

DocumentRelationshipType (required)
Comments

If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship.typeCode
  • cda: .relatedDocument.typeCode
  • fhirdocumentreference: DocumentReference.relatesTo.code
Composition.relatesTo.target[x]
DefinitionThe target composition/document of this relationship.
Cardinality1...1
TypeIdentifier
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .target[classCode="DOC", moodCode="EVN"].id
  • cda: .relatedDocument.id
  • fhirdocumentreference: DocumentReference.relatesTo.target
Composition.event
DefinitionThe clinical service, such as a colonoscopy or an appendectomy, being documented.
Cardinality0...*
TypeBackboneElement
SummaryTrue
Requirements

Provides context for the composition and creates a linkage between a resource describing an event and the composition created describing the event.

Comments

The event needs to be consistent with the type element, though can provide further information if desired.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: outboundRelationship[typeCode="SUBJ"].target[classCode<'ACT']
  • cda: .documentationOf.serviceEvent
  • fhirdocumentreference: DocumentReference.event
Composition.event.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Composition.event.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.event.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.event.code
DefinitionThis list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.
Cardinality0...*
TypeCodeableConcept
Binding

This list of codes represents the main clinical acts being documented.

v3.ActCode (example)
SummaryTrue
Comments

An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .code
  • cda: .code
  • fhirdocumentreference: DocumentReference.event.code
Composition.event.period
DefinitionThe period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • rim: .effectiveTime
  • cda: .effectiveTime
  • fhirdocumentreference: DocumentReference.event.period
Composition.event.detail
DefinitionThe description and/or reference of the event(s) being documented. For example, this could be used to document such a colonoscopy or an appendectomy.
Cardinality0...*
TypeReference(Resource)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .outboundRelationship[typeCode="SUBJ"].target
  • cda: n/a
Composition.section
DefinitionThe root of the sections that make up the composition.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cmp-1: A section must contain at least one of text, entries, or sub-sections
    text.exists() or entry.exists() or section.exists()
  • cmp-2: A section can only have an emptyReason if it is empty
    emptyReason.empty() or entry.empty()
Mappings
  • rim: n/a
  • rim: ./outboundRelationship[typeCode="COMP" and isNormalActRelationship()]/target[moodCode="EVN" and classCode="DOCSECT" and isNormalAct]
  • cda: .component.structuredBody.component.section
Composition.section.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Composition.section.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.section.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Composition.section.title
DefinitionThe label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.
Cardinality0...1
Typestring
Aliasheader, label, caption
Requirements

Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized.

Comments

The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ./title
  • cda: .title
Composition.section.code
DefinitionA code identifying the kind of content contained within the section. This must be consistent with the section title.
Cardinality0...1
TypeCodeableConcept
Binding

Classification of a section of a composition/document.

DocumentSectionCodes (example)
Requirements

Provides computable standardized labels to topics within the document.

Comments

The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document.

If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: ./code
  • cda: .code
Composition.section.author
DefinitionIdentifies who is responsible for the information in this section, not necessarily who typed it in.
Cardinality0...*
TypeReference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)
Requirements

Identifies who is responsible for the content.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.author
  • rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"]
  • cda: .author.assignedAuthor
Composition.section.focus
DefinitionThe actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).
Cardinality0...1
TypeReference(Resource)
Comments

Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • cda: .subject? (CDA did not differentiate between subject and focus)
Composition.section.text
DefinitionA human-readable narrative that contains the attested content of the section, 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.
Cardinality0...1
TypeNarrative
Comments

Document profiles may define what content should be represented in the narrative to ensure clinical safety.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: .text
  • cda: .text
Composition.section.mode
DefinitionHow the entry list was prepared - whether it is a working list that is suitable for being maintained on an ongoing basis, or if it represents a snapshot of a list of items from another source, or whether it is a prepared list where items may be marked as added, modified or deleted.
Cardinality0...1
Typecode
Binding

The processing mode that applies to this section.

ListMode (required)
Requirements

Sections are used in various ways, and it must be known in what way it is safe to use the entries in them.

Comments

This element is labeled as a modifier because a change list must not be misunderstood as a complete list.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.class
  • rim: .outBoundRelationship[typeCode=COMP].target[classCode=OBS"].value
  • cda: n/a
Composition.section.orderedBy
DefinitionSpecifies the order applied to the items in the section entries.
Cardinality0...1
TypeCodeableConcept
Binding

What order applies to the items in the entry.

ListOrderCodes (preferred)
Requirements

Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.

Comments

Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .outboundRelationship[typeCode=COMP].sequenceNumber > 1
  • cda: n/a
Composition.section.entry
DefinitionA reference to the actual resource from which the narrative in the section is derived.
Cardinality0...*
TypeReference(Resource)
Comments

If there are no entries in the list, an emptyReason SHOULD be provided.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .outboundRelationship[typeCode=COMP] or .participation[typeCode=SBJ]
  • cda: .entry
Composition.section.emptyReason
DefinitionIf the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.
Cardinality0...1
TypeCodeableConcept
Binding

If a section is empty, why it is empty.

ListEmptyReasons (preferred)
Requirements

Allows capturing things like "none exist" or "not asked" which can be important for most lists.

Comments

The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .inboundRelationship[typeCode=SUBJ,code<ListEmptyReason].value[type=CD]
  • cda: n/a
Composition.section.section
DefinitionA nested sub-section within this section.
Cardinality0...*
Typesee (section)
Comments

Nested sections are primarily used to help human readers navigate to particular portions of the document.

Mappings
  • rim: ./outboundRelationship[typeCode="COMP" and isNormalActRelationship()]/target[moodCode="EVN" and classCode="DOCSECT" and isNormalAct]
  • cda: .component.section



FHIRMDSHL7v2

Additional Guidance

status

Fixed value of 'final'

"status": "final",

type

SNOMED CT code for either a Laboratory Request (24691000000102) or Genetic report (1054161000000101)

"type": {
    "coding": [
        {
            "system": "http://snomed.info/sct",
            "code": "1054161000000101",
            "display": "Genetic report (record artifact)"
        }
    ]
},

subject

Matches subject reference included in either the DiagnosticReport or ServiceRequest

"subject": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9999999999"
        }
    },

date

SHALL be the dateTime the Composition was generated by the central broker

"date": "2022-07-11T09:00:00Z",

author

Fixed to an identifier for the central broker (TBC). The author for the underlying ServiceRequest or DiagnosticReport can be retrieved by interrogating the appropriate resources.

"author": [
    {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/spine-ASID",
            "value": "200000000215"
        }
    }
],

title

SHALL match the SNOMED CT display used within Composition.type

"status": "Genetic report (record artifact)",

section

SHALL only include the ServiceRequest or DiagnsoticReport forming the base of a GraphDefinition.

"section": [
    {
        "mode": "snapshot",
        "entry": [
            {
                "reference": "DiagnosticReport/DiagnosticReport-AnitaLamberts-Example"
            }
        ]
    }
]

Genomics-Condition

For detailing any Condition related information about the proband/consultands within a test order.

It is expected that the information used to populate this resource SHOULD be sourced from the requesters EHR system. As such, there is no limit on the amount of detail that can be provided, though at a minimum the code and subject fields SHOULD be populated.

It is also highly preferred if the verificationStatus, onsetDateTime, recordedDate, recorded and abatementDateTime are populated if applicable/known.

The primary condition, being tested for SHOULD be referenced via ServiceRequest.reasonReference, additional relevant conditions SHOULD be referenced via ServiceRequest.supportingInfo.

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Condition UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
bodyStructureR6I0..1Extension(Reference(BodyStructure))
conditionEpisodeI0..*Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
clinicalStatusS Σ ?! I0..1CodeableConceptBinding
verificationStatusS Σ ?! I0..1CodeableConceptBinding
category0..*CodeableConceptBinding
severityS0..1CodeableConceptBinding
codeS Σ0..1CodeableConceptBinding
bodySiteΣ0..*CodeableConceptBinding
subjectS Σ I1..1Reference(Patient | Group)
encounterΣ I0..1Reference(Encounter)
onsetDateTimedateTime
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
abatementDateTimedateTime
abatementAgeAge
abatementPeriodPeriod
abatementRangeRange
abatementStringstring
recordedDateΣ0..1dateTime
recorderS Σ I0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
asserterΣ I0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
summaryI0..1CodeableConcept
assessmentI0..*Reference(ClinicalImpression | DiagnosticReport | Observation)
type0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ I0..*CodeableConcept
detailΣ I0..*Reference(Resource)
note0..*Annotation

Differential from Condition

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
bodyStructureR6I0..1Extension(Reference(BodyStructure))
conditionEpisodeI0..*Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
clinicalStatusS Σ ?! I0..1CodeableConceptBinding
verificationStatusS Σ ?! I0..1CodeableConceptBinding
category0..*CodeableConceptBinding
severityS0..1CodeableConceptBinding
codeS Σ0..1CodeableConceptBinding
bodySiteΣ0..*CodeableConceptBinding
subjectS Σ I1..1Reference(Patient | Group)
encounterΣ I0..1Reference(Encounter)
onsetDateTimedateTime
onsetAgeAge
onsetPeriodPeriod
onsetRangeRange
onsetStringstring
abatementDateTimedateTime
abatementAgeAge
abatementPeriodPeriod
abatementRangeRange
abatementStringstring
recordedDateΣ0..1dateTime
recorderS Σ I0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
asserterΣ I0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
summaryI0..1CodeableConcept
assessmentI0..*Reference(ClinicalImpression | DiagnosticReport | Observation)
type0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ I0..*CodeableConcept
detailΣ I0..*Reference(Resource)
note0..*Annotation

Condition
DefinitionA clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
    verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
  • con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
    abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
  • con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item
    clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • sct-concept: < 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)
  • v2: PPR message
  • rim: Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
Condition.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Condition.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Condition.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Condition.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Condition.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Condition.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Condition.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Condition.extension:bodyStructureR6
DefinitionOptional Extension Element - found in all resources.
Cardinality0...1
TypeExtension(Reference(BodyStructure))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Condition.extension:conditionEpisode
DefinitionThe episodicity status of a condition.
Cardinality0...*
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Condition.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Condition.identifier
DefinitionBusiness identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • rim: .id
Condition.clinicalStatus
DefinitionThe clinical status of the condition.
Cardinality0...1
TypeCodeableConcept
Binding

The clinical status of the condition or diagnosis.

ConditionClinicalStatusCodes (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.status
  • w5: FiveWs.status
  • sct-concept: < 303105007 |Disease phases|
  • v2: PRB-14
  • rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
Condition.verificationStatus
DefinitionThe verification status to support the clinical status of the condition.
Cardinality0...1
TypeCodeableConcept
Binding

The verification status to support or decline the clinical status of the condition or diagnosis.

ConditionVerificationStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.status
  • w5: FiveWs.status
  • sct-concept: < 410514004 |Finding context value|
  • v2: PRB-13
  • rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
  • sct-attr: 408729009
Condition.category
DefinitionA category assigned to the condition.
Cardinality0...*
TypeCodeableConcept
Binding

A ValueSet to identify the category of a condition.

UKCoreConditionCategory (extensible)
Comments

The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • sct-concept: < 404684003 |Clinical finding|
  • v2: 'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message
  • rim: .code
Condition.severity
DefinitionA subjective assessment of the severity of the condition as evaluated by the clinician.
Cardinality0...1
TypeCodeableConcept
Binding

A subjective assessment of the severity of the condition as evaluated by the clinician.

Condition/DiagnosisSeverity (preferred)
Must SupportTrue
Comments

Coding of the severity with a terminology is preferred, where possible.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.grade
  • sct-concept: < 272141005 |Severities|
  • v2: PRB-26 / ABS-3
  • rim: Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value
  • sct-attr: 246112005
Condition.code
DefinitionIdentification of the condition, problem or diagnosis.
Cardinality0...1
TypeCodeableConcept
Binding

A code from the SNOMED Clinical Terminology UK with the expression (<404684003 |Clinical finding| OR <413350009 |Finding with explicit context| OR <272379006 |Event|).

UKCoreConditionCode (preferred)
Must SupportTrue
SummaryTrue
Aliastype
Requirements

0..1 to account for primarily narrative only resources.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.code
  • w5: FiveWs.what[x]
  • sct-concept: code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 413350009 |Finding with explicit context| OR < 272379006 |Event|
  • v2: PRB-3
  • rim: .value
  • sct-attr: 246090004
Condition.bodySite
DefinitionThe anatomical location where this condition manifests itself.
Cardinality0...*
TypeCodeableConcept
Binding

Codes describing anatomical locations. May include laterality.

SNOMEDCTBodyStructures (preferred)
SummaryTrue
Comments

Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • sct-concept: < 442083009 |Anatomical or acquired body structure|
  • rim: .targetBodySiteCode
  • sct-attr: 363698007
Condition.subject
DefinitionIndicates the patient or group who the condition record is associated with.
Cardinality1...1
TypeReference(Patient | Group)
Must SupportTrue
SummaryTrue
Aliaspatient
Requirements

Group is typically used for veterinary or public health use cases.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • v2: PID-3
  • rim: .participation[typeCode=SBJ].role[classCode=PAT]
  • w5: FiveWs.subject
Condition.encounter
DefinitionThe Encounter during which this Condition was created or to which the creation of this record is tightly associated.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.context
  • w5: FiveWs.context
  • v2: PV1-19 (+PV1-54)
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Condition.onset[x]
DefinitionEstimated or actual date or date-time the condition began, in the opinion of the clinician.
Cardinality0...1
TypedateTime
SummaryTrue
Comments

Age is generally used when the patient reports an age at which the Condition began to occur.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.init
  • v2: PRB-16
  • rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
Condition.abatement[x]
DefinitionThe date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.
Cardinality0...1
TypedateTime
Comments

There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.done[x]
  • rim: .effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
Condition.recordedDate
DefinitionThe recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.
Cardinality0...1
TypedateTime
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.recorded
  • v2: REL-11
  • rim: .participation[typeCode=AUT].time
Condition.recorder
DefinitionIndividual who recorded the record and takes responsibility for its content.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole | Patient | RelatedPerson)
Must SupportTrue
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
Condition.asserter
DefinitionIndividual who is making the condition statement.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole | Patient | RelatedPerson)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.source
  • v2: REL-7.1 identifier + REL-7.12 type code
  • rim: .participation[typeCode=INF].role
Condition.stage
DefinitionClinical stage or grade of a condition. May include formal severity assessments.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • con-1: Stage SHALL have summary or assessment
    summary.exists() or assessment.exists()
Mappings
  • rim: n/a
  • rim: ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage/grade"]
Condition.stage.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Condition.stage.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Condition.stage.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Condition.stage.summary
DefinitionA simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing condition stages (e.g. Cancer stages).

ConditionStage (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • sct-concept: < 254291000 |Staging and scales|
  • v2: PRB-14
  • rim: .value
Condition.stage.assessment
DefinitionReference to a formal record of the evidence on which the staging assessment is based.
Cardinality0...*
TypeReference(ClinicalImpression | DiagnosticReport | Observation)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .self
Condition.stage.type
DefinitionThe kind of staging, such as pathological or clinical staging.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing the kind of condition staging (e.g. clinical or pathological).

ConditionStageType (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage type"]
Condition.evidence
DefinitionSupporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.
Cardinality0...*
TypeBackboneElement
Comments

The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • con-2: evidence SHALL have code or details
    code.exists() or detail.exists()
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]
Condition.evidence.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Condition.evidence.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Condition.evidence.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Condition.evidence.code
DefinitionA manifestation or symptom that led to the recording of this condition.
Cardinality0...*
TypeCodeableConcept
Binding

Codes that describe the manifestation or symptoms of a condition.

ManifestationAndSymptomCodes (example)
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.reasonCode
  • w5: FiveWs.why[x]
  • sct-concept: < 404684003 |Clinical finding|
  • rim: [code="diagnosis"].value
Condition.evidence.detail
DefinitionLinks to other relevant information, including pathology reports.
Cardinality0...*
TypeReference(Resource)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.why[x]
  • rim: .self
Condition.note
DefinitionAdditional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.
Cardinality0...*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Event.note
  • v2: NTE child of PRB
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value


FHIRMDSHL7v2
ConditionPatient Clinical Presentation, Diabetic complicationsDG1
Condition.bodySiteHas multiple primary tumours, Count of tumours, Site of tumour (many), Abnormal infection history site, Abnormal infection history site organismMultiple DG1 segments (bodySite for condition not in scope for HL7v2)
Condition.verificationStatusKnown/suspected diseaseDG1-6
Condition.recordedDateDate of diagnosis, Diagnosis during pregnancyDG1-5
Condition.clinicalStatusDisease status, Is patient in treatment free remission, Is diabetes in remissionPotentially mapped to DG1-17
Condition.codePhenotypic details (Many), Solid tumour type, Liquid tumour type, Laterality of hearing loss, Fetal maternal screening genotype, Fetal paternal screening genotype, Thyroid gland state, Pituitary tumour type, Pancreatic tumour type, Phaeochromocytoma, Progeroid features, Severity of hearing loss, Retinal degeneration, Hepatic vs neurological presentation, Suspected inborn error type(s)Additional DG1 segments (DG1-3)
Condition.onsetDateTimeDate of disease onset, Duration of hyperinsulism (when compared to abatementDateTimefor non OML messages PRB-16
Condition.evidence.detail( reference( FamilyMemberHistory, Media ) )Pedigree details/diagram, Disease penetranceN/A not in scope for HL7v2, could be added as additional DG1 segments related to relatives (representation of family history in HL7v2 still pending investigation)
Condition.evidence.codeSymptoms at onsetSeparate DG1 with DG1-17=S

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Condition_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Condition-Genomics

Additional Guidance

extension:bodyStructureR6

Extension provided to allow users to ascribe topology and morphology items to conditions themselves. For collection of body structure information for primary and secondary tumours separately, these should be referenced from conditions associated with the primary and secondary tumour respectively.

"extension":  [
    {
        "url": "http://hl7.org/fhir/6.0/StructureDefinition/extension-Condition.bodyStructure",
        "valueReference": {
            "reference": "BodyStructure/BodyStructure-BodySiteLocationLungs-Example"
        }
    }
]

code

SHOULD be present. SNOMED CT coding is preferred, though alternative codings MAY be provided subject to review of the Coding system by the NHS England Genomics Unit.

"code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "95820000",
                "display": "Bilateral hearing loss"
            }
        ]
    },

subject

SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

note

For recording additional information regarding the condition where this does not fit into the structured fields or cannot be structured due to the way this information has been recorded in source systems.

"note":  [
        {
            "text": "hearing loss since childhood (example)"
        }
    ]

Genomics-DiagnosticReport

The requirements of a specific Genomics DiagnosticReport is currently under review.

The draft profile is provided below for completeness.

Currently, only requirements for initial Pathology reports, provided with a test order, have been reviewed. DiagnosticReports containing the results of genomic testing are expected to be attached/provided as PDF documents during the alpha phase of the GMS development programme.

It is expected structured DiagnosticReports will mimic the structure proposed within the HL7 International Genomic Reporting IG, though customizations for use within the UK still need to be investigated.

Genomic DiagnosticReports which have been updated post submission SHALL be accompanied by Provenance resources, referencing the DiagnosticReport which detail when the resource was changed, who made the change and why.

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-DiagnosticReport UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Composition)
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueStringstring
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(UKCoreDocumentReference)
url1..1uriFixed Value
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueAnnotationAnnotation
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueCodeableConceptCodeableConcept
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Procedure | Observation | DiagnosticReport)
url1..1uriFixed Value
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
basedOnI0..*Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
statusS Σ ?!1..1codeBinding
categoryS Σ0..*CodeableConcept
codeS Σ1..1CodeableConceptBinding
subjectS Σ I0..1Reference(Patient | Group | Device | Location)
encounterS Σ I0..1Reference(Encounter)
effectiveDateTimedateTime
effectivePeriodPeriod
issuedS Σ0..1instant
id0..1string
deviceReferenceI0..1Extension(Reference(Device))
referenceΣ I0..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
id0..1string
deviceReferenceI0..*Extension(Reference(Device))
referenceΣ I0..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
specimenI0..*Reference(Specimen)
resultS I0..*Reference(Observation)
imagingStudyI0..*Reference(ImagingStudy)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
comment0..1string
conclusion0..1string
conclusionCode0..*CodeableConceptBinding
presentedFormI0..*Attachment

Differential from DiagnosticReport

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Composition)
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueStringstring
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(UKCoreDocumentReference)
url1..1uriFixed Value
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueAnnotationAnnotation
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueCodeableConceptCodeableConcept
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Procedure | Observation | DiagnosticReport)
url1..1uriFixed Value
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
basedOnI0..*Reference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
statusS Σ ?!1..1codeBinding
categoryS Σ0..*CodeableConcept
codeS Σ1..1CodeableConceptBinding
subjectS Σ I0..1Reference(Patient | Group | Device | Location)
encounterS Σ I0..1Reference(Encounter)
effectiveDateTimedateTime
effectivePeriodPeriod
issuedS Σ0..1instant
id0..1string
deviceReferenceI0..1Extension(Reference(Device))
referenceΣ I0..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
id0..1string
deviceReferenceI0..*Extension(Reference(Device))
referenceΣ I0..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
specimenI0..*Reference(Specimen)
resultS I0..*Reference(Observation)
imagingStudyI0..*Reference(ImagingStudy)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
comment0..1string
conclusion0..1string
conclusionCode0..*CodeableConceptBinding
presentedFormI0..*Attachment

DiagnosticReport
DefinitionThe findings and interpretation of diagnostic tests performed on patients, groups of patients, devices, and locations, and/or specimens derived from these. The report includes clinical context such as requesting and provider information, and some mix of atomic results, images, textual and coded interpretations, and formatted representation of diagnostic reports.
Cardinality0...*
AliasReport, Test, Result, Results, Labs, Laboratory
Comments

This is intended to capture a single report and is not suitable for use in displaying summary information that covers multiple reports. For example, this resource has not been designed for laboratory cumulative reporting formats nor detailed structured reports for sequencing.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • v2: ORU -> OBR
  • rim: Observation[classCode=OBS, moodCode=EVN]
DiagnosticReport.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

DiagnosticReport.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
DiagnosticReport.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
DiagnosticReport.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
DiagnosticReport.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
DiagnosticReport.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:compositionReferenceR5
DefinitionA Reference to a Composition resource instance that provides structure for organizing the contents of the DiagnosticReport.
Cardinality0...1
TypeExtension(Reference(Composition))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:compositionReferenceR5.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.extension:compositionReferenceR5.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:compositionReferenceR5.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.composition

Mappings
  • rim: N/A
DiagnosticReport.extension:compositionReferenceR5.value[x]
DefinitionReference to a Composition resource instance that provides structure for organizing the contents of the DiagnosticReport.
Cardinality1...1
TypeReference(Composition)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5
DefinitionOptional Extension Element - found in all resources.
Cardinality1...*
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.extension:mediaR5.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality1...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5.extension:comment
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5.extension:comment.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.extension:mediaR5.extension:comment.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5.extension:comment.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

comment

Mappings
  • rim: N/A
DiagnosticReport.extension:mediaR5.extension:comment.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
Typestring
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5.extension:link
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality1...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5.extension:link.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.extension:mediaR5.extension:link.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5.extension:link.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

link

Mappings
  • rim: N/A
DiagnosticReport.extension:mediaR5.extension:link.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
TypeReference(UKCoreDocumentReference)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:mediaR5.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.media.link

Mappings
  • rim: N/A
DiagnosticReport.extension:mediaR5.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality0...0
Typebase64Binary
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:noteR5
DefinitionMay include general statements about the diagnostic report, or statements about significant, unexpected or unreliable results values contained within the diagnostic report, or information about its source when relevant to its interpretation.
Cardinality0...*
TypeExtension(Annotation)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:noteR5.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.extension:noteR5.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:noteR5.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.note

Mappings
  • rim: N/A
DiagnosticReport.extension:noteR5.value[x]
DefinitionMay include general statements about the diagnostic report, or statements about significant, unexpected or unreliable results values contained within the diagnostic report, or information about its source when relevant to its interpretation.
Cardinality1...1
TypeAnnotation
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5
DefinitionThis backbone element contains supporting information that was used in the creation of the report not included in the results already included in the report.
Cardinality0...*
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.extension:supportingInfoR5.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality2...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.extension:type
DefinitionThe code value for the role of the supporting information in the diagnostic report.
Cardinality1...1
TypeExtension
Bindinghttp://terminology.hl7.org/ValueSet/v2-0936 (example)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.extension:type.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.extension:supportingInfoR5.extension:type.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.extension:type.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

type

Mappings
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.extension:type.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
TypeCodeableConcept
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.extension:reference
DefinitionThe reference for the supporting information in the diagnostic report.
Cardinality1...1
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.extension:reference.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.extension:supportingInfoR5.extension:reference.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.extension:reference.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

reference

Mappings
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.extension:reference.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
TypeReference(Procedure | Observation | DiagnosticReport)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.supportingInfo

Mappings
  • rim: N/A
DiagnosticReport.extension:supportingInfoR5.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality0...0
Typebase64Binary
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.identifier
DefinitionIdentifiers assigned to this report by the performer or other systems.
Cardinality0...*
TypeIdentifier
SummaryTrue
AliasReportID, Filler ID, Placer ID
Requirements

Need to know what identifier to use when making queries about this report from the source laboratory, and for linking to the report outside FHIR context.

Comments

Usually assigned by the Information System of the diagnostic service provider (filler id).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • v2: OBR-51/ for globally unique filler ID - OBR-3 , For non-globally unique filler-id the flller/placer number must be combined with the universal service Id - OBR-2(if present)+OBR-3+OBR-4
  • rim: id
DiagnosticReport.basedOn
DefinitionDetails concerning a service requested.
Cardinality0...*
TypeReference(CarePlan | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
AliasRequest
Requirements

This allows tracing of authorization for the report and tracking whether proposals/recommendations were acted upon.

Comments

Note: Usually there is one test request for each result, however in some circumstances multiple test requests may be represented using a single test result resource. Note that there are also cases where one request leads to multiple reports.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.basedOn
  • v2: ORC? OBR-2/3?
  • rim: outboundRelationship[typeCode=FLFS].target
DiagnosticReport.status
DefinitionThe status of the diagnostic report.
Cardinality1...1
Typecode
Binding

The status of the diagnostic report.

DiagnosticReportStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Diagnostic services routinely issue provisional/incomplete reports, and sometimes withdraw previously released reports.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
  • v2: OBR-25 (not 1:1 mapping)
  • rim: statusCode Note: final and amended are distinguished by whether observation is the subject of a ControlAct event of type "revise"
DiagnosticReport.category
DefinitionA code that classifies the clinical discipline, department or diagnostic service that created the report (e.g. cardiology, biochemistry, hematology, MRI). This is used for searching, sorting and display purposes.
Cardinality0...*
TypeCodeableConcept
Binding

Codes for diagnostic service sections.

DiagnosticServiceSectionCodes (example)
Must SupportTrue
SummaryTrue
AliasDepartment, Sub-department, Service, Discipline
Comments

Multiple categories are allowed using various categorization schemes. The level of granularity is defined by the category concepts in the value set. More fine-grained filtering can be performed using the metadata and/or terminology hierarchy in DiagnosticReport.code.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • v2: OBR-24
  • rim: inboundRelationship[typeCode=COMP].source[classCode=LIST, moodCode=EVN, code < LabService].code
DiagnosticReport.code
DefinitionA code or name that describes this diagnostic report.
Cardinality1...1
TypeCodeableConcept
Binding

Codes that describe Diagnostic Reports.

UKCoreReportCode (preferred)
Must SupportTrue
SummaryTrue
AliasType
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.code
  • w5: FiveWs.what[x]
  • v2: OBR-4 (HL7 v2 doesn't provide an easy way to indicate both the ordered test and the performed panel)
  • rim: code
DiagnosticReport.subject
DefinitionThe subject of the report. Usually, but not always, this is a patient. However, diagnostic services also perform analyses on specimens collected from a variety of other sources.
Cardinality0...1
TypeReference(Patient | Group | Device | Location)
Must SupportTrue
SummaryTrue
AliasPatient
Requirements

SHALL know the subject context.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • v2: PID-3 (no HL7 v2 mapping for Group or Device)
  • rim: participation[typeCode=SBJ]
  • w5: FiveWs.subject
DiagnosticReport.encounter
DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) which this DiagnosticReport is about.
Cardinality0...1
TypeReference(Encounter)
Must SupportTrue
SummaryTrue
AliasContext
Requirements

Links the request to the Encounter context.

Comments

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.encounter
  • w5: FiveWs.context
  • v2: PV1-19
  • rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
DiagnosticReport.effective[x]
DefinitionThe time or time-period the observed values are related to. When the subject of the report is a patient, this is usually either the time of the procedure or of specimen collection(s), but very often the source of the date/time is not known, only the date/time itself.
Cardinality0...1
TypedateTime
SummaryTrue
AliasObservation time, Effective Time, Occurrence
Requirements

Need to know where in the patient history to file/present this report.

Comments

If the diagnostic procedure was performed on the patient, this is the time it was performed. If there are specimens, the diagnostically relevant time can be derived from the specimen collection times, but the specimen information is not always available, and the exact relationship between the specimens and the diagnostically relevant time is not always automatic.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • v2: OBR-7
  • rim: effectiveTime
DiagnosticReport.issued
DefinitionThe date and time that this version of the report was made available to providers, typically after the report was reviewed and verified.
Cardinality0...1
Typeinstant
Must SupportTrue
SummaryTrue
AliasDate published, Date Issued, Date Verified
Requirements

Clinicians need to be able to check the date that the report was released.

Comments

May be different from the update time of the resource itself, because that is the status of the record (potentially a secondary copy), not the actual release time of the report.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.recorded
  • v2: OBR-22
  • rim: participation[typeCode=VRF or AUT].time
DiagnosticReport.performer
DefinitionThe diagnostic service that is responsible for issuing the report.
Cardinality0...*
TypeReference(Practitioner | PractitionerRole | Organization | CareTeam)
SummaryTrue
AliasLaboratory, Service, Practitioner, Department, Company, Authorized by, Director
Requirements

Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

Comments

This is not necessarily the source of the atomic data items or the entity that interpreted the results. It is the entity that takes responsibility for the clinical report.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • w5: FiveWs.actor
  • v2: PRT-8 (where this PRT-4-Participation = "PO")
  • rim: .participation[typeCode=PRF]
DiagnosticReport.performer.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.performer.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.performer.extension:deviceReference
DefinitionAn additional Device reference for a DiagnosticReport, to allow Software as a Medical Device to perform / interpret a DiagnosticReport
Cardinality0...1
TypeExtension(Reference(Device))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.performer.reference
DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Cardinality0...1
Typestring
SummaryTrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.performer.type
DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Cardinality0...1
Typeuri
Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)
SummaryTrue
Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.performer.identifier
DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Cardinality0...1
TypeIdentifier
SummaryTrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • rim: .identifier
DiagnosticReport.performer.display
DefinitionPlain text narrative that identifies the resource in addition to the resource reference.
Cardinality0...1
Typestring
SummaryTrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.resultsInterpreter
DefinitionThe practitioner or organization that is responsible for the report's conclusions and interpretations.
Cardinality0...*
TypeReference(Practitioner | PractitionerRole | Organization | CareTeam)
SummaryTrue
AliasAnalyzed by, Reported by
Requirements

Need to know whom to contact if there are queries about the results. Also may need to track the source of reports for secondary data analysis.

Comments

Might not be the same entity that takes responsibility for the clinical report.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • w5: FiveWs.actor
  • v2: OBR-32, PRT-8 (where this PRT-4-Participation = "PI")
  • rim: .participation[typeCode=PRF]
DiagnosticReport.resultsInterpreter.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.resultsInterpreter.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.resultsInterpreter.extension:deviceReference
DefinitionAn additional Device reference for a DiagnosticReport, to allow Software as a Medical Device to perform / interpret a DiagnosticReport
Cardinality0...*
TypeExtension(Reference(Device))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.resultsInterpreter.reference
DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Cardinality0...1
Typestring
SummaryTrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.resultsInterpreter.type
DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Cardinality0...1
Typeuri
Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)
SummaryTrue
Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.resultsInterpreter.identifier
DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Cardinality0...1
TypeIdentifier
SummaryTrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • rim: .identifier
DiagnosticReport.resultsInterpreter.display
DefinitionPlain text narrative that identifies the resource in addition to the resource reference.
Cardinality0...1
Typestring
SummaryTrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.specimen
DefinitionDetails about the specimens on which this diagnostic report is based.
Cardinality0...*
TypeReference(Specimen)
Requirements

Need to be able to report information about the collected specimens on which the report is based.

Comments

If the specimen is sufficiently specified with a code in the test result name, then this additional data may be redundant. If there are multiple specimens, these may be represented per observation or group.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: SPM
  • rim: participation[typeCode=SBJ]
DiagnosticReport.result
Definition[Observations](observation.html) that are part of this diagnostic report.
Cardinality0...*
TypeReference(Observation)
Must SupportTrue
AliasData, Atomic Value, Result, Atomic result, Data, Test, Analyte, Battery, Organizer
Requirements

Need to support individual results, or groups of results, where the result grouping is arbitrary, but meaningful.

Comments

Observations can contain observations.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: OBXs
  • rim: outboundRelationship[typeCode=COMP].target
DiagnosticReport.imagingStudy
DefinitionOne or more links to full details of any imaging performed during the diagnostic investigation. Typically, this is imaging performed by DICOM enabled modalities, but this is not required. A fully enabled PACS viewer can use this information to provide views of the source images.
Cardinality0...*
TypeReference(ImagingStudy)
Comments

ImagingStudy and the image element are somewhat overlapping - typically, the list of image references in the image element will also be found in one of the imaging study resources. However, each caters to different types of displays for different types of purposes. Neither, either, or both may be provided.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: outboundRelationship[typeCode=COMP].target[classsCode=DGIMG, moodCode=EVN]
DiagnosticReport.media
DefinitionA list of key images associated with this report. The images are generally created during the diagnostic process, and may be directly of the patient, or of treated specimens (i.e. slides of interest).
Cardinality0...*
TypeBackboneElement
SummaryTrue
AliasDICOM, Slides, Scans
Requirements

Many diagnostic services include images in the report as part of their service.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: OBX?
  • rim: outboundRelationship[typeCode=COMP].target
DiagnosticReport.media.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DiagnosticReport.media.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.media.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DiagnosticReport.media.comment
DefinitionA comment about the image. Typically, this is used to provide an explanation for why the image is included, or to draw the viewer's attention to important features.
Cardinality0...1
Typestring
Requirements

The provider of the report should make a comment about each image included in the report.

Comments

The comment should be displayed with the image. It would be common for the report to include additional discussion of the image contents in other sections such as the conclusion.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=OBS, moodCode=EVN, code="annotation"].value
DiagnosticReport.media.link
DefinitionReference to the image source.
Cardinality1...1
TypeReference(Media)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .value.reference
DiagnosticReport.conclusion
DefinitionConcise and clinically contextualized summary conclusion (interpretation/impression) of the diagnostic report.
Cardinality0...1
Typestring
AliasReport
Requirements

Need to be able to provide a conclusion that is not lost among the basic result data.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: OBX
  • rim: inboundRelationship[typeCode="SPRT"].source[classCode=OBS, moodCode=EVN, code=LOINC:48767-8].value (type=ST)
DiagnosticReport.conclusionCode
DefinitionOne or more codes that represent the summary conclusion (interpretation/impression) of the diagnostic report.
Cardinality0...*
TypeCodeableConcept
Binding

Diagnosis codes provided as adjuncts to the report.

SNOMEDCTClinicalFindings (preferred)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: OBX
  • rim: inboundRelationship[typeCode=SPRT].source[classCode=OBS, moodCode=EVN, code=LOINC:54531-9].value (type=CD)
DiagnosticReport.presentedForm
DefinitionRich text representation of the entire result as issued by the diagnostic service. Multiple formats are allowed but they SHALL be semantically equivalent.
Cardinality0...*
TypeAttachment
Requirements

Gives laboratory the ability to provide its own fully formatted report for clinical fidelity.

Comments

"application/pdf" is recommended as the most reliable and interoperable in this context.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • att-1: If the Attachment has data, it SHALL have a contentType
    data.empty() or contentType.exists()
Mappings
  • rim: n/a
  • v2: ED/RP
  • rim: ED
  • v2: OBX
  • rim: text (type=ED)


FHIRMDSHL7v2
DiagnosticReportPrevious Genomic Report, Previous Diagnostic ReportOBX
DiagnosticReport.effectiveDateTimePLCM activity - Date and time dataset created, PLCM activity - Turnaround time (calendar days), Previous genomic report - Test performed date, Previous non genomic report - Test performed dateDerived from OBR-7 in the ORU response message for the activity based on the OML request, OBX-19
DiagnosticReport.identifierPLCM activity - Local report identifier, Previous genomic report - Report identifier, Previous non genomic report - Report identifierOBR-3 for report
DiagnosticReport.resultPLCM activity - Test outcome code (Many), Previous non genomic report - Test result value comparator, Previous non genomic report - Test result value unit of measure, Previous non genomic report - Test result reference range low, Previous non genomic report - Test result reference range high, Previous non genomic report - Test result test method, Previous non genomic report - Test result reference range text, Previous non genomic report - Test result clinical summaryOBX-3 elements for resulting report, OBX-5, OBX-6, OBX-7 (before operator), OBX-7 (after operator), OBX-17, OBX-7, OBX-8
DiagnosticReport.conclusionPrevious genomic report - Report referral summary, Previous non genomic report - Report referral summaryOBX-5
DiagnosticReport.presentedFormPrevious genomic report - Report file/link, Previous non genomic report - Report file/linkOBX-5 where OBX-2=ED or RP
DiagnosticReport.subjectPrevious genomic report - Patient's first name, Previous genomic report - Patient's surname, Previous genomic report - Patient's address, Previous genomic report - Patient's post code, Previous genomic report - Patient's country, Previous genomic report - Patient's date of birth, Previous genomic report - Patient's NHS number, Previous genomic report - Patient's alternative identifier, Previous genomic report - Patient's relationship to requesting patient, Previous genomic report - Patient's clinical genetics number, Previous genomic report - Patient's pedigree numberPID attached to Patient Prior
DiagnosticReport.basedOnPrevious genomic report - Report lab test number, Previous genomic report - Original requester full name, Previous genomic report - Original requester organisation ODS code, Previous genomic report - Original requester reason for request, Previous non genomic report - Original requester full name, Previous non genomic report - Original requester organisation ODS code, Previous non genomic report - Original requester reason for requestORC-2, ORC-12, ORC-21.10, ORC-16
DiagnosticReport.conclusionCodePrevious genomic report - Report of genetic analysis, Previous non genomic report - Report resultOBR-5
DiagnosticReport.performerPrevious genomic report - Report performer full name, Previous genomic report - Report performer organisation ODS code, Previous non genomic report - Report performer full name, Previous non genomic report - Report performer organisation ODS codeOBX-16, OBX-23.10
DiagnosticReport.codePrevious non genomic report - Test typeOBR-4

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_DiagnosticReport_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-DiagnosticReport-Genomics

Additional Guidance

extension:mediaR5

TBC. Only relevant for structured genomic reports. Reference to DocumentReference resources pointing to the Genomic Data Files used as the basis for the report. Usage of this field over extension:supporting-info is pending further investigation.

"extension" : [
        {
            "url" : "http://hl7.org/fhir/5.0/StructureDefinition/extension-DiagnosticReport.media.link",
            "extension" : [
                    {
                        "url" : "link",
                        "valueReference": {
                            "reference" : "DocumentReference/DocumentReference-PharmCAT-Example"
                        }
                    }
                ]
            }
        }
    ],

extension:recommended-action

TBC. Only relevant for structured genomic reports (included in the Genomic Report Profile in the Genomics Reporting IG). Reference to Task resource indicating recommended action to take in response to the report's result/conclusion

"extension" : [
        {
            "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/recommended-action",
            "valueReference" : {
                "reference" : "Task/MedicationRecommendationExample1"
            }
        }
    ],

extension:genomic-study

TBC. Only relevant for structured genomic reports (included in the Genomic Report Profile in the Genomics Reporting IG). Reference to Procedure resources indicating the analyses performed as part the genomic test order.

"extension" : [
    {
      "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-reference",
      "valueReference" : {
        🔗 "reference" : "Procedure/PGXGenomicStudy"
      }
    }
  ]

extension:supporting-info

TBC. Only relevant for structured genomic reports (included in the Genomics Report IG Genomic Report Profile). Reference to the genomic data files analysed as part of the test order, forming the report. Reference to DocumentReference resource which links to the binary data file.

"extension" : [
        {
            "url" : "http://hl7.org/fhir/StructureDefinition/workflow-supportingInfo",
            "valueReference" : {
                "reference" : "DocumentReference/DocumentReference-PharmCAT-Example"
            }
        }
    ],

extension:workflow-relatedArtifact

TBC. Only relevant for structured genomic reports (included in Genomic Report Profile in the Genomics Report IG) . A reference to the guidelines or other knowledge artifacts which were used to guide interpretation or recommended actions included within this DiagnosticReport.

If entries constitute published papers, they SHOULD be referenced using a known citation style, e.g. Vancouver/Harvard. Alternatively for online texts, these MAY be referenced via URL only.

A fixed value of 'citation' is expected for the type element, though this recommendation is pending further use cases.

"extension" : [
        {
            "url" : "http://hl7.org/fhir/StructureDefinition/workflow-relatedArtifact",
            "valueRelatedArtifact" : {
                "type" : "citation",
                "url" : "https://cpicpgx.org/guidelines/guideline-for-clopidogrel-and-cyp2c19)"
            }
        }
    ],

basedOn

SHOULD reference the originating ServiceRequest if this is an instance of a genomic diagnostic report resulting from a GMS test order.

"basedOn":  [
        {
            "reference": "ServiceRequest-SavedTestOrder-Example"
        }
    ],

status

SHALL use base HL7 codes for DiagnosticReport.status. A DiagnosticReport SHOULD only be marked as final if the report is complete and verified by an authorised person.

 "status": "final",

code

SHOULD use a record artifact concept from SNOMED CT where an appropriate code exists, else text is preferred to indicate the document type.

"code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "4321000179101",
                "display": "Hematology report (record artifact)"
            }
        ]
    },

subject

SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

performer

SHOULD reference the organization responsible for the testing, preferably by ODS code.

"performer":  [
        {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "REP"
            }
        }
    ],

resultsInterpreter

SHOULD reference the person responsible for interpreting the raw results, preferably by a recognised NHS identifier, such as SDS code.

"resultsInterpreter":  [
        {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/sds-user-id",
                "value": "999999999999"
            }
        }
    ],

specimen

SHOULD reference the specimen used during testing to generate the report, if the document is a Genomic report.

"specimen":  [
        {
            "reference": "Specimen/Specimen-BloodEDTA-Example"
        }
    ],

conclusionCode

If possible, unstructured reports wrapped within DiagnosticReports, SHOULD contain a conclusionCode element indicating the coded finding from the report, to aid analytics.

"conclusionCode":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "738542003",
                    "display": "Dihydropyrimidine dehydrogenase poor metabolizer (finding)"
                }
            ]
        }
    ],

presentedForm

Genomic reports SHALL include a presentedForm element either referencing the location of the PDF report (located and accessible on either the source/client system or via NRL using appropriate authentication) or include the PDF report as a base64 encoded attachment within the message payload.

Note: this guidance may change in the future as work on Structured Reporting matures

"presentedForm": [
        {
            "url": "https://example.com/GenomicReports/ExampleReport.pdf"
        }
    ]

result

Raw results included within the report, to aid interpretation. These SHOULD take the form of Observation references, if providing a structured report.

"result" : [
        {
            "reference" : "Observation/TherapeuticImplicationExample1",
            "display" : "impact for high risk allele"
        },
        {
            "reference" : "Observation/GenotypeExample1"
        },
        {
            "reference" : "Observation/OverallInterpExample1"
        }
    ]

Genomics-DocumentReference

The DocumentReference resource is used to reference data files generated as part of genomic testing and allow these files to be retrieved through the DRS API standard.

Primarily, the ServiceRequest SHALL be referenced via DiagnosticReport.basedOn. The DocumentReference then links back to the report via DocumentReference.context.related.

If following the Genomic Reporting IG, you could also reference the DocumentReference from the DiagnosticReport using the following chain: DiagnosticReport.extension:genomic-study -> Procedure (Genomic Study).extension:genomic-study-analysis -> Procedure (Genomic Study Analysis).extension:output.extension:file.valueReference -> DocumentReference (Genomic Data File)

This requires use of the Genomic Study and Genomic Study Analysis profiles which have not yet been assessed for suitability in the UK. As such, this reference chain is only provided for reference.

The NHS England Genomics unit is also investigating backporting the R5 DiagnosticReport.media.link reference to DocumentReference to support referencing the data files from the DiagnosticReport directly. Until investigation is complete, DiagnosticReport resources MAY reference the DocumentReference for the data used by the report though the DiagnosticReport.extension:supporting-info element. In all cases the DocumentReference SHOULD reference the DNA Specimen from which the data originated and the ServiceRequest which triggered the capture of the data.

The Genomics-DocumentReference is currently based on the HL7 international version of the resource as the UKCore-DocumentReference profile is still in a draft status (and is pending use cases from the Unified Genomic Record project). Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.

The base DocumentReference resource is provided below for completeness.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/DocumentReference HL7 International trial-use

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
masterIdentifierΣ0..1Identifier
identifierΣ0..*Identifier
statusΣ ?!1..1codeBinding
docStatusΣ0..1codeBinding
typeΣ0..1CodeableConceptBinding
categoryΣ0..*CodeableConcept
subjectΣ I0..1Reference(Patient | Practitioner | Group | Device)
dateΣ0..1instant
authorΣ I0..*Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)
authenticatorI0..1Reference(Practitioner | PractitionerRole | Organization)
custodianI0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ1..1codeBinding
targetΣ I1..1Reference(DocumentReference)
descriptionΣ0..1string
securityLabelΣ0..*CodeableConceptBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
attachmentΣ I1..1Attachment
formatΣ0..1CodingBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
encounterI0..*Reference(Encounter | EpisodeOfCare)
event0..*CodeableConcept
periodΣ I0..1Period
facilityType0..1CodeableConcept
practiceSetting0..1CodeableConcept
sourcePatientInfoI0..1Reference(Patient)
relatedI0..*Reference(Resource)

Differential from DocumentReference

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
masterIdentifierΣ0..1Identifier
identifierΣ0..*Identifier
statusΣ ?!1..1codeBinding
docStatusΣ0..1codeBinding
typeΣ0..1CodeableConceptBinding
categoryΣ0..*CodeableConcept
subjectΣ I0..1Reference(Patient | Practitioner | Group | Device)
dateΣ0..1instant
authorΣ I0..*Reference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)
authenticatorI0..1Reference(Practitioner | PractitionerRole | Organization)
custodianI0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ1..1codeBinding
targetΣ I1..1Reference(DocumentReference)
descriptionΣ0..1string
securityLabelΣ0..*CodeableConceptBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
attachmentΣ I1..1Attachment
formatΣ0..1CodingBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
encounterI0..*Reference(Encounter | EpisodeOfCare)
event0..*CodeableConcept
periodΣ I0..1Period
facilityType0..1CodeableConcept
practiceSetting0..1CodeableConcept
sourcePatientInfoI0..1Reference(Patient)
relatedI0..*Reference(Resource)

DocumentReference
DefinitionA reference to a document of any kind for any purpose. Provides metadata about the document so that the document can be discovered and managed. The scope of a document is any seralized object with a mime-type, so includes formal patient centric documents (CDA), cliical notes, scanned paper, and non-patient specific documents like policy text.
Cardinality0...*
Comments

Usually, this is used for documents other than those defined by FHIR.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • fhircomposition: when describing a Composition
  • rim: Document[classCode="DOC" and moodCode="EVN"]
  • cda: when describing a CDA
DocumentReference.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

DocumentReference.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
DocumentReference.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
DocumentReference.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
DocumentReference.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
DocumentReference.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.masterIdentifier
DefinitionDocument identifier as assigned by the source of the document. This identifier is specific to this version of the document. This unique identifier may be used elsewhere to identify this version of the document.
Cardinality0...1
TypeIdentifier
SummaryTrue
Requirements

The structure and format of this Id shall be consistent with the specification corresponding to the formatCode attribute. (e.g. for a DICOM standard document a 64-character numeric UID, for an HL7 CDA format a serialization of the CDA Document Id extension and root in the form "oid^extension", where OID is a 64 digits max, and the Id is a 16 UTF-8 char max. If the OID is coded without the extension then the '^' character shall not be included.).

Comments

CDA Document Id extension and root.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • fhircomposition: Composition.identifier
  • v2: TXA-12
  • rim: .id
  • xds: DocumentEntry.uniqueId
  • cda: ClinicalDocument/id
DocumentReference.identifier
DefinitionOther identifiers associated with the document, including version independent identifiers.
Cardinality0...*
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • v2: TXA-16?
  • rim: .id / .setId
  • xds: DocumentEntry.entryUUID
DocumentReference.status
DefinitionThe status of this document reference.
Cardinality1...1
Typecode
Binding

The status of the document reference.

DocumentReferenceStatus (required)
ModifierTrue
SummaryTrue
Comments

This is the status of the DocumentReference object, which might be independent from the docStatus element.

This element is labeled as a modifier because the status contains the codes that mark the document or reference as not currently valid.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
  • v2: TXA-19
  • rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseDocument", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"
  • xds: DocumentEntry.availabilityStatus
DocumentReference.docStatus
DefinitionThe status of the underlying document.
Cardinality0...1
Typecode
Binding

Status of the underlying document.

CompositionStatus (required)
SummaryTrue
Comments

The document that is pointed to might be in various lifecycle states.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • fhircomposition: Composition.status
  • v2: TXA-17
  • rim: .statusCode
DocumentReference.type
DefinitionSpecifies the particular kind of document referenced (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the document referenced.
Cardinality0...1
TypeCodeableConcept
Binding

Precise type of clinical document.

DocumentTypeValueSet (preferred)
SummaryTrue
Comments

Key metadata element describing the document that describes he exact type of document. Helps humans to assess whether the document is of interest when viewing a list of documents.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.code
  • w5: FiveWs.class
  • fhircomposition: Composition.type
  • v2: TXA-2
  • rim: ./code
  • xds: DocumentEntry.type
  • cda: ClinicalDocument/code/@code The typeCode should be mapped from the ClinicalDocument/code element to a set of document type codes configured in the affinity domain. One suggested coding system to use for typeCode is LOINC, in which case the mapping step can be omitted.
DocumentReference.category
DefinitionA categorization for the type of document referenced - helps for indexing and searching. This may be implied by or derived from the code specified in the DocumentReference.type.
Cardinality0...*
TypeCodeableConcept
Binding

High-level kind of a clinical document at a macro level.

DocumentClassValueSet (example)
SummaryTrue
Aliasclaxs
Comments

Key metadata element describing the the category or classification of the document. This is a broader perspective that groups similar documents based on how they would be used. This is a primary key used in searching.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • fhircomposition: Composition.class
  • rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
  • xds: DocumentEntry.class
  • cda: Derived from a mapping of /ClinicalDocument/code/@code to an Affinity Domain specified coded value to use and coding system. Affinity Domains are encouraged to use the appropriate value for Type of Service, based on the LOINC Type of Service (see Page 53 of the LOINC User's Manual). Must be consistent with /ClinicalDocument/code/@code
DocumentReference.subject
DefinitionWho or what the document is about. The document can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of farm animals, or a set of patients that share a common exposure).
Cardinality0...1
TypeReference(Patient | Practitioner | Group | Device)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • fhircomposition: Composition.subject
  • v2: PID-3 (No standard way to define a Practitioner or Group subject in HL7 v2 MDM message)
  • rim: .participation[typeCode="SBJ"].role[typeCode="PAT"]
  • xds: DocumentEntry.patientId
  • cda: ClinicalDocument/recordTarget/
  • w5: FiveWs.subject
DocumentReference.date
DefinitionWhen the document reference was created.
Cardinality0...1
Typeinstant
SummaryTrue
Aliasindexed
Comments

Referencing/indexing time is used for tracking, organizing versions and searching.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.recorded
  • fhircomposition: Composition.date
  • rim: .availabilityTime[type="TS"]
DocumentReference.author
DefinitionIdentifies who is responsible for adding the information to the document.
Cardinality0...*
TypeReference(Practitioner | PractitionerRole | Organization | Device | Patient | RelatedPerson)
SummaryTrue
Comments

Not necessarily who did the actual data entry (i.e. typist) or who was the source (informant).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • fhircomposition: Composition.author
  • v2: TXA-9 (No standard way to indicate a Device in HL7 v2 MDM message)
  • rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"]
  • xds: DocumentEntry.author
  • cda: ClinicalDocument/author
DocumentReference.authenticator
DefinitionWhich person or organization authenticates that this document is valid.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole | Organization)
Comments

Represents a participant within the author institution who has legally authenticated or attested the document. Legal authentication implies that a document has been signed manually or electronically by the legal Authenticator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • w5: FiveWs.witness
  • fhircomposition: Composition.attester
  • v2: TXA-10
  • rim: .participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"]
  • xds: DocumentEntry.legalAuthenticator
  • cda: ClinicalDocument/legalAuthenticator
DocumentReference.custodian
DefinitionIdentifies the organization or group who is responsible for ongoing maintenance of and access to the document.
Cardinality0...1
TypeReference(Organization)
Comments

Identifies the logical organization (software system, vendor, or department) to go to find the current version, where to report issues, etc. This is different from the physical location (URL, disk drive, or server) of the document, which is the technical location of the document, which host may be delegated to the management of some other organization.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • fhircomposition: Composition.custodian
  • rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
DocumentReference.relatesTo
DefinitionRelationships that this document has with other document references that already exist.
Cardinality0...*
TypeBackboneElement
SummaryTrue
Comments

This element is labeled as a modifier because documents that append to other documents are incomplete on their own.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • fhircomposition: Composition.relatesTo
  • rim: .outboundRelationship
  • xds: DocumentEntry Associations
DocumentReference.relatesTo.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DocumentReference.relatesTo.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.relatesTo.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.relatesTo.code
DefinitionThe type of relationship that this document has with anther document.
Cardinality1...1
Typecode
Binding

The type of relationship between documents.

DocumentRelationshipType (required)
SummaryTrue
Comments

If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • fhircomposition: Composition.relatesTo.code
  • rim: .outboundRelationship.typeCode
  • xds: DocumentEntry Associations type
DocumentReference.relatesTo.target
DefinitionThe target document of this relationship.
Cardinality1...1
TypeReference(DocumentReference)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • fhircomposition: Composition.relatesTo.target
  • rim: .target[classCode="DOC", moodCode="EVN"].id
  • xds: DocumentEntry Associations reference
DocumentReference.description
DefinitionHuman-readable description of the source document.
Cardinality0...1
Typestring
SummaryTrue
Requirements

Helps humans to assess whether the document is of interest.

Comments

What the document is about, a terse summary of the document.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: TXA-25
  • rim: .outboundRelationship[typeCode="SUBJ"].target.text
  • xds: DocumentEntry.comments
DocumentReference.securityLabel
DefinitionA set of Security-Tag codes specifying the level of privacy/security of the Document. Note that DocumentReference.meta.security contains the security labels of the "reference" to the document, while DocumentReference.securityLabel contains a snapshot of the security labels on the document the reference refers to.
Cardinality0...*
TypeCodeableConcept
Binding

Security Labels from the Healthcare Privacy and Security Classification System.

All Security Labels (extensible)
SummaryTrue
Requirements

Use of the Health Care Privacy/Security Classification (HCS) system of security-tag use is recommended.

Comments

The confidentiality codes can carry multiple vocabulary items. HL7 has developed an understanding of security and privacy tags that might be desirable in a Document Sharing environment, called HL7 Healthcare Privacy and Security Classification System (HCS). The following specification is recommended but not mandated, as the vocabulary bindings are an administrative domain responsibility. The use of this method is up to the policy domain such as the XDS Affinity Domain or other Trust Domain where all parties including sender and recipients are trusted to appropriately tag and enforce.

In the HL7 Healthcare Privacy and Security Classification (HCS) there are code systems specific to Confidentiality, Sensitivity, Integrity, and Handling Caveats. Some values would come from a local vocabulary as they are related to workflow roles and special projects.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • fhircomposition: Composition.confidentiality, Composition.meta.security
  • v2: TXA-18
  • rim: .confidentialityCode
  • xds: DocumentEntry.confidentialityCode
  • cda: ClinicalDocument/confidentialityCode/@code
DocumentReference.content
DefinitionThe document and format referenced. There may be multiple content element repetitions, each with a different format.
Cardinality1...*
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • fhircomposition: Bundle(Composition+*)
  • rim: document.text
DocumentReference.content.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DocumentReference.content.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.content.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.content.attachment
DefinitionThe document or URL of the document along with critical metadata to prove content has integrity.
Cardinality1...1
TypeAttachment
SummaryTrue
Comments

When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • att-1: If the Attachment has data, it SHALL have a contentType
    data.empty() or contentType.exists()
Mappings
  • rim: n/a
  • v2: ED/RP
  • rim: ED
  • fhircomposition: Composition.language, Composition.title, Composition.date
  • v2: TXA-3 for mime type
  • rim: document.text
  • xds: DocumentEntry.mimeType, DocumentEntry.languageCode, DocumentEntry.URI, DocumentEntry.size, DocumentEntry.hash, DocumentEntry.title, DocumentEntry.creationTime
  • cda: ClinicalDocument/languageCode, ClinicalDocument/title, ClinicalDocument/date
DocumentReference.content.format
DefinitionAn identifier of the document encoding, structure, and template that the document conforms to beyond the base format indicated in the mimeType.
Cardinality0...1
TypeCoding
Binding

Document Format Codes.

DocumentReferenceFormatCodeSet (preferred)
SummaryTrue
Comments

Note that while IHE mostly issues URNs for format types, not all documents can be identified by a URI.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • fhircomposition: Composition.meta.profile
  • rim: document.text
  • xds: DocumentEntry.formatCode
  • cda: derived from the IHE Profile or Implementation Guide templateID
DocumentReference.context
DefinitionThe clinical context in which the document was prepared.
Cardinality0...1
TypeBackboneElement
SummaryTrue
Comments

These values are primarily added to help with searching for interesting/relevant documents.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: outboundRelationship[typeCode="SUBJ"].target[classCode<'ACT']
DocumentReference.context.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
DocumentReference.context.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.context.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
DocumentReference.context.encounter
DefinitionDescribes the clinical encounter or type of care that the document content is associated with.
Cardinality0...*
TypeReference(Encounter | EpisodeOfCare)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.context
  • w5: FiveWs.context
  • fhircomposition: Composition.encounter
  • rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
DocumentReference.context.event
DefinitionThis list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the type Code, such as a "History and Physical Report" in which the procedure being documented is necessarily a "History and Physical" act.
Cardinality0...*
TypeCodeableConcept
Binding

This list of codes represents the main clinical acts being documented.

v3.ActCode (example)
Comments

An event can further specialize the act inherent in the type, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more event codes are included, they shall not conflict with the values inherent in the class or type elements as such a conflict would create an ambiguous situation.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • fhircomposition: Composition.event.code
  • rim: .code
  • xds: DocumentEntry.eventCodeList
DocumentReference.context.period
DefinitionThe time period over which the service that is described by the document was provided.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • fhircomposition: Composition.event.period
  • rim: .effectiveTime
  • xds: DocumentEntry.serviceStartTime, DocumentEntry.serviceStopTime
  • cda: ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/low/ @value --> ClinicalDocument/documentationOf/ serviceEvent/effectiveTime/high/ @value
DocumentReference.context.facilityType
DefinitionThe kind of facility where the patient was seen.
Cardinality0...1
TypeCodeableConcept
Binding

XDS Facility Type.

FacilityTypeCodeValueSet (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • fhircomposition: usually from a mapping to a local ValueSet
  • rim: .participation[typeCode="LOC"].role[classCode="DSDLOC"].code
  • xds: DocumentEntry.healthcareFacilityTypeCode
  • cda: usually a mapping to a local ValueSet. Must be consistent with /clinicalDocument/code
DocumentReference.context.practiceSetting
DefinitionThis property may convey specifics about the practice setting where the content was created, often reflecting the clinical specialty.
Cardinality0...1
TypeCodeableConcept
Binding

Additional details about where the content was created (e.g. clinical specialty).

PracticeSettingCodeValueSet (example)
Requirements

This is an important piece of metadata that providers often rely upon to quickly sort and/or filter out to find specific content.

Comments

This element should be based on a coarse classification system for the class of specialty practice. Recommend the use of the classification system for Practice Setting, such as that described by the Subject Matter Domain in LOINC.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • fhircomposition: usually from a mapping to a local ValueSet
  • rim: .participation[typeCode="LOC"].role[classCode="DSDLOC"].code
  • xds: DocumentEntry.practiceSettingCode
  • cda: usually from a mapping to a local ValueSet
DocumentReference.context.sourcePatientInfo
DefinitionThe Patient Information as known when the document was published. May be a reference to a version specific, or contained.
Cardinality0...1
TypeReference(Patient)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • fhircomposition: Composition.subject
  • rim: .participation[typeCode="SBJ"].role[typeCode="PAT"]
  • xds: DocumentEntry.sourcePatientInfo, DocumentEntry.sourcePatientId
  • cda: ClinicalDocument/recordTarget/
DocumentReference.context.related
DefinitionRelated identifiers or resources associated with the DocumentReference.
Cardinality0...*
TypeReference(Resource)
Comments

May be identifiers or resources that caused the DocumentReference or referenced Document to be created.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • fhircomposition: Composition.event.detail
  • rim: ./outboundRelationship[typeCode="PERT" and isNormalActRelationship()] / target[isNormalAct]
  • xds: DocumentEntry.referenceIdList
  • cda: ClinicalDocument/relatedDocument


Additional Guidance

subject

SHOULD be present if related to a patient. Reference to the Patient this data file is pertaining to. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

author

SHOULD reference the organization responsible for creating the data file, preferably by ODS code.

"performer":  [
        {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "REP"
            }
        }
    ],

description

Human readable description for the data file. NOTE: this is being used in place of DocumentReference.type until suitable LOINC or SNOMED CT concepts are identified for the file types expected.

 "description": "Phenotype Report",

content

SHOULD be a DRS compatible reference to the data file.

"content": [
    {
      "attachment": {
        "contentType": "application/json",
        "url": "drs://drs.genomicsengland.nhs.uk/ga4gh/drs/v1/objects/42375e7d-071c-4eb3-b1c8-cec11e245cf0",
        "title": "PharmCAT JSON report"
      }
    }
  ],

context

In all cases the DocumentReference SHOULD reference the DNA Specimen from which the data originated, where available, and the ServiceRequest which triggered the capture of the data.

The DiagnosticReport using the data file SHOULD reference the DocumentReference via the DiagnosticReport.extension:supporting-info element. This guidance will be updated upon release of the R5 backport of DiagnosticReport.media, allowing references to DocumentReference. Once backported, the DiagnosticReport.media.link SHOULD be used to reference the DocumentReference resources for data files analysed for the report instead.

"context": {
    "related": [
      {
        "reference": "ServiceRequest/ServiceRequest-NonWGSTestOrderForm-NewFollowupTest-Example"
      },
      {
        "reference": "Specimen/Specimen-BloodEDTA-Example"
      }
    ]
  }

Genomics-FamilyMemberHistory

For collecting relevant Family Member History to aid interpretation of Genomic results. This is limited to collection of Pedigree information. The FamilyMemberHistory resource is not to be used to record participants involved in testing, e.g. in the case of Duo/Trio scenarios (in this case the RelatedPerson resource SHOULD be used instead.

The Genomics FamilyMemberHistory is currently pending Clinical and Technical Assurance of the base UKCore resource. Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.

The draft profile for the UKCore-FamilyMemberHistory is provided below for completeness.


The CareConnect profile will be uplifted to the R4 UKCore in a future release
Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-FamilyMemberHistory UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
associatedEncounterI0..1Extension(Reference(Encounter))
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueCodeableConceptCodeableConcept
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Patient | Practitioner | PractitionerRole | RelatedPerson | Device | Organization | CareTeam)
url1..1uriFixed Value
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
instantiatesCanonicalΣ0..*canonical(PlanDefinition | Questionnaire | ActivityDefinition | Measure | OperationDefinition)
instantiatesUriΣ0..*uri
statusS Σ ?!1..1codeBinding
dataAbsentReasonΣ0..1CodeableConceptBinding
patientS Σ I1..1Reference(Patient)
dateS Σ0..1dateTime
nameS Σ0..1string
relationshipS Σ1..1CodeableConceptBinding
sexΣ0..1CodeableConceptBinding
bornPeriodPeriod
bornDatedate
bornStringstring
ageAgeAge
ageRangeRange
ageStringstring
estimatedAgeΣ I0..1boolean
deceasedBooleanboolean
deceasedAgeAge
deceasedRangeRange
deceasedDatedate
deceasedStringstring
reasonCodeΣ0..*CodeableConcept
reasonReferenceΣ I0..*Reference(Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference)
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
code1..1CodeableConceptBinding
outcome0..1CodeableConceptBinding
contributedToDeath0..1boolean
onsetAgeAge
onsetRangeRange
onsetPeriodPeriod
onsetStringstring
note0..*Annotation

Differential from FamilyMemberHistory

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
associatedEncounterI0..1Extension(Reference(Encounter))
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueCodeableConceptCodeableConcept
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Patient | Practitioner | PractitionerRole | RelatedPerson | Device | Organization | CareTeam)
url1..1uriFixed Value
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
instantiatesCanonicalΣ0..*canonical(PlanDefinition | Questionnaire | ActivityDefinition | Measure | OperationDefinition)
instantiatesUriΣ0..*uri
statusS Σ ?!1..1codeBinding
dataAbsentReasonΣ0..1CodeableConceptBinding
patientS Σ I1..1Reference(Patient)
dateS Σ0..1dateTime
nameS Σ0..1string
relationshipS Σ1..1CodeableConceptBinding
sexΣ0..1CodeableConceptBinding
bornPeriodPeriod
bornDatedate
bornStringstring
ageAgeAge
ageRangeRange
ageStringstring
estimatedAgeΣ I0..1boolean
deceasedBooleanboolean
deceasedAgeAge
deceasedRangeRange
deceasedDatedate
deceasedStringstring
reasonCodeΣ0..*CodeableConcept
reasonReferenceΣ I0..*Reference(Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference)
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
code1..1CodeableConceptBinding
outcome0..1CodeableConceptBinding
contributedToDeath0..1boolean
onsetAgeAge
onsetRangeRange
onsetPeriodPeriod
onsetStringstring
note0..*Annotation

FamilyMemberHistory
DefinitionSignificant health conditions for a person related to the patient relevant in the context of care for the patient.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • fhs-2: Can only have estimatedAge if age[x] is present
    age.exists() or estimatedAge.empty()
  • fhs-1: Can have age[x] or born[x], but not both
    age.empty() or born.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • v2: Not in scope for v2
  • rim: Observation[classCode=OBS, moodCode=EVN]
FamilyMemberHistory.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

FamilyMemberHistory.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
FamilyMemberHistory.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
FamilyMemberHistory.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
FamilyMemberHistory.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
FamilyMemberHistory.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:associatedEncounter
DefinitionAn associated encounter reference.
Cardinality0...1
TypeExtension(Reference(Encounter))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5
DefinitionAn extension to record who or what participated in the activities related to the family member history.
Cardinality0...*
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
FamilyMemberHistory.extension:participantR5.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality1...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5.extension:function
DefinitionDistinguishes the type of involvement of the actor in the activities related to the family member history.
Cardinality0...1
TypeExtension
BindingParticipationRoleType (extensible)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5.extension:function.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
FamilyMemberHistory.extension:participantR5.extension:function.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5.extension:function.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

function

Mappings
  • rim: N/A
FamilyMemberHistory.extension:participantR5.extension:function.value[x]
DefinitionThis FHIR value set is comprised of Actor participation Type codes, which can be used to value FHIR agents, actors, and other role elements. The codes are intended to express how the agent participated in some activity. Sometimes referred to the agent functional-role relative to the activity.
Cardinality1...1
TypeCodeableConcept
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5.extension:actor
DefinitionIndicates who or what participated in the activities related to the family member history.
Cardinality1...1
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5.extension:actor.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
FamilyMemberHistory.extension:participantR5.extension:actor.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5.extension:actor.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

actor

Mappings
  • rim: N/A
FamilyMemberHistory.extension:participantR5.extension:actor.value[x]
DefinitionA reference to a Patient, Practitioner, PractitionerRole, RelatedPerson, Device, Organization, or CareTeam.
Cardinality1...1
TypeReference(Patient | Practitioner | PractitionerRole | RelatedPerson | Device | Organization | CareTeam)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.extension:participantR5.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/5.0/StructureDefinition/extension-FamilyMemberHistory.participant

Mappings
  • rim: N/A
FamilyMemberHistory.extension:participantR5.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality0...0
Typebase64Binary
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.identifier
DefinitionBusiness identifiers assigned to this family member history by the performer or other systems which remain constant as the resource is updated and propagates from server to server.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

Allows identification of the family member history as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • rim: id
FamilyMemberHistory.instantiatesCanonical
DefinitionThe URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.
Cardinality0...*
Typecanonical(PlanDefinition | Questionnaire | ActivityDefinition | Measure | OperationDefinition)
SummaryTrue
Comments

see Canonical References

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.instantiatesCanonical
  • rim: .outboundRelationship[typeCode=DEFN].target
FamilyMemberHistory.instantiatesUri
DefinitionThe URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this FamilyMemberHistory.
Cardinality0...*
Typeuri
SummaryTrue
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.instantiatesUri
  • rim: .outboundRelationship[typeCode=DEFN].target
FamilyMemberHistory.status
DefinitionA code specifying the status of the record of the family history of a specific family member.
Cardinality1...1
Typecode
Binding

A code that identifies the status of the family history record.

FamilyHistoryStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
FamilyMemberHistory.dataAbsentReason
DefinitionDescribes why the family member's history is not available.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing the reason why a family member's history is not available.

FamilyHistoryAbsentReason (extensible)
SummaryTrue
Requirements

This is a separate element to allow it to have a distinct binding from reasonCode.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .reasonCode
FamilyMemberHistory.patient
DefinitionThe person who this history concerns.
Cardinality1...1
TypeReference(Patient)
Must SupportTrue
SummaryTrue
AliasProband
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • rim: participation[typeCode=SBJ].role
  • w5: FiveWs.subject
FamilyMemberHistory.date
DefinitionThe date (and possibly time) when the family member history was recorded or last updated.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
Requirements

Allows determination of how current the summary is.

Comments

This should be captured even if the same as the date on the List aggregating the full family history.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.recorded
  • rim: participation[typeCode=AUT].time
FamilyMemberHistory.name
DefinitionThis will either be a name or a description; e.g. "Aunt Susan", "my cousin with the red hair".
Cardinality0...1
Typestring
Must SupportTrue
SummaryTrue
Requirements

Allows greater ease in ensuring the same person is being talked about.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: name
FamilyMemberHistory.relationship
DefinitionThe type of relationship this person has to the patient (father, mother, brother etc.).
Cardinality1...1
TypeCodeableConcept
Binding

The nature of the relationship between the patient and the related person being described in the family member history.

UKCorePersonRelationshipType (extensible)
Must SupportTrue
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: code
FamilyMemberHistory.sex
DefinitionThe birth sex of the family member.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing the sex assigned at birth as documented on the birth registration.

AdministrativeGender (extensible)
SummaryTrue
Requirements

Not all relationship codes imply sex and the relative's sex can be relevant for risk assessments.

Comments

This element should ideally reflect whether the individual is genetically male or female. However, as reported information based on the knowledge of the patient or reporting friend/relative, there may be situations where the reported sex might not be totally accurate. E.g. 'Aunt Sue' might be XY rather than XX. Questions soliciting this information should be phrased to encourage capture of genetic sex where known. However, systems performing analysis should also allow for the possibility of imprecision with this element.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
FamilyMemberHistory.born[x]
DefinitionThe actual or approximate date of birth of the relative.
Cardinality0...1
TypePeriod
Requirements

Allows calculation of the relative's age.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: player[classCode=LIV, determinerCode=INSTANCE]. birthDate (could be URG)
FamilyMemberHistory.age[x]
DefinitionThe age of the relative at the time the family member history is recorded.
Cardinality0...1
TypeAge
SummaryTrue
Requirements

While age can be calculated from date of birth, sometimes recording age directly is more natural for clinicians.

Comments

use estimatedAge to indicate whether the age is actual or not.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: participation[typeCode=SBJ].act[classCode=OBS,moodCode=EVN, code="age"].value
FamilyMemberHistory.estimatedAge
DefinitionIf true, indicates that the age value specified is an estimated value.
Cardinality0...1
Typeboolean
SummaryTrue
Requirements

Clinicians often prefer to specify an estimaged age rather than an age range.

Comments

This element is labeled as a modifier because the fact that age is estimated can/should change the results of any algorithm that calculates based on the specified age.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
FamilyMemberHistory.deceased[x]
DefinitionDeceased flag or the actual or approximate age of the relative at the time of death for the family member history record.
Cardinality0...1
Typeboolean
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: player[classCode=LIV, determinerCode=INSTANCE].deceasedInd, deceasedDate (could be URG) For age, you'd hang an observation off the role
FamilyMemberHistory.reasonCode
DefinitionDescribes why the family member history occurred in coded or textual form.
Cardinality0...*
TypeCodeableConcept
Binding

Codes indicating why the family member history was done.

SNOMEDCTClinicalFindings (example)
SummaryTrue
Comments

Textual reasons can be captured using reasonCode.text.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.reasonCode
  • w5: FiveWs.why[x]
  • rim: .reasonCode
FamilyMemberHistory.reasonReference
DefinitionIndicates a Condition, Observation, AllergyIntolerance, or QuestionnaireResponse that justifies this family member history event.
Cardinality0...*
TypeReference(Condition | Observation | AllergyIntolerance | QuestionnaireResponse | DiagnosticReport | DocumentReference)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.reasonReference
  • w5: FiveWs.why[x]
  • rim: .outboundRelationship[typeCode=RSON].target
FamilyMemberHistory.note
DefinitionThis property allows a non condition-specific note to the made about the related person. Ideally, the note would be in the condition property, but this is not always possible.
Cardinality0...*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Event.note
  • rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=ActCode#ANNGEN].value
FamilyMemberHistory.condition
DefinitionThe significant Conditions (or condition) that the family member had. This is a repeating section to allow a system to represent more than one condition per resource, though there is nothing stopping multiple resources - one per condition.
Cardinality0...*
TypeBackboneElement
Must SupportTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=ActCode#ASSERTION, value<Diagnosis]
FamilyMemberHistory.condition.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
FamilyMemberHistory.condition.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.condition.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
FamilyMemberHistory.condition.code
DefinitionThe actual condition specified. Could be a coded condition (like MI or Diabetes) or a less specific string like 'cancer' depending on how much is known about the condition and the capabilities of the creating system.
Cardinality1...1
TypeCodeableConcept
Binding

Identification of the Condition or diagnosis.

Condition/Problem/DiagnosisCodes (preferred)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .value
FamilyMemberHistory.condition.outcome
DefinitionIndicates what happened following the condition. If the condition resulted in death, deceased date is captured on the relation.
Cardinality0...1
TypeCodeableConcept
Binding

The result of the condition for the patient; e.g. death, permanent disability, temporary disability, etc.

ConditionOutcomeCodes (preferred)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: outboundRelationship[typeCode=OUTC)].target[classCode=OBS, moodCode=EVN, code=ActCode#ASSERTION].value
FamilyMemberHistory.condition.contributedToDeath
DefinitionThis condition contributed to the cause of death of the related person. If contributedToDeath is not populated, then it is unknown.
Cardinality0...1
Typeboolean
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
FamilyMemberHistory.condition.onset[x]
DefinitionEither the age of onset, range of approximate age or descriptive string can be recorded. For conditions with multiple occurrences, this describes the first known occurrence.
Cardinality0...1
TypeAge
Requirements

Age of onset of a condition in relatives is predictive of risk for the patient.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="Subject Age at measurement", value<Diagnosis].value[@xsi:typeCode='TS' or 'IVL_TS'] Use originalText for string
FamilyMemberHistory.condition.note
DefinitionAn area where general notes can be placed about this specific condition.
Cardinality0...*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • rim: inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=ActCode#ANNGEN].value


FHIRMDSHL7v2
FamilyMemberHistoryPedigree details/diagram, Disease penetranceN/A not in scope for HL7v2, could be added as additional DG1 segments related to relatives (representation of family history in HL7v2 still pending investigation)

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_FamilyMemberHistory_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-FamilyMemberHistory-Genomics

Additional Guidance

extension:genetics-observation

An extension on the FamilyMemberHistory resource to include Observations relevant to Genomic testing/interpretation.

"extension":  [
        {
            "url": "http://hl7.org/fhir/StructureDefinition/family-member-history-genetics-observation",
            "valueReference": {
                "reference": "Observation/Observation-BloodPressure-Example"
            }
        }
    ],

identifier

This SHOULD be NHS number or local identifier (if NHS number is unavailable e.g. for non UK residents). If a local identifier is used, an assigner SHALL be provided. The FamilyMemberHistory.identifier field SHALL match the identifier used for a RelatedPerson resource if the same person is being referenced.

   "identifier": {
      "system": "urn:oid:2.16.840.1.113883.2.1.3.2.4.18.24",
      "value": "FT-RWT13521",
      "assigner": {
        "identifier": {
          "system": "https://fhir.nhs.uk/Id/ods-organization-code",
          "value": "RAX"
        }
      }
    }
  }

status

Used to mark the completeness of a given family member's clinical history. If the history of a family member is expected but no history could be obtained, this element SHOULD be filled with 'health-unknown'.

Assertions regarding absence of relevant history SHOULD follow guidance within the HL7 FHIR R4 FamilyMemberHistory resource.

"status": "completed",

patient

SHALL be present. Reference to the associated proband Patient for which this family history is being obtained. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

relationship

SHALL be present. Relationship between the person the FamilyMemberHistory references and the proband Patient. Clinical histories for each family member are expected to be recorded in separate FamilyMemberHistory resources. If multiple resources are required, both FamilyMemberHistory and related clinical artifacts such as Condition/Observation resources, these MAY be contained within a List resource to improve readability.

"relationship": {
        "coding":  [
            {
                "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                "code": "PRN",
                "display": "parent"
            }
        ]
    }

Genomics-Observation

Used to represent the bulk of clinical information to be sent alongside a Genomic Test Order, as well as clinical results included within structured Diagnostic Reports.

Observations within Genomics are used to represent a point-in-time observation made about a patient or specimen. This means Observations SHOULD NOT be updated post-submission unless the original Observation has been entered in error or incorrectly coded (in this case, the appropriate status SHALL be used, e.g. entered-in-error or corrected).

For new observations which invalidate previous observations made about a patient, a new Observation resource SHOULD be created, the new observation MAY reference the invalidated observation via the observation-replaces extension.

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Observation UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Observation)
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueCodecode
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueStringstring
url1..1uriFixed Value
bodyStructureR5I0..1Extension(Reference(BodyStructure))
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
basedOnΣ I0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
partOfΣ I0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)
statusS Σ ?!1..1codeBinding
categoryS0..*CodeableConceptBinding
codeS Σ1..1CodeableConceptBinding
subjectS Σ I0..1Reference(Patient | Group | Device | Location)
focusΣ I0..*Reference(Resource)
encounterΣ I0..1Reference(Encounter)
effectiveDateTimedateTime
effectivePeriodPeriod
effectiveTimingTiming
effectiveInstantinstant
issuedΣ0..1instant
performerS Σ I0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)
valueQuantityQuantity
valueCodeableConceptCodeableConcept
valueStringstring
valueBooleanboolean
valueIntegerinteger
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueTimetime
valueDateTimedateTime
valuePeriodPeriod
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
note0..*Annotation
bodySite0..1CodeableConceptBinding
method0..1CodeableConceptBinding
specimenI0..1Reference(Specimen)
deviceI0..1Reference(Device | DeviceMetric)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
lowI0..1SimpleQuantity
highI0..1SimpleQuantity
type0..1CodeableConceptBinding
appliesTo0..*CodeableConcept
ageI0..1Range
text0..1string
hasMemberΣ I0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)
derivedFromΣ I0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ1..1CodeableConceptBinding
valueQuantityQuantity
valueCodeableConceptCodeableConcept
valueStringstring
valueBooleanboolean
valueIntegerinteger
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueTimetime
valueDateTimedateTime
valuePeriodPeriod
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
referenceRange0..*see (referenceRange)

Differential from Observation

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Observation)
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueCodecode
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueStringstring
url1..1uriFixed Value
bodyStructureR5I0..1Extension(Reference(BodyStructure))
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
basedOnΣ I0..*Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
partOfΣ I0..*Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)
statusS Σ ?!1..1codeBinding
categoryS0..*CodeableConceptBinding
codeS Σ1..1CodeableConceptBinding
subjectS Σ I0..1Reference(Patient | Group | Device | Location)
focusΣ I0..*Reference(Resource)
encounterΣ I0..1Reference(Encounter)
effectiveDateTimedateTime
effectivePeriodPeriod
effectiveTimingTiming
effectiveInstantinstant
issuedΣ0..1instant
performerS Σ I0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)
valueQuantityQuantity
valueCodeableConceptCodeableConcept
valueStringstring
valueBooleanboolean
valueIntegerinteger
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueTimetime
valueDateTimedateTime
valuePeriodPeriod
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
note0..*Annotation
bodySite0..1CodeableConceptBinding
method0..1CodeableConceptBinding
specimenI0..1Reference(Specimen)
deviceI0..1Reference(Device | DeviceMetric)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
lowI0..1SimpleQuantity
highI0..1SimpleQuantity
type0..1CodeableConceptBinding
appliesTo0..*CodeableConcept
ageI0..1Range
text0..1string
hasMemberΣ I0..*Reference(Observation | QuestionnaireResponse | MolecularSequence)
derivedFromΣ I0..*Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ1..1CodeableConceptBinding
valueQuantityQuantity
valueCodeableConceptCodeableConcept
valueStringstring
valueBooleanboolean
valueIntegerinteger
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueTimetime
valueDateTimedateTime
valuePeriodPeriod
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
referenceRange0..*see (referenceRange)

Observation
DefinitionMeasurements and simple assertions made about a patient, device or other subject.
Cardinality0...*
AliasVital Signs, Measurement, Results, Tests
Comments

Used for simple observations such as device measurements, laboratory atomic results, vital signs, height, weight, smoking status, comments, etc. Other resources are used to provide context for observations such as laboratory reports, etc.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.empty()
  • dom-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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • obs-7: If Observation.code is the same as an Observation.component.code then the value element associated with the code SHALL NOT be present
    value.empty() or component.code.where(coding.intersect(%resource.code.coding).exists()).empty()
  • obs-6: dataAbsentReason SHALL only be present if Observation.value[x] is not present
    dataAbsentReason.empty() or value.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • sct-concept: < 363787002 |Observable entity|
  • v2: OBX
  • rim: Observation[classCode=OBS, moodCode=EVN]
Observation.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Observation.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Observation.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Observation.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Observation.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Observation.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Observation.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5
DefinitionIdentifies the observation(s) that triggered the performance of this observation.
Cardinality0...*
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Observation.extension:triggeredByR5.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality2...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:observation
DefinitionReference to the triggering observation.
Cardinality1...1
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:observation.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Observation.extension:triggeredByR5.extension:observation.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:observation.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

observation

Mappings
  • rim: N/A
Observation.extension:triggeredByR5.extension:observation.value[x]
DefinitionA reference to the triggering observation.
Cardinality1...1
TypeReference(Observation)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:type
DefinitionThe type of trigger. Reflex | Repeat | Re-run.
Cardinality1...1
TypeExtension
Bindinghttp://hl7.org/fhir/ValueSet/observation-triggeredbytype (required)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:type.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Observation.extension:triggeredByR5.extension:type.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:type.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

type

Mappings
  • rim: N/A
Observation.extension:triggeredByR5.extension:type.value[x]
DefinitionThe type of trigger. Reflex | Repeat | Re-run
Cardinality1...1
Typecode
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:reason
DefinitionProvides the reason why this observation was performed as a result of the observation(s) referenced.
Cardinality0...1
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:reason.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Observation.extension:triggeredByR5.extension:reason.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.extension:reason.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

reason

Mappings
  • rim: N/A
Observation.extension:triggeredByR5.extension:reason.value[x]
DefinitionProvides the reason why this observation was performed as a result of the observation referenced.
Cardinality1...1
Typestring
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:triggeredByR5.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/5.0/StructureDefinition/extension-Observation.triggeredBy

Mappings
  • rim: N/A
Observation.extension:triggeredByR5.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality0...0
Typebase64Binary
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Observation.extension:bodyStructureR5
DefinitionIndicates the body structure on the subject's body where the observation was made (i.e. the target site).
Cardinality0...1
TypeExtension(Reference(BodyStructure))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.identifier
DefinitionA unique identifier assigned to this observation.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

Allows observations to be distinguished and referenced.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • v2: OBX.21 For OBX segments from systems without OBX-21 support a combination of ORC/OBR and OBX must be negotiated between trading partners to uniquely identify the OBX segment. Depending on how V2 has been implemented each of these may be an option: 1) OBR-3 + OBX-3 + OBX-4 or 2) OBR-3 + OBR-4 + OBX-3 + OBX-4 or 2) some other way to uniquely ID the OBR/ORC + OBX-3 + OBX-4.
  • rim: id
Observation.basedOn
DefinitionA plan, proposal or order that is fulfilled in whole or in part by this event. For example, a MedicationRequest may require a patient to have laboratory test performed before it is dispensed.
Cardinality0...*
TypeReference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
SummaryTrue
AliasFulfills
Requirements

Allows tracing of authorization for the event and tracking whether proposals/recommendations were acted upon.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.basedOn
  • v2: ORC
  • rim: .inboundRelationship[typeCode=COMP].source[moodCode=EVN]
Observation.partOf
DefinitionA larger event of which this particular Observation is a component or step. For example, an observation as part of a procedure.
Cardinality0...*
TypeReference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)
SummaryTrue
AliasContainer
Comments

To link an Observation to an Encounter use encounter. See the Notes below for guidance on referencing another Observation.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.partOf
  • v2: Varies by domain
  • rim: .outboundRelationship[typeCode=FLFS].target
Observation.status
DefinitionThe status of the result value.
Cardinality1...1
Typecode
Binding

Codes providing the status of an observation.

ObservationStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Need to track the status of individual results. Some results are finalized before the whole report is finalized.

Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
  • sct-concept: < 445584004 |Report by finality status|
  • v2: OBX-11
  • rim: status Amended & Final are differentiated by whether it is the subject of a ControlAct event with a type of "revise"
Observation.category
DefinitionA code that classifies the general type of observation being made.
Cardinality0...*
TypeCodeableConcept
Binding

Codes for high level observation categories.

ObservationCategoryCodes (preferred)
Must SupportTrue
Requirements

Used for filtering what observations are retrieved and displayed.

Comments

In addition to the required category valueset, this element allows various categorization schemes based on the owner’s definition of the category and effectively multiple categories can be used at once. The level of granularity is defined by the category concepts in the value set.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
Observation.code
DefinitionDescribes what was observed. Sometimes this is called the observation "name".
Cardinality1...1
TypeCodeableConcept
Binding

A code from the SNOMED Clinical Terminology UK coding system describing a type of observation

UKCoreObservationType (preferred)
Must SupportTrue
SummaryTrue
AliasName
Requirements

Knowing what kind of observation is being made is essential to understanding the observation.

Comments

All code-value and, if present, component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.code
  • w5: FiveWs.what[x]
  • sct-concept: < 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
  • v2: OBX-3
  • rim: code
  • sct-attr: 116680003 |Is a|
Observation.subject
DefinitionThe patient, or group of patients, location, or device this observation is about and into whose record the observation is placed. If the actual focus of the observation is different from the subject (or a sample of, part, or region of the subject), the `focus` element or the `code` itself specifies the actual focus of the observation.
Cardinality0...1
TypeReference(Patient | Group | Device | Location)
Must SupportTrue
SummaryTrue
Requirements

Observations have no value if you don't know who or what they're about.

Comments

One would expect this element to be a cardinality of 1..1. The only circumstance in which the subject can be missing is when the observation is made by a device that does not know the patient. In this case, the observation SHALL be matched to a patient through some context/channel matching technique, and at this point, the observation should be updated.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • v2: PID-3
  • rim: participation[typeCode=RTGT]
  • w5: FiveWs.subject
Observation.focus
DefinitionThe actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focus.
Cardinality0...*
TypeReference(Resource)
SummaryTrue
Comments

Typically, an observation is made about the subject - a patient, or group of patients, location, or device - and the distinction between the subject and what is directly measured for an observation is specified in the observation code itself ( e.g., "Blood Glucose") and does not need to be represented separately using this element. Use specimen if a reference to a specimen is required. If a code is required instead of a resource use either bodysite for bodysites or the standard extension focusCode.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.subject[x]
  • v2: OBX-3
  • rim: participation[typeCode=SBJ]
  • w5: FiveWs.subject
Observation.encounter
DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) during which this observation is made.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
AliasContext
Requirements

For some observations it may be important to know the link between an observation and a particular encounter.

Comments

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission laboratory tests).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.context
  • w5: FiveWs.context
  • v2: PV1
  • rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Observation.effective[x]
DefinitionThe time or time-period the observed value is asserted as being true. For biological subjects - e.g. human patients - this is usually called the "physiologically relevant time". This is usually either the time of the procedure or of specimen collection, but very often the source of the date/time is not known, only the date/time itself.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
AliasOccurrence
Requirements

Knowing when an observation was deemed true is important to its relevance as well as determining trends.

Comments

At least a date should be present unless this observation is a historical report. For recording imprecise or "fuzzy" times (For example, a blood glucose measurement taken "after breakfast") use the Timing datatype which allow the measurement to be tied to regular life events.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • v2: OBX-14, and/or OBX-19 after v2.4 (depends on who observation made)
  • rim: effectiveTime
Observation.issued
DefinitionThe date and time this version of the observation was made available to providers, typically after the results have been reviewed and verified.
Cardinality0...1
Typeinstant
SummaryTrue
Comments

For Observations that don’t require review and verification, it may be the same as the lastUpdated time of the resource itself. For Observations that do require review and verification for certain updates, it might not be the same as the lastUpdated time of the resource itself due to a non-clinically significant update that doesn’t require the new version to be reviewed and verified again.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.recorded
  • v2: OBR.22 (or MSH.7), or perhaps OBX-19 (depends on who observation made)
  • rim: participation[typeCode=AUT].time
Observation.performer
DefinitionWho was responsible for asserting the observed value as "true".
Cardinality0...*
TypeReference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)
Must SupportTrue
SummaryTrue
Requirements

May give a degree of confidence in the observation and also indicates where follow-up questions should be directed.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • w5: FiveWs.actor
  • v2: OBX.15 / (Practitioner) OBX-16, PRT-5:PRT-4='RO' / (Device) OBX-18 , PRT-10:PRT-4='EQUIP' / (Organization) OBX-23, PRT-8:PRT-4='PO'
  • rim: participation[typeCode=PRF]
Observation.value[x]
DefinitionThe information determined as a result of making the observation, if the information has a simple value.
Cardinality0...1
TypeQuantity
Must SupportTrue
SummaryTrue
Requirements

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

Comments

An observation may have; 1) a single value here, 2) both a value and a set of related or component values, or 3) only a set of related or component values. If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • sct-concept: < 441742003 |Evaluation finding|
  • v2: OBX.2, OBX.5, OBX.6
  • rim: value
  • sct-attr: 363714003 |Interprets|
Observation.dataAbsentReason
DefinitionProvides a reason why the expected value in the element Observation.value[x] is missing.
Cardinality0...1
TypeCodeableConcept
Binding

Codes specifying why the result (Observation.value[x]) is missing.

DataAbsentReason (extensible)
Requirements

For many results it is necessary to handle exceptional values in measurements.

Comments

Null or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "specimen unsatisfactory".

The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Note that an observation may only be reported if there are values to report. For example differential cell counts values may be reported only when > 0. Because of these options, use-case agreements are required to interpret general observations for null or exceptional values.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: N/A
  • rim: value.nullFlavor
Observation.interpretation
DefinitionA categorical assessment of an observation value. For example, high, low, normal.
Cardinality0...*
TypeCodeableConcept
Binding

Codes identifying interpretations of observations.

ObservationInterpretationCodes (extensible)
AliasAbnormal Flag
Requirements

For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

Comments

Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • sct-concept: < 260245000 |Findings values|
  • v2: OBX-8
  • rim: interpretationCode
  • sct-attr: 363713009 |Has interpretation|
Observation.note
DefinitionComments about the observation or the results.
Cardinality0...*
TypeAnnotation
Requirements

Need to be able to provide free text additional information.

Comments

May include general statements about the observation, or statements about significant, unexpected or unreliable results values, or information about its source when relevant to its interpretation.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • v2: NTE.3 (partner NTE to OBX, or sometimes another (child?) OBX)
  • rim: subjectOf.observationEvent[code="annotation"].value
Observation.bodySite
DefinitionIndicates the site on the subject's body where the observation was made (i.e. the target site).
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing anatomical locations. May include laterality.

SNOMEDCTBodyStructures (preferred)
Comments

Only used if not implicit in code found in Observation.code. In many systems, this may be represented as a related observation instead of an inline component.

If the use case requires BodySite to be handled as a separate resource (e.g. to identify and track separately) then use the standard extension bodySite.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • sct-concept: < 123037004 |Body structure|
  • v2: OBX-20
  • rim: targetSiteCode
  • sct-attr: 718497002 |Inherent location|
Observation.method
DefinitionIndicates the mechanism used to perform the observation.
Cardinality0...1
TypeCodeableConcept
Binding

Methods for simple observations.

ObservationMethods (preferred)
Requirements

In some cases, method can impact results and is thus used for determining whether results can be compared or determining significance of results.

Comments

Only used if not implicit in code for Observation.code.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: OBX-17
  • rim: methodCode
Observation.specimen
DefinitionThe specimen that was used when this observation was made.
Cardinality0...1
TypeReference(Specimen)
Comments

Should only be used if not implicit in code found in Observation.code. Observations are not made on specimens themselves; they are made on a subject, but in many cases by the means of a specimen. Note that although specimens are often involved, they are not always tracked and reported explicitly. Also note that observation resources may be used in contexts that track the specimen explicitly (e.g. Diagnostic Report).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • sct-concept: < 123038009 |Specimen|
  • v2: SPM segment
  • rim: participation[typeCode=SPC].specimen
  • sct-attr: 704319004 |Inherent in|
Observation.device
DefinitionThe device used to generate the observation data.
Cardinality0...1
TypeReference(Device | DeviceMetric)
Comments

Note that this is not meant to represent a device involved in the transmission of the result, e.g., a gateway. Such devices may be documented using the Provenance resource where relevant.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • sct-concept: < 49062001 |Device|
  • v2: OBX-17 / PRT -10
  • rim: participation[typeCode=DEV]
  • sct-attr: 424226004 |Using device|
Observation.referenceRange
DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range. Multiple reference ranges are interpreted as an "OR". In other words, to represent two distinct target populations, two `referenceRange` elements would be used.
Cardinality0...*
TypeBackboneElement
Requirements

Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

Comments

Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • obs-3: Must have at least a low or a high or text
    low.exists() or high.exists() or text.exists()
Mappings
  • rim: n/a
  • v2: OBX.7
  • rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]
Observation.referenceRange.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Observation.referenceRange.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.referenceRange.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.referenceRange.low
DefinitionThe value of the low bound of the reference range. The low bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the low bound is omitted, it is assumed to be meaningless (e.g. reference range is <=2.3).
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • v2: OBX-7
  • rim: value:IVL_PQ.low
Observation.referenceRange.high
DefinitionThe value of the high bound of the reference range. The high bound of the reference range endpoint is inclusive of the value (e.g. reference range is >=5 - <=9). If the high bound is omitted, it is assumed to be meaningless (e.g. reference range is >= 2.3).
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • v2: OBX-7
  • rim: value:IVL_PQ.high
Observation.referenceRange.type
DefinitionCodes to indicate the what part of the targeted reference population it applies to. For example, the normal or therapeutic range.
Cardinality0...1
TypeCodeableConcept
Binding

Code for the meaning of a reference range.

ObservationReferenceRangeMeaningCodes (preferred)
Requirements

Need to be able to say what kind of reference range this is - normal, recommended, therapeutic, etc., - for proper interpretation.

Comments

This SHOULD be populated if there is more than one range. If this element is not present then the normal range is assumed.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • sct-concept: < 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
  • v2: OBX-10
  • rim: interpretationCode
Observation.referenceRange.appliesTo
DefinitionCodes to indicate the target population this reference range applies to. For example, a reference range may be based on the normal population or a particular sex or race. Multiple `appliesTo` are interpreted as an "AND" of the target populations. For example, to represent a target population of African American females, both a code of female and a code for African American would be used.
Cardinality0...*
TypeCodeableConcept
Binding

Codes identifying the population the reference range applies to.

ObservationReferenceRangeAppliesToCodes (example)
Requirements

Need to be able to identify the target population for proper interpretation.

Comments

This SHOULD be populated if there is more than one range. If this element is not present then the normal population is assumed.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • sct-concept: < 260245000 |Findings values| OR < 365860008 |General clinical state finding| OR < 250171008 |Clinical history or observation findings| OR < 415229000 |Racial group| OR < 365400002 |Finding of puberty stage| OR < 443938003 |Procedure carried out on subject|
  • v2: OBX-10
  • rim: interpretationCode
Observation.referenceRange.age
DefinitionThe age at which this reference range is applicable. This is a neonatal age (e.g. number of weeks at term) if the meaning says so.
Cardinality0...1
TypeRange
Requirements

Some analytes vary greatly over age.

Comments

The stated low and high value are assumed to have arbitrarily high precision when it comes to determining which values are in the range. I.e. 1.99 is not in the range 2 -> 3.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • rng-2: If present, low SHALL have a lower value than high
    low.empty() or high.empty() or (low <= high)
Mappings
  • rim: n/a
  • v2: NR and also possibly SN (but see also quantity)
  • rim: IVL<QTY[not(type="TS")]> [lowClosed="true" and highClosed="true"]or URG<QTY[not(type="TS")]>
  • rim: outboundRelationship[typeCode=PRCN].targetObservationCriterion[code="age"].value
Observation.referenceRange.text
DefinitionText based reference range in an observation which may be used when a quantitative range is not appropriate for an observation. An example would be a reference value of "Negative" or a list or table of "normals".
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: OBX-7
  • rim: value:ST
Observation.hasMember
DefinitionThis observation is a group observation (e.g. a battery, a panel of tests, a set of vital sign measurements) that includes the target as a member of the group.
Cardinality0...*
TypeReference(Observation | QuestionnaireResponse | MolecularSequence)
SummaryTrue
Comments

When using this element, an observation will typically have either a value or a set of related resources, although both may be present in some cases. For a discussion on the ways Observations can assembled in groups together, see Notes below. Note that a system may calculate results from QuestionnaireResponse into a final score and represent the score as an Observation.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: Relationships established by OBX-4 usage
  • rim: outBoundRelationship
Observation.derivedFrom
DefinitionThe target resource that represents a measurement from which this observation value is derived. For example, a calculated anion gap or a fetal measurement based on an ultrasound image.
Cardinality0...*
TypeReference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)
SummaryTrue
Comments

All the reference choices that are listed in this element can represent clinical observations and other measurements that may be the source for a derived value. The most common reference will be another Observation. For a discussion on the ways Observations can assembled in groups together, see Notes below.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: Relationships established by OBX-4 usage
  • rim: .targetObservation
Observation.component
DefinitionSome observations have multiple component observations. These component observations are expressed as separate code value pairs that share the same attributes. Examples include systolic and diastolic component observations for blood pressure measurement and multiple component observations for genetics observations.
Cardinality0...*
TypeBackboneElement
Must SupportTrue
SummaryTrue
Requirements

Component observations share the same attributes in the Observation resource as the primary observation and are always treated a part of a single observation (they are not separable). However, the reference range for the primary observation value is not inherited by the component values and is required when appropriate for each component observation.

Comments

For a discussion on the ways Observations can be assembled in groups together see Notes below.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: containment by OBX-4?
  • rim: outBoundRelationship[typeCode=COMP]
Observation.component.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Observation.component.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.component.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Observation.component.code
DefinitionDescribes what was observed. Sometimes this is called the observation "code".
Cardinality1...1
TypeCodeableConcept
Binding

A code from the SNOMED Clinical Terminology UK coding system describing a type of observation

UKCoreObservationType (preferred)
SummaryTrue
Requirements

Knowing what kind of observation is being made is essential to understanding the observation.

Comments

All code-value and component.code-component.value pairs need to be taken into account to correctly understand the meaning of the observation.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.what[x]
  • sct-concept: < 363787002 |Observable entity| OR < 386053000 |Evaluation procedure|
  • v2: OBX-3
  • rim: code
Observation.component.value[x]
DefinitionThe information determined as a result of making the observation, if the information has a simple value.
Cardinality0...1
TypeQuantity
SummaryTrue
Requirements

An observation exists to have a value, though it might not if it is in error, or if it represents a group of observations.

Comments

Used when observation has a set of component observations. An observation may have both a value (e.g. an Apgar score) and component observations (the observations from which the Apgar score was derived). If a value is present, the datatype for this element should be determined by Observation.code. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Observation.code defines a coded value. For additional guidance, see the Notes section below.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • sct-concept: 363714003 |Interprets| < 441742003 |Evaluation finding|
  • v2: OBX.2, OBX.5, OBX.6
  • rim: value
  • sct-attr: 363714003 |Interprets|
Observation.component.dataAbsentReason
DefinitionProvides a reason why the expected value in the element Observation.component.value[x] is missing.
Cardinality0...1
TypeCodeableConcept
Binding

Codes specifying why the result (Observation.value[x]) is missing.

DataAbsentReason (extensible)
Requirements

For many results it is necessary to handle exceptional values in measurements.

Comments

"Null" or exceptional values can be represented two ways in FHIR Observations. One way is to simply include them in the value set and represent the exceptions in the value. For example, measurement values for a serology test could be "detected", "not detected", "inconclusive", or "test not done".

The alternate way is to use the value element for actual observations and use the explicit dataAbsentReason element to record exceptional values. For example, the dataAbsentReason code "error" could be used when the measurement was not completed. Because of these options, use-case agreements are required to interpret general observations for exceptional values.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: N/A
  • rim: value.nullFlavor
Observation.component.interpretation
DefinitionA categorical assessment of an observation value. For example, high, low, normal.
Cardinality0...*
TypeCodeableConcept
Binding

Codes identifying interpretations of observations.

ObservationInterpretationCodes (extensible)
AliasAbnormal Flag
Requirements

For some results, particularly numeric results, an interpretation is necessary to fully understand the significance of a result.

Comments

Historically used for laboratory results (known as 'abnormal flag' ), its use extends to other use cases where coded interpretations are relevant. Often reported as one or more simple compact codes this element is often placed adjacent to the result value in reports and flow sheets to signal the meaning/normalcy status of the result.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • sct-concept: < 260245000 |Findings values|
  • v2: OBX-8
  • rim: interpretationCode
  • sct-attr: 363713009 |Has interpretation|
Observation.component.referenceRange
DefinitionGuidance on how to interpret the value by comparison to a normal or recommended range.
Cardinality0...*
Typesee (referenceRange)
Requirements

Knowing what values are considered "normal" can help evaluate the significance of a particular result. Need to be able to provide multiple reference ranges for different contexts.

Comments

Most observations only have one generic reference range. Systems MAY choose to restrict to only supplying the relevant reference range based on knowledge about the patient (e.g., specific to the patient's age, gender, weight and other factors), but this might not be possible or appropriate. Whenever more than one reference range is supplied, the differences between them SHOULD be provided in the reference range and/or age properties.

Mappings
  • v2: OBX.7
  • rim: outboundRelationship[typeCode=REFV]/target[classCode=OBS, moodCode=EVN]

Observation-AutisticBehaviour-Example
Observation-BlastPercentage-Example
Observation-Bruising-Example
Observation-Cellularity-Example
Observation-CellularityKayBurbridge-Example
Observation-DelayedSpeechLanguageDevt-Example
Observation-DiseasePenetrance-Example
Observation-DiseasePenetrancePheobeSmitham-Example
Observation-DiseaseStatus-Example
Observation-DutchLipidScore-Example
Observation-EnlargedKidney-Example
Observation-Haemoglobin-Example
Observation-HepaticCysts-Example
Observation-Immunodefficiency-Example
Observation-IntellectualDisabilityMild-Example
Observation-IntellectualDisabilityProfound-Example
Observation-NatureAndAgeOfHearingLoss-Example
Observation-Necrosis-Example
Observation-NecrosisKayBurbridge-Example
Observation-NeoplasticCell-Example
Observation-NeoplasticCellKayBurbridge-Example
Observation-Neutrophils-Example
Observation-GenomicEthnicity-Example
Observation-MultipleRenalCysts-Example
Observation-Nephronophthisis-Example
Observation-NoBoneMarrowTransplantProbandFather-Example
Observation-NoBoneMarrowTransplantProbandMother-Example
Observation-NoFirstTrimesterFetalAnomalies-Example
Observation-NoPregnancy-Example
Observation-NoSecondTrimesterFetalAnomalies-Example
Observation-NoTransfusion-Example
Observation-NoTransfusionProbandFather-Example
Observation-NoTransfusionProbandMother-Example
Observation-NoTransplant-Example
Observation-NonConsanguinousUnion-Example
Observation-NonConsanguinousUnionProband-Example
Observation-NonConsanguinousUnionProbandFather-Example
Observation-NonConsanguinousUnionProbandMother-Example
Observation-NucleatedCellCount-Example
Observation-Platelets-Example
Observation-PregnancyConfirmation-Example
Observation-QueryXanthoma-Example
Observation-RenalInsufficiency-Example
Observation-SimonBroomeCriteria-Example
Observation-TumourType-Example
Observation-TumourTypeKayBurbridge-Example
Observation-UnknownConsanguinousUnionStatus-Example
Observation-WhiteBloodCell-Example
Observation-SampleCellContent-Example
Observation-HistoryOfFetalLoss-Example


FHIRMDSHL7v2
ObservationRaw specimen/biopsy - Additional specimen/biopsy information, Extracted specimen - Additional specimen information, Further clinical informationOBX segments (may be attached to SPM)
Observation.codePatient - Sexual orientation, Patient - Karyotypic sex, Patient - Pregnancy status, Patient - Fetal karyotypic sex, Patient - Is from consanguinous union, Fetus - Karyotypic sex, Fetus - Is testing for fetal loss from 24 weeks of gestation, PLCM activity - DNA concentration, PLCM activity - DNA quantification, PLCM activity - Test outcome code (Many), Raw specimen/biopsy - Taken alive/post mortem, Diabetic complications, Has absent reflexesOBX-5 with appropriate SNOMED/READ/LOINC code
Observation.componentPatient - Pregnancy gestation period, Patient - Fetal gestation, Patient - Estimated Delivery Date (EDD), Patient - Pregnancy type, Absent reflexes detailOBX-14 (compared with other ORC segments), OBR segments with appropriate codes
Observation.value\[x\]Patient - Height (m), Raw specimen/biopsy - Skin/Bone affected status, Raw specimen/biopsy - Blasts %, Raw specimen/biopsy - Neoplastic cell content (%), Raw specimen/biopsy - Necrosis, Raw specimen/biopsy - Nucleated cell count, Raw specimen/biopsy - Tumour cellularity, Raw specimen/biopsy - Maternal cell contamination (MCC), Previous non genomic report - Test result value comparator, Previous non genomic report - Test result value unit of measure, Genomic ethnicity, ISTH BAT score, MODY probability calculator score, Patient BMI at time of genomic test request, Patient BMI at time of diagnosis, Maternal BMI at time of request, Paternal BMI at time of request, Birth weightOBX-5/6
Observation.referenceRange.lowPrevious non genomic report - Test result reference range lowOBX-7 (before operator)
Observation.referenceRange.highPrevious non genomic report - Test result reference range highOBX-7 (after operator)
Observation.methodPrevious non genomic report - Test result test methodOBX-17
Observation.referenceRange.textPrevious non genomic report - Test result reference range textOBX-7
Observation.interpretationPrevious non genomic report - Test result clinical summaryOBX-8
Observation.bodySiteSubcutaneous fat loss areas, Increased fat deposition areasOBX-5

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Observation_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Observation-Genomics

Additional Guidance

extension:observation-replaces

A core extension on the base HL7 International Observation resource. Used to link to previous Observation resources which have been invalidated by this Observation instance, e.g. for cases where a previously present HPO term is now no longer applicable. For new observations which invalidate previous observations made about a patient, the new Observation resource SHOULD be created, and MAY reference the invalidated observation via the observation-replaces extension.

    {
      "url": "http://hl7.org/fhir/StructureDefinition/observation-replaces",
      "valueReference": {
        "reference": "Observation/Observation-IntellectualDisabilityMild-Example"
      }
    }

status

SHOULD be marked as final for most observations unless corrected after submission. Observations within Genomics are used to represent a point-in-time observation made about a patient or specimen. This means Observations should not be updated post-submission unless the original Observation has been entered in error or incorrectly coded (in this case, the appropriate status SHALL be used, e.g. entered-in-error or corrected, respectively).

"status": "final",

code

SHALL be present. SNOMED CT coding is preferred, though it is expected that alternative codings will be used depending on the appropriateness for a particular observation e.g. HPO or other codings found within the HL7 International Genomic Reporting IG as their use may already be widespread within Genomics. If a SNOMED CT equivalent exists for a code regularly captured within another CodeSystem, additional 'coding' elements within 'code' SHOULD be provided to aid analytics.

"code": {
        "coding":  [
            {
                "system": "https://hpo.jax.org/app/",
                "code": "HP:0000105",
                "display": "Enlarged kidney"
            }
        ]
    },

subject

SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

focus

For recording the Specimen the observation relates to, when the observation is not related to the patient from which the sample was taken e.g. Sample nucleated cell count.

This can also be used for observations related to the state of the patient at the time of collection e.g. pregnancy status.

"focus": {
        "reference": "Specimen/Specimen-BloodEDTA-Example"
    },

effectiveDateTime

It is expected that all Observations SHOULD include the effective time the observation was made, if known, to aid interpretation.

"effectiveDateTime": "2022-07-11T09:00:00Z",

value[x]

The value element SHOULD use the most appropriate data type for the observation in question. Using preferred CodeSystems as specified within HL7 International FHIR R4 or the UK Core. For asserting absence of a particular condition/situation, the finding SHOULD be specified within the 'code' element and 'valueBoolean' set to 'false' or 'valueCodeableConcept' set to an appropriate qualifier value code from SNOMED CT. For an assertion of a particular situation being present, e.g. a Condition or Procedure having been performed, these SHOULD be collected within the relevant clinical resources, alongside additional information needed to inform interpretation.

"valueQuantity": {
        "value": 6.5,
        "system": "http://unitsofmeasure.org",
        "code": "10*12/L"
    }

component

SHOULD be used to group qualifiers of an observation. In particular, details regarding observations related to a pregnancy SHOULD be added as components on a pregnancy status observation.

Examples of how pregnancy information can be captured within Observations (pregnancy status with EDD, gestation etc. recorded as components) will be added to the Fetus Management Clinical Scenario.

"component": [
		{
			"code": {
				"coding": [
					{
						"system": "http://snomed.info/sct",
						"code": "720451000000102",
						"display": "Assisted conception"
					}
				]
			}
		},
		{
			"code": {
				"coding": [
					{
						"system": "http://snomed.info/sct",
						"code": "226081000000107",
						"display": "Gestational age"
					}
				]
			},
			"valueQuantity": {
				"value": 87,
				"unit": "day",
				"system": "http://unitsofmeasure.org",
				"code": "d"
			}
		},
		{
			"code": {
				"coding": [
					{
						"system": "http://snomed.info/sct",
						"code": "161714006",
						"display": "Estimated date of delivery"
					}
				]
			},
			"valueDateTime": "2024-05-01"
		}
	],

Genomics-OperationOutcome

The Genomics OperationOutcome is the same as provided within FHIR R4. The FHIR R4 OperationOutcome is provided below for completeness.

OperationOutcomes are expected for any create or update operations made on the server resulting in validation messages (or any create or update operations made within a transaction bundle). It is not expected that connecting systems would need to construct OperationOutcome resources or submit these to the server, though key elements within the resource are detailed here for receiving systems.

It is expected that all issue codes raised by the Genomic Medicine Service will fall under existing codes bound in the below resource. If further codes are needed, these will be promoted to UK Core for release in a future ballot/sprint.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/OperationOutcome HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
severityΣ1..1codeBinding
codeΣ1..1codeBinding
detailsΣ0..1CodeableConcept
diagnosticsΣ0..1string
locationΣ0..*string
expressionΣ0..*string

Differential from OperationOutcome

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
severityΣ1..1codeBinding
codeΣ1..1codeBinding
detailsΣ0..1CodeableConcept
diagnosticsΣ0..1string
locationΣ0..*string
expressionΣ0..*string

OperationOutcome
DefinitionA collection of error, warning, or information messages that result from a system action.
Cardinality0...*
Comments

Can result from the failure of a REST call or be part of the response message returned from a request message.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • rim: Grouping is handled through multiple repetitions from whatever context references the outcomes (no specific grouper required)
OperationOutcome.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

OperationOutcome.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
OperationOutcome.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
OperationOutcome.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
OperationOutcome.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
OperationOutcome.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
OperationOutcome.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
OperationOutcome.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
OperationOutcome.issue
DefinitionAn error, warning, or information message that results from a system action.
Cardinality1...*
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: ERR
  • rim: AcknowledgementDetail or Observation[classCode="ALRT" and moodCode="EVN"]
OperationOutcome.issue.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
OperationOutcome.issue.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
OperationOutcome.issue.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
OperationOutcome.issue.severity
DefinitionIndicates whether the issue indicates a variation from successful processing.
Cardinality1...1
Typecode
Binding

How the issue affects the success of the action.

IssueSeverity (required)
SummaryTrue
Requirements

Indicates how relevant the issue is to the overall success of the action.

Comments

This is labeled as "Is Modifier" because applications should not confuse hints and warnings with errors.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: ERR-4
  • rim: ./typeCode[parent::AcknowledgmentDetail] or unique(./inboundRelationship[parent::Observation and typeCode='SUBJ' and isNormalActRelationship()]/source[classCode="OBS" and moodCode="EVN" and implies(code, ActCode#SEV and isNormalAct())/value[xsi:type="CD"]
OperationOutcome.issue.code
DefinitionDescribes the type of the issue. The system that creates an OperationOutcome SHALL choose the most applicable code from the IssueType value set, and may additional provide its own code for the error in the details element.
Cardinality1...1
Typecode
Binding

A code that describes the type of issue.

IssueType (required)
SummaryTrue
Requirements

Expresses the issue in a human and computer-friendly way, allowing the requesting system to behave differently based on the type of issue.

The required element provides a base level of computable interoperability across all systems for processing an outcome, allowing systems to respond appropriately regardless of the internal system error codes returned.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: ERR-3
  • rim: ./code
OperationOutcome.issue.details
DefinitionAdditional details about the error. This may be a text description of the error or a system code that identifies the error.
Cardinality0...1
TypeCodeableConcept
Binding

A code that provides details as the exact issue.

OperationOutcomeCodes (example)
SummaryTrue
Comments

A human readable description of the error issue SHOULD be placed in details.text.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: ERR-5
  • rim: ./code
OperationOutcome.issue.diagnostics
DefinitionAdditional diagnostic information about the issue.
Cardinality0...1
Typestring
SummaryTrue
Comments

This may be a description of how a value is erroneous, a stack dump to help trace the issue or other troubleshooting information.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: ERR-8
  • rim: ./text[parent::AcknowledgmentDetail]
OperationOutcome.issue.location
DefinitionThis element is deprecated because it is XML specific. It is replaced by issue.expression, which is format independent, and simpler to parse. For resource issues, this will be a simple XPath limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised. For HTTP errors, will be "http." + the parameter name.
Cardinality0...*
Typestring
SummaryTrue
Requirements

Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.

Comments

The root of the XPath is the resource or bundle that generated OperationOutcome. Each XPath SHALL resolve to a single node. This element is deprecated, and is being replaced by expression.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: ERR-2
  • rim: ./location[parent::AcknowledgmentDetail]
OperationOutcome.issue.expression
DefinitionA [simple subset of FHIRPath](fhirpath.html#simple) limited to element names, repetition indicators and the default child accessor that identifies one of the elements in the resource that caused this issue to be raised.
Cardinality0...*
Typestring
SummaryTrue
Requirements

Allows systems to highlight or otherwise guide users to elements implicated in issues to allow them to be fixed more easily.

Comments

The root of the FHIRPath is the resource or bundle that generated OperationOutcome. Each FHIRPath SHALL resolve to a single node.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: ERR-2
  • rim: ./location[parent::AcknowledgmentDetail]


FHIRMDSHL7v2

Additional Guidance

issue

An issue element will be included within the OperationOutcome for each issue that needs to be communicated to the requesting system, e.g. errors, warnings or informational messages. Appropriate 'severity' and 'code' codes will be assigned to help categorization of an messages returned, using the standard HL7 bound ValueSets.

The diagnostics field will be used to present a human readable version of the message and location will be used to detail the location within the request payload that resulted in the associated issue/message.

If an error or warning is returned, the 'details' element will be populated with any validation specific messages. Details of the systems and codes used for these messages will be determined by the validation package used by the central order management broker (this is still to be determined at the time of publication).

"issue":[
            {
              "severity":"error",
              "code":"processing",
              "details":{
                "coding":[
                  {
                    "system": "http://terminology.hl7.org/CodeSystem/operation-outcome",
                    "code": "MSG_LOCAL_FAIL",
                    "display": "Unable to resolve local reference to resource Patient/Patient-MeirLieberman-Example"
                  }
                ]
              },
              "diagnostics": "Validation errors occurred during processing",
              "location": [
                  "Bundle.entry[1].resource.ofType(ServiceRequest)"
              ]
            }
          ]

Genomics-Organization

Organization is not expected to be sent within Test Order or other interactions with the central GMS. Instead, client systems SHOULD strive to reference organizations via their ODS code and display name only.

The below profile is provided for information, if referencing by ODS code is intractable (though repeated issues with requester ability to reference via ODS code SHOULD be reported to the NHS England Genomic Unit for investigation).

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Organization UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
mainLocationI0..1Extension(Reference(Location))
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valuePeriodPeriod
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
activeS Σ ?!0..1boolean
typeΣ0..*CodeableConceptBinding
nameS Σ I0..1string
alias0..*string
telecomS I0..*ContactPoint
addressS I0..*Address
partOfΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
purpose0..1CodeableConceptBinding
name0..1HumanName
telecomI0..*ContactPoint
address0..1Address
endpointI0..*Reference(Endpoint)

Differential from Organization

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
mainLocationI0..1Extension(Reference(Location))
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valuePeriodPeriod
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
activeS Σ ?!0..1boolean
typeΣ0..*CodeableConceptBinding
nameS Σ I0..1string
alias0..*string
telecomS I0..*ContactPoint
addressS I0..*Address
partOfΣ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
purpose0..1CodeableConceptBinding
name0..1HumanName
telecomI0..*ContactPoint
address0..1Address
endpointI0..*Reference(Endpoint)

Organization
DefinitionA formally or informally recognized grouping of people or organizations formed for the purpose of achieving some form of collective action. Includes companies, institutions, corporations, departments, community groups, healthcare practice groups, payer/insurer, etc.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • org-1: The organization SHALL at least have a name or an identifier, and possibly more than one
    (identifier.count() + name.count()) > 0
Mappings
  • rim: Entity. Role, or Act
  • v2: (also see master files messages)
  • rim: Organization(classCode=ORG, determinerCode=INST)
  • servd: Organization
Organization.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Organization.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Organization.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Organization.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Organization.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Organization.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Organization.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.extension:mainLocation
DefinitionThe main location of the organisation.
Cardinality0...1
TypeExtension(Reference(Location))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.extension:organizationPeriod
DefinitionThe date range that this organization SHOULD be considered available.
Cardinality0...1
TypeExtension(Period)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.extension:organizationPeriod.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Organization.extension:organizationPeriod.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...0
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.extension:organizationPeriod.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/StructureDefinition/organization-period

Mappings
  • rim: N/A
Organization.extension:organizationPeriod.value[x]
DefinitionThe date range that this organization SHOULD be considered available.
Cardinality1...1
TypePeriod
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Organization.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.identifier
DefinitionIdentifier for the organization that is used to identify the organization across multiple disparate systems.
Cardinality0...*
TypeIdentifier
Must SupportTrue
SummaryTrue
Requirements

Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.

SlicingUnordered, Open, by system(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: XON.10 / XON.3
  • rim: .scopes[Role](classCode=IDENT)
  • servd: ./Identifiers
Organization.identifier:odsOrganisationCode
DefinitionIdentifier code supplier by the Organisation Data Service.
Cardinality0...1
TypeIdentifier
SummaryTrue
Requirements

Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: XON.10 / XON.3
  • rim: .scopes[Role](classCode=IDENT)
  • servd: ./Identifiers
Organization.identifier:odsOrganisationCode.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Organization.identifier:odsOrganisationCode.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.identifier:odsOrganisationCode.use
DefinitionThe purpose of this identifier.
Cardinality0...1
Typecode
Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)
ModifierTrue
SummaryTrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Role.code or implied by context
Organization.identifier:odsOrganisationCode.type
DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Cardinality0...1
TypeCodeableConcept
Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Identifier Type Codes (extensible)
SummaryTrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: CX.5
  • rim: Role.code or implied by context
Organization.identifier:odsOrganisationCode.system
DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique.
Cardinality1...1
Typeuri
SummaryTrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

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

https://fhir.nhs.uk/Id/ods-organization-code

Mappings
  • rim: n/a
  • v2: CX.4 / EI-2-4
  • rim: II.root or Role.id.root
  • servd: ./IdentifierType
Organization.identifier:odsOrganisationCode.value
DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system.
Cardinality1...1
Typestring
SummaryTrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

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

123456


Mappings
  • rim: n/a
  • v2: CX.1 / EI.1
  • rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
  • servd: ./Value
Organization.identifier:odsOrganisationCode.period
DefinitionTime period during which identifier is/was valid for use.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: CX.7 + CX.8
  • rim: Role.effectiveTime or implied by context
  • servd: ./StartDate and ./EndDate
Organization.identifier:odsOrganisationCode.assigner
DefinitionOrganization that issued/manages the identifier.
Cardinality0...1
TypeReference(Organization)
SummaryTrue
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: CX.4 / (CX.4,CX.9,CX.10)
  • rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
  • servd: ./IdentifierIssuingAuthority
Organization.identifier:odsSiteCode
DefinitionODS Site code to identify the organisation at site level.
Cardinality0...1
TypeIdentifier
SummaryTrue
Requirements

Organizations are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the organization.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: XON.10 / XON.3
  • rim: .scopes[Role](classCode=IDENT)
  • servd: ./Identifiers
Organization.identifier:odsSiteCode.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Organization.identifier:odsSiteCode.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.identifier:odsSiteCode.use
DefinitionThe purpose of this identifier.
Cardinality0...1
Typecode
Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)
ModifierTrue
SummaryTrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Role.code or implied by context
Organization.identifier:odsSiteCode.type
DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Cardinality0...1
TypeCodeableConcept
Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Identifier Type Codes (extensible)
SummaryTrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: CX.5
  • rim: Role.code or implied by context
Organization.identifier:odsSiteCode.system
DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique.
Cardinality1...1
Typeuri
SummaryTrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

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

https://fhir.nhs.uk/Id/ods-site-code

Mappings
  • rim: n/a
  • v2: CX.4 / EI-2-4
  • rim: II.root or Role.id.root
  • servd: ./IdentifierType
Organization.identifier:odsSiteCode.value
DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system.
Cardinality1...1
Typestring
SummaryTrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

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

123456


Mappings
  • rim: n/a
  • v2: CX.1 / EI.1
  • rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
  • servd: ./Value
Organization.identifier:odsSiteCode.period
DefinitionTime period during which identifier is/was valid for use.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: CX.7 + CX.8
  • rim: Role.effectiveTime or implied by context
  • servd: ./StartDate and ./EndDate
Organization.identifier:odsSiteCode.assigner
DefinitionOrganization that issued/manages the identifier.
Cardinality0...1
TypeReference(Organization)
SummaryTrue
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: CX.4 / (CX.4,CX.9,CX.10)
  • rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
  • servd: ./IdentifierIssuingAuthority
Organization.active
DefinitionWhether the organization's record is still in active use.
Cardinality0...1
Typeboolean
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Need a flag to indicate a record is no longer to be used and should generally be hidden for the user in the UI.

Comments

This active flag is not intended to be used to mark an organization as temporarily closed or under construction. Instead the Location(s) within the Organization should have the suspended status. If further details of the reason for the suspension are required, then an extension on this element should be used.

This element is labeled as a modifier because it may be used to mark that the resource was created in error.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • v2: No equivalent in HL7 v2
  • rim: .status
  • servd: ./Status (however this concept in ServD more covers why the organization is active or not, could be delisted, deregistered, not operational yet) this could alternatively be derived from ./StartDate and ./EndDate and given a context date.
Organization.type
DefinitionThe kind(s) of organization that this is.
Cardinality0...*
TypeCodeableConcept
Binding

A set of concepts indicating the organisation type, derived from the base CodeSystem, and Genomics specific concepts

UKCoreOrganizationType (extensible)
SummaryTrue
Requirements

Need to be able to track the kind of organization that this is - different organization types have different uses.

Comments

Organizations can be corporations, wards, sections, clinical teams, government departments, etc. Note that code is generally a classifier of the type of organization; in many applications, codes are used to identity a particular organization (say, ward) as opposed to another of the same type - these are identifiers, not codes

When considering if multiple types are appropriate, you should evaluate if child organizations would be a more appropriate use of the concept, as different types likely are in different sub-areas of the organization. This is most likely to be used where type values have orthogonal values, such as a religious, academic and medical center.

We expect that some jurisdictions will profile this optionality to be a single cardinality.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • v2: No equivalent in v2
  • rim: .code
  • servd: n/a
Organization.name
DefinitionA name associated with the organization.
Cardinality0...1
Typestring
Must SupportTrue
SummaryTrue
Requirements

Need to use the name as the label of the organization.

Comments

If the name of an organization changes, consider putting the old name in the alias column so that it can still be located through searches.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XON.1
  • rim: .name
  • servd: .PreferredName/Name
Organization.alias
DefinitionA list of alternate names that the organization is known as, or was known as in the past.
Cardinality0...*
Typestring
Requirements

Over time locations and organizations go through many changes and can be known by different names.

For searching knowing previous names that the organization was known by can be very useful.

Comments

There are no dates associated with the alias/historic names, as this is not intended to track when names were used, but to assist in searching so that older names can still result in identifying the organization.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .name
Organization.telecom
DefinitionA contact detail for the organization.
Cardinality0...*
TypeContactPoint
Must SupportTrue
Requirements

Human contact for the organization.

Comments

The use code 'home' is not to be used. Note that these contacts are not the contact details of people who are employed by or represent the organization, but official contacts for the organization itself.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
  • org-3: The telecom of an organization can never be of use 'home'
    where(use = 'home').empty()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • v2: ORC-22?
  • rim: .telecom
  • servd: ./ContactPoints
Organization.address
DefinitionAn address for the organization.
Cardinality0...*
TypeAddress
Must SupportTrue
Requirements

May need to keep track of the organization's addresses for contacting, billing or reporting requirements.

Comments

Organization may have multiple addresses with different uses or applicable periods. The use code 'home' is not to be used.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • org-2: An address of an organization can never be of use 'home'
    where(use = 'home').empty()
Mappings
  • rim: n/a
  • v2: XAD
  • rim: AD
  • servd: Address
  • v2: ORC-23?
  • rim: .address
  • servd: ./PrimaryAddress and ./OtherAddresses
Organization.partOf
DefinitionThe organization of which this organization forms a part.
Cardinality0...1
TypeReference(Organization)
SummaryTrue
Requirements

Need to be able to track the hierarchy of organizations within an organization.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: No equivalent in HL7 v2
  • rim: .playedBy[classCode=Part].scoper
  • servd: n/a
Organization.contact
DefinitionContact for the organization for a certain purpose.
Cardinality0...*
TypeBackboneElement
Requirements

Need to keep track of assigned contact points within bigger organization.

Comments

Where multiple contacts for the same purpose are provided there is a standard extension that can be used to determine which one is the preferred contact to use.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .contactParty
Organization.contact.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Organization.contact.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.contact.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Organization.contact.purpose
DefinitionIndicates a purpose for which the contact can be reached.
Cardinality0...1
TypeCodeableConcept
Binding

The purpose for which you would contact a contact party.

ContactEntityType (extensible)
Requirements

Need to distinguish between multiple contact persons.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: ./type
Organization.contact.name
DefinitionA name associated with the contact.
Cardinality0...1
TypeHumanName
Requirements

Need to be able to track the person by name.

Comments

Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: PID-5, PID-9
  • rim: ./name
Organization.contact.telecom
DefinitionA contact detail (e.g. a telephone number or an email address) by which the party may be contacted.
Cardinality0...*
TypeContactPoint
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • v2: PID-13, PID-14
  • rim: ./telecom
Organization.contact.address
DefinitionVisiting or postal addresses for the contact.
Cardinality0...1
TypeAddress
Requirements

May need to keep track of a contact party's address for contacting, billing or reporting requirements.

Comments

Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD
  • rim: AD
  • servd: Address
  • v2: PID-11
  • rim: ./addr
Organization.endpoint
DefinitionTechnical endpoints providing access to services operated for the organization.
Cardinality0...*
TypeReference(Endpoint)
Requirements

Organizations have multiple systems that provide various services and need to be able to define the technical connection details for how to connect to them, and for what purpose.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)


FHIRMDSHL7v2
Organization.nameRequestor - Organization name, Additional contact - Organization name, address and ODS codeORC-21
Organization.addressRequestor - Organization address, Additional contact - Organization addressORC-22
Organization.identifierRequestor - Organization ODS code, Additional contact - Organization ODS code, Patient - GP Practice ODS Code, Previous genomic report - Report performer organisation ODS code, Previous genomic report - Original requester organisation ODS code, Previous non genomic report - Report performer organisation ODS code, Previous non genomic report - Original requester organisation ODS codeORC-21.10, OBX-23.10
Organization.partOfPLCM activity - ODS code of commissioning regionN/A - not in scope for HL7v2

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Organization_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Organization-Genomics

Genomics-Patient

The focal resource for recording who a test order and genomic report are for.

It is expected that client's will need to post Patient resources to the central GMS as some demographic information specific to Genomics will not have been captured within other systems such as PDS.

For patients included within PDS, it is expected source systems SHOULD only send genomic specific information not recorded against PDS, e.g. birthSex, genomic specific identifiers and a link to the PDS record, as well as the NHS number identifier. (NOTE: examples provided for patient resources are fully expanded to illustrate how information should be structured but any infomation already recorded by PDS SHOULD NOT be duplicated within the genomic order management services). Querying patient demographic information, will be supported using the search parameters provided by the Genomic Order Management Service, whch will pass through parameters to PDS where demographics are stored against this system. Client systems will then be required to follow the PDS link within the Genomics-Patient record to retrieve the PDS patient.

It is a requirement on source systems that patient NHS numbers are traced and verified with PDS, if the patient is registered with PDS, before creation of patient resources on the Genomic Order Management broker

For patients not included on PDS, e.g. private/overseas patients or fetal records, the requester SHOULD send all information necessary to facilitate testing and interpretation of the request. Where this patient is later registered on PDS, identified through assignment of an NHS number, demographic details SHALL be stripped from the genomic record to avoid data duplication.

Alternatively, systems MAY opt to include pointers to the Patient resource on their local system, though the mechanism preferred by the NHS England Genomics Unit has yet to be decided.

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Patient UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueAddressAddress
birthSexI0..1Extension(CodeableConcept)
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueBooleanboolean
contactPreferenceI0..1Extension(Complex)
deathNotificationStatusI0..1Extension(Complex)
ethnicCategoryI0..1Extension(CodeableConcept)
fetalStatusI0..1Extension(code)
residentialStatusI0..1Extension(CodeableConcept)
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueBooleanboolean
nhsNumberUnavailableReasonI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
id0..1string
nhsNumberVerificationStatusI0..1Extension(CodeableConcept)
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
activeS Σ ?!0..1boolean
nameS Σ0..*HumanName
id0..1string
extensionI0..*Extension
id0..1string
otherContactSystemI0..1Extension(CodeableConcept)
value0..1System.String
valueΣ0..1string
useΣ ?!0..1codeBinding
rankΣ0..1positiveInt
periodΣ I0..1Period
genderS Σ0..1codeBinding
id0..1string
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueDateTimedateTime
value0..1System.Date
deceasedBooleanboolean
deceasedDateTimedateTime
id0..1string
addressKeyI0..*Extension(Complex)
useΣ ?!0..1codeBinding
typeΣ0..1codeBinding
textΣ0..1string
lineΣ0..*string
cityΣ0..1string
districtΣ0..1string
stateΣ0..1string
postalCodeΣ0..1string
countryΣ0..1string
periodΣ I0..1Period
maritalStatus0..1CodeableConceptBinding
multipleBirthBooleanboolean
multipleBirthIntegerinteger
photoI0..*Attachment
id0..1string
contactRankI0..1Extension(positiveInt)
copyCorrespondenceIndicatorI0..1Extension(boolean)
modifierExtensionΣ ?! I0..*Extension
relationship0..*CodeableConceptBinding
name0..1HumanName
id0..1string
extensionI0..*Extension
id0..1string
otherContactSystemI0..1Extension(CodeableConcept)
value0..1System.String
valueΣ0..1string
useΣ ?!0..1codeBinding
rankΣ0..1positiveInt
periodΣ I0..1Period
address0..1Address
gender0..1codeBinding
organizationI0..1Reference(Organization)
periodI0..1Period
id0..1string
id0..1string
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueCodingCoding
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueCodingCoding
url1..1uriFixed Value
modifierExtensionΣ ?! I0..*Extension
language1..1CodeableConceptBinding
preferred0..1boolean
generalPractitionerI0..*Reference(Organization | Practitioner | PractitionerRole)
managingOrganizationS Σ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
otherΣ I1..1Reference(Patient | RelatedPerson)
typeΣ1..1codeBinding

Differential from Patient

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueAddressAddress
birthSexI0..1Extension(CodeableConcept)
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueBooleanboolean
contactPreferenceI0..1Extension(Complex)
deathNotificationStatusI0..1Extension(Complex)
ethnicCategoryI0..1Extension(CodeableConcept)
fetalStatusI0..1Extension(code)
residentialStatusI0..1Extension(CodeableConcept)
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueBooleanboolean
nhsNumberUnavailableReasonI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
id0..1string
nhsNumberVerificationStatusI0..1Extension(CodeableConcept)
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
activeS Σ ?!0..1boolean
nameS Σ0..*HumanName
id0..1string
extensionI0..*Extension
id0..1string
otherContactSystemI0..1Extension(CodeableConcept)
value0..1System.String
valueΣ0..1string
useΣ ?!0..1codeBinding
rankΣ0..1positiveInt
periodΣ I0..1Period
genderS Σ0..1codeBinding
id0..1string
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueDateTimedateTime
value0..1System.Date
deceasedBooleanboolean
deceasedDateTimedateTime
id0..1string
addressKeyI0..*Extension(Complex)
useΣ ?!0..1codeBinding
typeΣ0..1codeBinding
textΣ0..1string
lineΣ0..*string
cityΣ0..1string
districtΣ0..1string
stateΣ0..1string
postalCodeΣ0..1string
countryΣ0..1string
periodΣ I0..1Period
maritalStatus0..1CodeableConceptBinding
multipleBirthBooleanboolean
multipleBirthIntegerinteger
photoI0..*Attachment
id0..1string
contactRankI0..1Extension(positiveInt)
copyCorrespondenceIndicatorI0..1Extension(boolean)
modifierExtensionΣ ?! I0..*Extension
relationship0..*CodeableConceptBinding
name0..1HumanName
id0..1string
extensionI0..*Extension
id0..1string
otherContactSystemI0..1Extension(CodeableConcept)
value0..1System.String
valueΣ0..1string
useΣ ?!0..1codeBinding
rankΣ0..1positiveInt
periodΣ I0..1Period
address0..1Address
gender0..1codeBinding
organizationI0..1Reference(Organization)
periodI0..1Period
id0..1string
id0..1string
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueCodingCoding
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueCodingCoding
url1..1uriFixed Value
modifierExtensionΣ ?! I0..*Extension
language1..1CodeableConceptBinding
preferred0..1boolean
generalPractitionerI0..*Reference(Organization | Practitioner | PractitionerRole)
managingOrganizationS Σ I0..1Reference(Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
otherΣ I1..1Reference(Patient | RelatedPerson)
typeΣ1..1codeBinding

Patient
DefinitionDemographics and other administrative information about an individual or animal receiving care or other health-related services.
Cardinality0...*
AliasSubjectOfCare Client Resident
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • rim: Patient[classCode=PAT]
  • cda: ClinicalDocument.recordTarget.patientRole
Patient.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Patient.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Patient.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Patient.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Patient.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Patient.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:birthPlace
DefinitionThe registered place of birth of the patient.
Cardinality0...1
TypeExtension(Address)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:birthPlace.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.extension:birthPlace.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...0
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:birthPlace.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/StructureDefinition/patient-birthPlace

Mappings
  • rim: N/A
Patient.extension:birthPlace.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
TypeAddress
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:birthSex
DefinitionThe patient's phenotypic sex at birth.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:cadavericDonor
DefinitionFlag indicating whether the patient authorized the donation of body parts after death.
Cardinality0...1
TypeExtension(boolean)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:cadavericDonor.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.extension:cadavericDonor.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...0
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:cadavericDonor.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/StructureDefinition/patient-cadavericDonor

Mappings
  • rim: N/A
Patient.extension:cadavericDonor.value[x]
DefinitionFlag indicating whether the patient authorized the donation of body parts after death.
Cardinality1...1
Typeboolean
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:contactPreference
DefinitionThe preferred method of contact, contact times and written communication format given by a Patient or Related Person.
Cardinality0...1
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:deathNotificationStatus
DefinitionThe patient's death notification status.
Cardinality0...1
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:ethnicCategory
DefinitionThe ethnicity of the subject.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:fetalStatus
DefinitionTypically used in maternity where the patient record may be created before the birth of the baby.
Cardinality0...1
TypeExtension(code)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:residentialStatus
DefinitionThe residential status of the patient. For example if this patient is a UK resident.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:patientInterpreterRequired
DefinitionThis Patient requires an interpreter to communicate healthcare information to the practitioner.
Cardinality0...1
TypeExtension(boolean)
Aliasextensions, user content
Comments

The Patient does not speak the default language of the organization, and hence requires an interpreter. If the patient has other languages in the Communications list, then that would be the type of interpreter required.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:patientInterpreterRequired.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.extension:patientInterpreterRequired.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...0
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:patientInterpreterRequired.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/StructureDefinition/patient-interpreterRequired

Mappings
  • rim: N/A
Patient.extension:patientInterpreterRequired.value[x]
DefinitionIndicator showing if this Patient requires an interpreter to communicate healthcare information to the practitioner.
Cardinality1...1
Typeboolean
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.extension:nhsNumberUnavailableReason
DefinitionThe reason why a patient does not have an NHS Number. For example if this patient is an overseas patient.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.identifier
DefinitionAn identifier for this patient.
Cardinality0...*
TypeIdentifier
Must SupportTrue
SummaryTrue
Requirements

Patients are almost always assigned specific numerical identifiers.

SlicingUnordered, Open, by system(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: PID-3
  • rim: id
  • cda: .id
Patient.identifier:nhsNumber
DefinitionAn identifier for this patient.
Cardinality0...1
TypeIdentifier
SummaryTrue
Requirements

Patients are almost always assigned specific numerical identifiers.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: PID-3
  • rim: id
  • cda: .id
Patient.identifier:nhsNumber.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.identifier:nhsNumber.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.identifier:nhsNumber.extension:nhsNumberVerificationStatus
DefinitionThe verification/tracing status of the NHS number.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.identifier:nhsNumber.use
DefinitionThe purpose of this identifier.
Cardinality0...1
Typecode
Binding

Identifies the purpose for this identifier, if known .

IdentifierUse (required)
ModifierTrue
SummaryTrue
Requirements

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Comments

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Role.code or implied by context
Patient.identifier:nhsNumber.type
DefinitionA coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
Cardinality0...1
TypeCodeableConcept
Binding

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Identifier Type Codes (extensible)
SummaryTrue
Requirements

Allows users to make use of identifiers when the identifier system is not known.

Comments

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: CX.5
  • rim: Role.code or implied by context
Patient.identifier:nhsNumber.system
DefinitionEstablishes the namespace for the value - that is, a URL that describes a set values that are unique.
Cardinality1...1
Typeuri
SummaryTrue
Requirements

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Comments

Identifier.system is always case sensitive.

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

https://fhir.nhs.uk/Id/nhs-number

Mappings
  • rim: n/a
  • v2: CX.4 / EI-2-4
  • rim: II.root or Role.id.root
  • servd: ./IdentifierType
Patient.identifier:nhsNumber.value
DefinitionThe portion of the identifier typically relevant to the user and which is unique within the context of the system.
Cardinality1...1
Typestring
SummaryTrue
Comments

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

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

123456


Mappings
  • rim: n/a
  • v2: CX.1 / EI.1
  • rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
  • servd: ./Value
Patient.identifier:nhsNumber.period
DefinitionTime period during which identifier is/was valid for use.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: CX.7 + CX.8
  • rim: Role.effectiveTime or implied by context
  • servd: ./StartDate and ./EndDate
Patient.identifier:nhsNumber.assigner
DefinitionOrganization that issued/manages the identifier.
Cardinality0...1
TypeReference(Organization)
SummaryTrue
Comments

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: CX.4 / (CX.4,CX.9,CX.10)
  • rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
  • servd: ./IdentifierIssuingAuthority
Patient.active
DefinitionWhether this patient record is in active use. Many systems use this property to mark as non-current patients, such as those that have not been seen for a period of time based on an organization's business rules. It is often used to filter patient lists to exclude inactive patients Deceased patients may also be marked as inactive for the same reasons, but may be active for some time after death.
Cardinality0...1
Typeboolean
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Need to be able to mark a patient record as not to be used because it was created in error.

Comments

If a record is inactive, and linked to an active record, then future patient/record updates should occur on the other patient.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • rim: statusCode
  • cda: n/a
Patient.name
DefinitionA name associated with the individual.
Cardinality0...*
TypeHumanName
Must SupportTrue
SummaryTrue
Requirements

Need to be able to track the patient by multiple names. Examples are your official name and a partner name.

Comments

A patient may have multiple names with different uses or applicable periods. For animals, the name is a "HumanName" in the sense that is assigned and used by humans and has the same patterns.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: PID-5, PID-9
  • rim: name
  • cda: .patient.name
Patient.telecom
DefinitionA contact detail (e.g. a telephone number or an email address) by which the individual may be contacted.
Cardinality0...*
TypeContactPoint
Must SupportTrue
SummaryTrue
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Comments

A Patient may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and also to help with identification. The address might not go directly to the individual, but may reach another party that is able to proxy for the patient (i.e. home phone, or pet owner's phone).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • v2: PID-13, PID-14, PID-40
  • rim: telecom
  • cda: .telecom
Patient.telecom.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.telecom.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.telecom.system
DefinitionTelecommunications form for contact point - what communications system is required to make use of the contact.
Cardinality0...1
Typecode
Binding

Telecommunications form for contact point.

ContactPointSystem (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.3
  • rim: ./scheme
  • servd: ./ContactPointType
Patient.telecom.system.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.telecom.system.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.telecom.system.extension:otherContactSystem
DefinitionOther contact system value which extends the system element in the ContactPoint datatype.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.telecom.system.value
DefinitionPrimitive value for code
Cardinality0...1
TypeSystem.String
Patient.telecom.value
DefinitionThe actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).
Cardinality0...1
Typestring
SummaryTrue
Requirements

Need to support legacy numbers that are not in a tightly controlled format.

Comments

Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.1 (or XTN.12)
  • rim: ./url
  • servd: ./Value
Patient.telecom.use
DefinitionIdentifies the purpose for the contact point.
Cardinality0...1
Typecode
Binding

Use of contact point.

ContactPointUse (required)
ModifierTrue
SummaryTrue
Requirements

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

Comments

Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.2 - but often indicated by field
  • rim: unique(./use)
  • servd: ./ContactPointPurpose
Patient.telecom.rank
DefinitionSpecifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Cardinality0...1
TypepositiveInt
SummaryTrue
Comments

Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: n/a
Patient.telecom.period
DefinitionTime period when the contact point was/is in use.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: N/A
  • rim: ./usablePeriod[type="IVL<TS>"]
  • servd: ./StartDate and ./EndDate
Patient.gender
DefinitionAdministrative Gender - the gender that the patient is considered to have for administration and record keeping purposes.
Cardinality0...1
Typecode
Binding

The gender of a person used for administrative purposes.

AdministrativeGender (required)
Must SupportTrue
SummaryTrue
Requirements

Needed for identification of the individual, in combination with (at least) name and birth date.

Comments

The gender might not match the biological sex as determined by genetics or the individual's preferred identification. Note that for both humans and particularly animals, there are other legitimate possibilities than male and female, though the vast majority of systems and contexts only support male and female. Systems providing decision support or enforcing business rules should ideally do this on the basis of Observations dealing with the specific sex or gender aspect of interest (anatomical, chromosomal, social, etc.) However, because these observations are infrequently recorded, defaulting to the administrative gender is common practice. Where such defaulting occurs, rule enforcement should allow for the variation between administrative and biological, chromosomal and other gender aspects. For example, an alert about a hysterectomy on a male should be handled as a warning or overridable error, not a "hard" error. See the Patient Gender and Sex section for additional information about communicating patient gender and sex.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-8
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender
  • cda: .patient.administrativeGenderCode
Patient.birthDate
DefinitionThe date of birth for the individual.
Cardinality0...1
Typedate
Must SupportTrue
SummaryTrue
Requirements

Age of the individual drives many clinical processes.

Comments

At least an estimated year should be provided as a guess if the real DOB is unknown There is a standard extension "patient-birthTime" available that should be used where Time is required (such as in maternity/infant care systems).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-7
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/birthTime
  • cda: .patient.birthTime
  • loinc: 21112-8
Patient.birthDate.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.birthDate.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.birthDate.extension:birthTime
DefinitionThe time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively.
Cardinality0...1
TypeExtension(dateTime)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.birthDate.extension:birthTime.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.birthDate.extension:birthTime.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...0
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.birthDate.extension:birthTime.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/StructureDefinition/patient-birthTime

Mappings
  • rim: N/A
Patient.birthDate.extension:birthTime.value[x]
DefinitionThe time of day that the patient was born. This includes the date to ensure that the timezone information can be communicated effectively.
Cardinality1...1
TypedateTime
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.birthDate.value
DefinitionPrimitive value for date
Cardinality0...1
TypeSystem.Date
Patient.deceased[x]
DefinitionIndicates if the individual is deceased or not.
Cardinality0...1
Typeboolean
ModifierTrue
SummaryTrue
Requirements

The fact that a patient is deceased influences the clinical process. Also, in human communication and relation management it is necessary to know whether the person is alive.

Comments

If there's no value in the instance, it means there is no statement on whether or not the individual is deceased. Most systems will interpret the absence of a value as a sign of the person being alive.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-30 (bool) and PID-29 (datetime)
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/deceasedTime
  • cda: n/a
Patient.address
DefinitionAn address for the individual.
Cardinality0...*
TypeAddress
Must SupportTrue
SummaryTrue
Requirements

May need to keep track of patient addresses for contacting, billing or reporting requirements and also to help with identification.

Comments

Patient may have multiple addresses with different uses or applicable periods.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD
  • rim: AD
  • servd: Address
  • v2: PID-11
  • rim: addr
  • cda: .addr
Patient.address.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.address.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.address.extension:addressKey
DefinitionA patient's address key and type.
Cardinality0...*
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.address.use
DefinitionThe purpose of this address.
Cardinality0...1
Typecode
Binding

The use of an address.

AddressUse (required)
ModifierTrue
SummaryTrue
Requirements

Allows an appropriate address to be chosen from a list of many.

Comments

Applications can assume that an address is current unless it explicitly says that it is temporary or old.

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

home


Mappings
  • rim: n/a
  • v2: XAD.7
  • rim: unique(./use)
  • servd: ./AddressPurpose
Patient.address.type
DefinitionDistinguishes between physical addresses (those you can visit) and mailing addresses (e.g. PO Boxes and care-of addresses). Most addresses are both.
Cardinality0...1
Typecode
Binding

The type of an address (physical / postal).

AddressType (required)
SummaryTrue
Comments

The definition of Address states that "address is intended to describe postal addresses, not physical locations". However, many applications track whether an address has a dual purpose of being a location that can be visited as well as being a valid delivery destination, and Postal addresses are often used as proxies for physical locations (also see the Location resource).

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

both


Mappings
  • rim: n/a
  • v2: XAD.18
  • rim: unique(./use)
  • vcard: address type parameter
Patient.address.text
DefinitionSpecifies the entire address as it should be displayed e.g. on a postal label. This may be provided instead of or as well as the specific parts.
Cardinality0...1
Typestring
SummaryTrue
Requirements

A renderable, unencoded form.

Comments

Can provide both a text representation and parts. Applications updating an address SHALL ensure that when both text and parts are present, no content is included in the text that isn't found in a part.

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

137 Nowhere Street, Erewhon 9132


Mappings
  • rim: n/a
  • v2: XAD.1 + XAD.2 + XAD.3 + XAD.4 + XAD.5 + XAD.6
  • rim: ./formatted
  • vcard: address label parameter
Patient.address.line
DefinitionThis component contains the house number, apartment number, street name, street direction, P.O. Box number, delivery hints, and similar address information.
Cardinality0...*
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

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

137 Nowhere Street


Mappings
  • rim: n/a
  • v2: XAD.1 + XAD.2 (note: XAD.1 and XAD.2 have different meanings for a company address than for a person address)
  • rim: AD.part[parttype = AL]
  • vcard: street
  • servd: ./StreetAddress (newline delimitted)
Patient.address.city
DefinitionThe name of the city, town, suburb, village or other community or delivery center.
Cardinality0...1
Typestring
SummaryTrue
AliasMunicpality
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

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

Erewhon


Mappings
  • rim: n/a
  • v2: XAD.3
  • rim: AD.part[parttype = CTY]
  • vcard: locality
  • servd: ./Jurisdiction
Patient.address.district
DefinitionThe name of the administrative area (county).
Cardinality0...1
Typestring
SummaryTrue
AliasCounty
Comments

District is sometimes known as county, but in some regions 'county' is used in place of city (municipality), so county name should be conveyed in city instead.

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

Madison


Mappings
  • rim: n/a
  • v2: XAD.9
  • rim: AD.part[parttype = CNT | CPA]
Patient.address.state
DefinitionSub-unit of a country with limited sovereignty in a federally organized country. A code may be used if codes are in common use (e.g. US 2 letter state codes).
Cardinality0...1
Typestring
SummaryTrue
AliasProvince, Territory
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD.4
  • rim: AD.part[parttype = STA]
  • vcard: region
  • servd: ./Region
Patient.address.postalCode
DefinitionA postal code designating a region defined by the postal service.
Cardinality0...1
Typestring
SummaryTrue
AliasZip
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

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

9132


Mappings
  • rim: n/a
  • v2: XAD.5
  • rim: AD.part[parttype = ZIP]
  • vcard: code
  • servd: ./PostalIdentificationCode
Patient.address.country
DefinitionCountry - a nation as commonly understood or generally accepted.
Cardinality0...1
Typestring
SummaryTrue
Comments

ISO 3166 3 letter codes can be used in place of a human readable country name.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD.6
  • rim: AD.part[parttype = CNT]
  • vcard: country
  • servd: ./Country
Patient.address.period
DefinitionTime period when address was/is in use.
Cardinality0...1
TypePeriod
SummaryTrue
Requirements

Allows addresses to be placed in historical context.

Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Examples
General

{
  "start": "2010-03-23",
  "end": "2010-07-01"
}


Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: XAD.12 / XAD.13 + XAD.14
  • rim: ./usablePeriod[type="IVL<TS>"]
  • servd: ./StartDate and ./EndDate
Patient.maritalStatus
DefinitionThis field contains a patient's most recent marital (civil) status.
Cardinality0...1
TypeCodeableConcept
Binding

An indicator to identify the legal marital status of a person

UKCorePersonMaritalStatusCode (extensible)
Requirements

Most, if not all systems capture it.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: PID-16
  • rim: player[classCode=PSN]/maritalStatusCode
  • cda: .patient.maritalStatusCode
Patient.multipleBirth[x]
DefinitionIndicates whether the patient is part of a multiple (boolean) or indicates the actual birth order (integer).
Cardinality0...1
Typeboolean
Requirements

For disambiguation of multiple-birth children, especially relevant where the care provider doesn't meet the patient, such as labs.

Comments

Where the valueInteger is provided, the number is the birth number in the sequence. E.g. The middle birth in triplets would be valueInteger=2 and the third born would have valueInteger=3 If a boolean value was provided for this triplets example, then all 3 patient records would have valueBoolean=true (the ordering is not indicated).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-24 (bool), PID-25 (integer)
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthInd, player[classCode=PSN|ANM and determinerCode=INSTANCE]/multipleBirthOrderNumber
  • cda: n/a
Patient.photo
DefinitionImage of the patient.
Cardinality0...*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of the patient. Fits with newer social media usage too.

Comments

Guidelines:

  • Use id photos, not clinical photos.
  • Limit dimensions to thumbnail.
  • Keep byte count low to ease resource updates.
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • att-1: If the Attachment has data, it SHALL have a contentType
    data.empty() or contentType.exists()
Mappings
  • rim: n/a
  • v2: ED/RP
  • rim: ED
  • v2: OBX-5 - needs a profile
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/desc
  • cda: n/a
Patient.contact
DefinitionA contact party (e.g. guardian, partner, friend) for the patient.
Cardinality0...*
TypeBackboneElement
Requirements

Need to track people you can contact about the patient.

Comments

Contact covers all kinds of contact parties: family members, business contacts, guardians, caregivers. Not applicable to register pedigree and family ties beyond use of having contact.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • pat-1: SHALL at least contain a contact's details or a reference to an organization
    name.exists() or telecom.exists() or address.exists() or organization.exists()
Mappings
  • rim: n/a
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/scopedRole[classCode=CON]
  • cda: n/a
Patient.contact.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.contact.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.extension:contactRank
DefinitionThe preferred ranking or order of contact applied to a contact on a patient's contact list.
Cardinality0...1
TypeExtension(positiveInt)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.extension:copyCorrespondenceIndicator
DefinitionExtension carrying a boolean indicator showing that a patient's contact or related person SHALL be copied in to patient correspondence.
Cardinality0...1
TypeExtension(boolean)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.relationship
DefinitionThe nature of the relationship between the patient and the contact person.
Cardinality0...*
TypeCodeableConcept
Binding

The nature of the relationship between a patient and a contact person for that patient.

UKCorePersonRelationshipType (extensible)
Requirements

Used to determine which contact person is the most relevant to approach, depending on circumstances.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: NK1-7, NK1-3
  • rim: code
  • cda: n/a
Patient.contact.name
DefinitionA name associated with the contact person.
Cardinality0...1
TypeHumanName
Requirements

Contact persons need to be identified by name, but it is uncommon to need details about multiple other names for that contact person.

Comments

Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: NK1-2
  • rim: name
  • cda: n/a
Patient.contact.telecom
DefinitionA contact detail for the person, e.g. a telephone number or an email address.
Cardinality0...*
TypeContactPoint
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Comments

Contact may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • v2: NK1-5, NK1-6, NK1-40
  • rim: telecom
  • cda: n/a
Patient.contact.telecom.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.contact.telecom.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.telecom.system
DefinitionTelecommunications form for contact point - what communications system is required to make use of the contact.
Cardinality0...1
Typecode
Binding

Telecommunications form for contact point.

ContactPointSystem (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.3
  • rim: ./scheme
  • servd: ./ContactPointType
Patient.contact.telecom.system.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.contact.telecom.system.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.telecom.system.extension:otherContactSystem
DefinitionOther contact system value which extends the system element in the ContactPoint datatype.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.contact.telecom.system.value
DefinitionPrimitive value for code
Cardinality0...1
TypeSystem.String
Patient.contact.telecom.value
DefinitionThe actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).
Cardinality0...1
Typestring
SummaryTrue
Requirements

Need to support legacy numbers that are not in a tightly controlled format.

Comments

Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.1 (or XTN.12)
  • rim: ./url
  • servd: ./Value
Patient.contact.telecom.use
DefinitionIdentifies the purpose for the contact point.
Cardinality0...1
Typecode
Binding

Use of contact point.

ContactPointUse (required)
ModifierTrue
SummaryTrue
Requirements

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

Comments

Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.2 - but often indicated by field
  • rim: unique(./use)
  • servd: ./ContactPointPurpose
Patient.contact.telecom.rank
DefinitionSpecifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Cardinality0...1
TypepositiveInt
SummaryTrue
Comments

Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: n/a
Patient.contact.telecom.period
DefinitionTime period when the contact point was/is in use.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: N/A
  • rim: ./usablePeriod[type="IVL<TS>"]
  • servd: ./StartDate and ./EndDate
Patient.contact.address
DefinitionAddress for the contact person.
Cardinality0...1
TypeAddress
Requirements

Need to keep track where the contact person can be contacted per postal mail or visited.

Comments

Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD
  • rim: AD
  • servd: Address
  • v2: NK1-4
  • rim: addr
  • cda: n/a
Patient.contact.gender
DefinitionAdministrative Gender - the gender that the contact person is considered to have for administration and record keeping purposes.
Cardinality0...1
Typecode
Binding

The gender of a person used for administrative purposes.

AdministrativeGender (required)
Requirements

Needed to address the person correctly.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: NK1-15
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/administrativeGender
  • cda: n/a
Patient.contact.organization
DefinitionOrganization on behalf of which the contact is acting or for which the contact is working.
Cardinality0...1
TypeReference(Organization)
Requirements

For guardians or business related contacts, the organization is relevant.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: NK1-13, NK1-30, NK1-31, NK1-32, NK1-41
  • rim: scoper
  • cda: n/a
Patient.contact.period
DefinitionThe period during which this contact person or organization is valid to be contacted relating to this patient.
Cardinality0...1
TypePeriod
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • rim: effectiveTime
  • cda: n/a
Patient.communication
DefinitionA language which may be used to communicate with the patient about his or her health.
Cardinality0...*
TypeBackboneElement
Requirements

If a patient does not speak the local language, interpreters may be required, so languages spoken and proficiency are important things to keep track of both for patient and other persons of interest.

Comments

If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple Patient.Communication associations. For animals, language is not a relevant field, and should be absent from the instance. If the Patient does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: LanguageCommunication
  • cda: patient.languageCommunication
Patient.communication.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.communication.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency
DefinitionProficiency level of the communication.
Cardinality0...1
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.communication.extension:proficiency.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency.extension:level
DefinitionHow well the patient can communicate this communication (good, poor, etc.).
Cardinality0...1
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency.extension:level.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.communication.extension:proficiency.extension:level.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...0
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency.extension:level.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

level

Mappings
  • rim: N/A
Patient.communication.extension:proficiency.extension:level.value[x]
DefinitionThe proficiency level for the communication.
Cardinality1...1
TypeCoding
Binding

The proficiency level for the communication.

v3.LanguageAbilityProficiency (preferred)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency.extension:type
DefinitionWhat type of communication for the proficiency (spoken, written, etc.).
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency.extension:type.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.communication.extension:proficiency.extension:type.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...0
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency.extension:type.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

type

Mappings
  • rim: N/A
Patient.communication.extension:proficiency.extension:type.value[x]
DefinitionThe proficiency type for the communication.
Cardinality1...1
TypeCoding
Binding

The proficiency type for the communication.

v3.LanguageAbilityMode (preferred)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.extension:proficiency.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/StructureDefinition/patient-proficiency

Mappings
  • rim: N/A
Patient.communication.extension:proficiency.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality0...0
Typebase64Binary
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.communication.language
DefinitionA ValueSet that identifies the language used by a person.
Cardinality1...1
TypeCodeableConcept
Binding

A ValueSet that identifies the language used by a person.

AllLanguages (required)
Requirements

Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

Comments

The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: PID-15, LAN-2
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code
  • cda: .languageCode
Patient.communication.preferred
DefinitionIndicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Cardinality0...1
Typeboolean
Requirements

People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

Comments

This language is specifically identified for communicating healthcare information.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: PID-15
  • rim: preferenceInd
  • cda: .preferenceInd
Patient.generalPractitioner
DefinitionPatient's nominated care provider.
Cardinality0...*
TypeReference(Organization | Practitioner | PractitionerRole)
AliascareProvider
Comments

This may be the primary care provider (in a GP context), or it may be a patient nominated care manager in a community/disability setting, or even organization that will provide people to perform the care provider roles. It is not to be used to record Care Teams, these should be in a CareTeam resource that may be linked to the CarePlan or EpisodeOfCare resources. Multiple GPs may be recorded against the patient for various reasons, such as a student that has his home GP listed along with the GP at university during the school semesters, or a "fly-in/fly-out" worker that has the onsite GP also included with his home GP to remain aware of medical issues.

Jurisdictions may decide that they can profile this down to 1 if desired, or 1 per type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: PD1-4
  • rim: subjectOf.CareEvent.performer.AssignedEntity
  • cda: n/a
Patient.managingOrganization
DefinitionOrganization that is the custodian of the patient record.
Cardinality0...1
TypeReference(Organization)
Must SupportTrue
SummaryTrue
Requirements

Need to know who recognizes this patient record, manages and updates it.

Comments

There is only one managing organization for a specific patient record. Other organizations will have their own Patient record, and may use the Link property to join the records together (or a Person resource which can include confidence ratings for the association).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: scoper
  • cda: .providerOrganization
Patient.link
DefinitionLink to another patient resource that concerns the same actual patient.
Cardinality0...*
TypeBackboneElement
ModifierTrue
SummaryTrue
Requirements

There are multiple use cases:

  • Duplicate patient records due to the clerical errors associated with the difficulties of identifying humans consistently, and
  • Distribution of patient information across multiple servers.
Comments

There is no assumption that linked patient records have mutual links.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: outboundLink
  • cda: n/a
Patient.link.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Patient.link.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.link.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Patient.link.other
DefinitionThe other patient resource that the link refers to.
Cardinality1...1
TypeReference(Patient | RelatedPerson)
SummaryTrue
Comments

Referencing a RelatedPerson here removes the need to use a Person record to associate a Patient and RelatedPerson as the same individual.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: PID-3, MRG-1
  • rim: id
  • cda: n/a
Patient.link.type
DefinitionThe type of link between this patient resource and another patient resource.
Cardinality1...1
Typecode
Binding

The type of link between this patient resource and another patient resource.

LinkType (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: typeCode
  • cda: n/a


FHIRMDSHL7v2
Patient.identifierPatient - NHS number, Patient - Local identifier, Patient - Pedigree/Family Identifier, Fetus - Local identifier, Previous genomic report - Patient's NHS number, Previous genomic report - Patient's alternative identifier, Previous genomic report - Patient's clinical genetics number, Previous genomic report - Patient's pedigree numberPID-3
Patient.extension:nhsNumberUnavailableReasonPatient - Reason for unavailable NHS number, Patient - Withheld identity reasonN/A, could use PID-32 as surrogate
Patient.name.prefixPatient - TitlePID-5.5
Patient.name.givenPatient - First name, Previous genomic report - Patient's first namePID-5.2
Patient.name.familyPatient - Surname, Previous genomic report - Patient's surnamePID-5.1
Patient.birthDatePatient - Date of birth, PLCM activity - Patient age at activity date, Previous genomic report - Patient's date of birthPID-7, Age derived from the difference between PID-7 and TQ1-7 for the relevant activity
Patient.addressPatient - Address, Previous genomic report - Patient's addressPID-11
Patient.address.postalCodePatient - Postcode, Previous genomic report - Patient's post codePID-11.5
Patient.address.countryPatient - Country, Previous genomic report - Patient's countryPID-11.6
Patient.deceasedBooleanPatient - Life status at time of requestPID-30
Patient.deceasedDateTimePatient - Date of deathPID-29
Patient.extension:EthnicCategoryPatient - EthnicityPID-22
Patient.extension:birthSexPatient - Sex assigned at birthPID-8
Patient.extension:patient-genderIdentityPatient - Gender IdentityN/A - not part of the HL7v2 standard, though PID-8 or an OBX segment could be used
Patient.generalPractitionerPatient - GP Practice ODS Code, Patient - GP full name, Patient - GP GMC numberPD1-4
Patient.genderFetus - Observed sexPID-8

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Patient_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Patient-Genomics

Additional Guidance

extension:UKCore-birthSex

Extension used for recording the phenotypic sex of the patient, as recorded at birth.

    {
      "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BirthSex",
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v3-AdministrativeGender",
            "code": "M",
            "display": "Male"
          }
        ]
      }
    }

identifier

SHALL be present for Patients within the Genomic Order Management ecosystem. It is preferred that all patients with an NHS number have this included within the Patient resource upon submission of a test order. Patient who do not have an NHS number SHOULD have a temporary one registered/assigned with PDS.

For patient records where the NHS number has been traced from PDS, the trace status SHOULD be provided within the NHS Number identifier slice.

Additional identifiers SHOULD include an appropriate naming system scheme which clearly identifies the assigner (to disambiguate the identifier from other resources where these are not nationally unique). Alternatively, the OID for local identifier MAY be used, with the 'assigner' organization explicitly referenced.

"identifier":  [
        {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307946",
            "extension":  [
                {
                    "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-NHSNumberVerificationStatus",
                    "valueCodeableConcept": {
                        "coding":  [
                            {
                                "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-NHSNumberVerificationStatusEngland",
                                "version": "2.2.0",
                                "code": "01",
                                "display": "Number present and verified"
                            }
                        ]
                    }
                }
            ]
        },
        {
            "system": "urn:oid:2.16.840.1.113883.2.1.3.2.4.18.24",
            "value": "RWT14789",
            "assigner": {
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                    "value": "RAX01"
                }
            }
        }
    ],

generalPractitioner

Where patients are registered with a General Practitioner within the UK, both the ODS code for the practice and GMP number for the practitioner SHOULD be provided, where known, as separate objects within the generalPractitioner array.

"generalPractitioner":  [
        {
            "identifier": {
                "system": "https://fhir.hl7.org.uk/Id/gmp-number",
                "value": "G9999999"
            },
            "display": "Dr. Aero Smith"
        },
        {
            "identifier": {
                "system": "https://fhir.hl7.org.uk/Id/ODS-code",
                "value": "AP123"
            },
            "display": "anywhere place"
        }
    ],

For patient records where additional information exists elsewhere, for example, within PDS or the source system EHR, this MAY be referenced through the link field, specifying the url through which the related patient information can be accessed.

"link":  [
        {
            "other": {
                "reference": "https://api.service.nhs.uk/personal-demographics/FHIR/R4/Patient/9449307946"
            },
            "type": "seealso"
        }
    ]

Genomics-Practitioner

Practitioner is not expected to be sent within Test Order or other interactions with the central GMS. Instead, client systems SHOULD strive to reference practitioners via their identifier within a national coding system and display name only.

The below profile is provided for information, if referencing by identifier is intractable (though repeated issues with requester ability to reference via identifier/code SHOULD be reported to the NHS England Genomic Unit for investigation).

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Practitioner UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierS Σ0..*Identifier
activeΣ0..1boolean
nameS Σ0..*HumanName
telecomS Σ I0..*ContactPoint
addressΣ0..*Address
genderΣ0..1codeBinding
birthDateΣ0..1date
photoI0..*Attachment
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
identifier0..*Identifier
code1..1CodeableConcept
periodI0..1Period
issuerI0..1Reference(Organization)
communication0..*CodeableConceptBinding

Differential from Practitioner

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierS Σ0..*Identifier
activeΣ0..1boolean
nameS Σ0..*HumanName
telecomS Σ I0..*ContactPoint
addressΣ0..*Address
genderΣ0..1codeBinding
birthDateΣ0..1date
photoI0..*Attachment
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
identifier0..*Identifier
code1..1CodeableConcept
periodI0..1Period
issuerI0..1Reference(Organization)
communication0..*CodeableConceptBinding

Practitioner
DefinitionA person who is directly or indirectly involved in the provisioning of healthcare.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • v2: PRD (as one example)
  • rim: Role
  • servd: Provider
Practitioner.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Practitioner.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Practitioner.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Practitioner.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Practitioner.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Practitioner.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Practitioner.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Practitioner.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Practitioner.identifier
DefinitionAn identifier that applies to this person in this role.
Cardinality0...*
TypeIdentifier
Must SupportTrue
SummaryTrue
Requirements

Often, specific identities are assigned for the agent.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: PRD-7 (or XCN.1)
  • rim: ./id
  • servd: ./Identifiers
Practitioner.active
DefinitionWhether this practitioner's record is in active use.
Cardinality0...1
Typeboolean
SummaryTrue
Requirements

Need to be able to mark a practitioner record as not to be used because it was created in error.

Comments

If the practitioner is not in use by one organization, then it should mark the period on the PractitonerRole with an end date (even if they are active) as they may be active in another role.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • rim: ./statusCode
Practitioner.name
DefinitionThe name(s) associated with the practitioner.
Cardinality0...*
TypeHumanName
Must SupportTrue
SummaryTrue
Requirements

The name(s) that a Practitioner is known by. Where there are multiple, the name that the practitioner is usually known as should be used in the display.

Comments

The selection of the use property should ensure that there is a single usual name specified, and others use the nickname (alias), old, or other values as appropriate.

In general, select the value to be used in the ResourceReference.display based on this:

  1. There is more than 1 name
  2. Use = usual
  3. Period is current to the date of the usage
  4. Use = official
  5. Other order as decided by internal business rules.
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: XCN Components
  • rim: ./name
  • servd: ./PreferredName (GivenNames, FamilyName, TitleCode)
Practitioner.telecom
DefinitionA contact detail for the practitioner, e.g. a telephone number or an email address.
Cardinality0...*
TypeContactPoint
Must SupportTrue
SummaryTrue
Requirements

Need to know how to reach a practitioner independent to any roles the practitioner may have.

Comments

Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently and to help with identification. These typically will have home numbers, or mobile numbers that are not role specific.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • v2: PRT-15, STF-10, ROL-12
  • rim: ./telecom
  • servd: ./ContactPoints
Practitioner.address
DefinitionAddress(es) of the practitioner that are not role specific (typically home address). Work addresses are not typically entered in this property as they are usually role dependent.
Cardinality0...*
TypeAddress
SummaryTrue
Requirements

The home/mailing address of the practitioner is often required for employee administration purposes, and also for some rostering services where the start point (practitioners home) can be used in calculations.

Comments

The PractitionerRole does not have an address value on it, as it is expected that the location property be used for this purpose (which has an address).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD
  • rim: AD
  • servd: Address
  • v2: ORC-24, STF-11, ROL-11, PRT-14
  • rim: ./addr
  • servd: ./Addresses
Practitioner.gender
DefinitionAdministrative Gender - the gender that the person is considered to have for administration and record keeping purposes.
Cardinality0...1
Typecode
Binding

The gender of a person used for administrative purposes.

AdministrativeGender (required)
SummaryTrue
Requirements

Needed to address the person correctly.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: STF-5
  • rim: ./administrativeGender
  • servd: ./GenderCode
Practitioner.birthDate
DefinitionThe date of birth for the practitioner.
Cardinality0...1
Typedate
SummaryTrue
Requirements

Needed for identification.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: STF-6
  • rim: ./birthTime
  • servd: (not represented in ServD)
Practitioner.photo
DefinitionImage of the person.
Cardinality0...*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of patients and personnel. Fits with newer social media usage too.

Comments

When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • att-1: If the Attachment has data, it SHALL have a contentType
    data.empty() or contentType.exists()
Mappings
  • rim: n/a
  • v2: ED/RP
  • rim: ED
  • rim: ./subjectOf/ObservationEvent[code="photo"]/value
  • servd: ./ImageURI (only supports the URI reference)
Practitioner.qualification
DefinitionThe official certifications, training, and licenses that authorize or otherwise pertain to the provision of care by the practitioner. For example, a medical license issued by a medical board authorizing the practitioner to practice medicine within a certian locality.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CER?
  • rim: .playingEntity.playingRole[classCode=QUAL].code
  • servd: ./Qualifications
Practitioner.qualification.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Practitioner.qualification.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Practitioner.qualification.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Practitioner.qualification.identifier
DefinitionAn identifier that applies to this person's qualification in this role.
Cardinality0...*
TypeIdentifier
Requirements

Often, specific identities are assigned for the qualification.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • rim: .playingEntity.playingRole[classCode=QUAL].id
Practitioner.qualification.code
DefinitionCoded representation of the qualification.
Cardinality1...1
TypeCodeableConcept
Binding

Specific qualification the practitioner has to provide a service.

v2.0360.2.7 (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .playingEntity.playingRole[classCode=QUAL].code
  • servd: ./Qualifications.Value
Practitioner.qualification.period
DefinitionPeriod during which the qualification is valid.
Cardinality0...1
TypePeriod
Requirements

Qualifications are often for a limited period of time, and can be revoked.

Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • rim: .playingEntity.playingRole[classCode=QUAL].effectiveTime
  • servd: ./Qualifications.StartDate and ./Qualifications.EndDate
Practitioner.qualification.issuer
DefinitionOrganization that regulates and issues the qualification.
Cardinality0...1
TypeReference(Organization)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .playingEntity.playingRole[classCode=QUAL].scoper
Practitioner.communication
DefinitionA language the practitioner can use in patient communication.
Cardinality0...*
TypeCodeableConcept
Binding

A ValueSet that identifies the language used by a person.

AllLanguages (required)
Requirements

Knowing which language a practitioner speaks can help in facilitating communication with patients.

Comments

The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: PID-15, NK1-20, LAN-2
  • rim: ./languageCommunication
  • servd: ./Languages.LanguageSpokenCode


FHIRMDSHL7v2
Practitioner.nameRequestor - Full name, Additional contact - Full name, Patient - GP full name, Previous genomic report - Report performer full name, Previous genomic report - Original requester full name, Previous non genomic report - Report performer full name, Previous non genomic report - Original requester full nameORC-12, PD1-4.2 and PD1-4.3, OBX-16, ORC-12
Practitioner.identifierRequestor - Professional registration number, Additional contact - Professional registration number, Patient - GP GMC numberORC-12.1, PD1-4.1
Practitioner.identifier.system, Additional contact - Professional registration number typeRequestor - Professional registration number typeORC-12.9

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Practitioner_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Practitioner-Genomics

Genomics-PractitionerRole

PractitionerRole resources SHOULD be used where information about both a practitioner and their role within a specific organization is required, e.g. as the ServiceRequest.requestor.

References to Practitioner and Organization resources SHOULD only be made via identifier, rather than appending Practitioner and Organization resources to test order bundles. Issues with referencing via identifier SHOULD be reported to the NHS England Genomics Unit for investigation.

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-PractitionerRole UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
activeS Σ0..1boolean
periodS Σ I0..1Period
practitionerS Σ I0..1Reference(Practitioner)
organizationS Σ I0..1Reference(Organization)
codeΣ0..*CodeableConcept
specialtyS Σ0..*CodeableConceptBinding
locationS Σ I0..*Reference(Location)
healthcareServiceI0..*Reference(HealthcareService)
telecomS Σ I0..*ContactPoint
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
daysOfWeek0..*codeBinding
allDay0..1boolean
availableStartTime0..1time
availableEndTime0..1time
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
description1..1string
duringI0..1Period
availabilityExceptions0..1string
endpointI0..*Reference(Endpoint)

Differential from PractitionerRole

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
activeS Σ0..1boolean
periodS Σ I0..1Period
practitionerS Σ I0..1Reference(Practitioner)
organizationS Σ I0..1Reference(Organization)
codeΣ0..*CodeableConcept
specialtyS Σ0..*CodeableConceptBinding
locationS Σ I0..*Reference(Location)
healthcareServiceI0..*Reference(HealthcareService)
telecomS Σ I0..*ContactPoint
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
daysOfWeek0..*codeBinding
allDay0..1boolean
availableStartTime0..1time
availableEndTime0..1time
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
description1..1string
duringI0..1Period
availabilityExceptions0..1string
endpointI0..*Reference(Endpoint)

PractitionerRole
DefinitionA specific set of Roles/Locations/specialties/services that a practitioner may perform at an organization for a period of time.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • v2: PRD (as one example)
  • rim: Role
  • servd: ServiceSiteProvider
PractitionerRole.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

PractitionerRole.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
PractitionerRole.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
PractitionerRole.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
PractitionerRole.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
PractitionerRole.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
PractitionerRole.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
PractitionerRole.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
PractitionerRole.identifier
DefinitionBusiness Identifiers that are specific to a role/location.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

Often, specific identities are assigned for the agent.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: PRD-7 (or XCN.1)
  • rim: .id
  • servd: ./Identifiers
PractitionerRole.active
DefinitionWhether this practitioner role record is in active use.
Cardinality0...1
Typeboolean
Must SupportTrue
SummaryTrue
Requirements

Need to be able to mark a practitioner role record as not to be used because it was created in error, or otherwise no longer in active use.

Comments

If this value is false, you may refer to the period to see when the role was in active use. If there is no period specified, no inference can be made about when it was active.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • v2: STF-7
  • rim: .statusCode
PractitionerRole.period
DefinitionThe period during which the person is authorized to act as a practitioner in these role(s) for the organization.
Cardinality0...1
TypePeriod
Must SupportTrue
SummaryTrue
Requirements

Even after the agencies is revoked, the fact that it existed must still be recorded.

Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • w5: FiveWs.done[x]
  • v2: PRD-8/9 / PRA-5.4
  • rim: .performance[@typeCode <= 'PPRF'].ActDefinitionOrEvent.effectiveTime
  • servd: (ServD maps Practitioners and Organizations via another entity, so this concept is not available)
PractitionerRole.practitioner
DefinitionPractitioner that is able to provide the defined services for the organization.
Cardinality0...1
TypeReference(Practitioner)
Must SupportTrue
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .player
PractitionerRole.organization
DefinitionThe organization where the Practitioner performs the roles associated.
Cardinality0...1
TypeReference(Organization)
Must SupportTrue
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .scoper
PractitionerRole.code
DefinitionRoles which this practitioner is authorized to perform for the organization.
Cardinality0...*
TypeCodeableConcept
Binding

The role a person plays representing an organization.

PractitionerRole (example)
SummaryTrue
Requirements

Need to know what authority the practitioner has - what can they do?

Comments

A person may have more than one role.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: PRD-1 / STF-18 / PRA-3 / PRT-4 / ROL-3 / ORC-12 / OBR-16 / PV1-7 / PV1-8 / PV1-9 / PV1-17
  • rim: .code
  • servd: (ServD maps Practitioners and Organizations via another entity, so this concept is not available)
PractitionerRole.specialty
DefinitionSpecific specialty of the practitioner.
Cardinality0...*
TypeCodeableConcept
Binding

Specific specialty associated with the agency.

UKCorePracticeSettingCode (extensible)
Must SupportTrue
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: PRA-5
  • rim: .player.HealthCareProvider[@classCode = 'PROV'].code
  • servd: ./Specialty
PractitionerRole.location
DefinitionThe location(s) at which this practitioner provides care.
Cardinality0...*
TypeReference(Location)
Must SupportTrue
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.where[x]
  • rim: .performance.ActDefinitionOrEvent.ServiceDeliveryLocation[@classCode = 'SDLOC']
  • servd: (ServD maps Practitioners and Organizations via another entity, so this concept is not available)<br/> However these are accessed via the Site.ServiceSite.ServiceSiteProvider record. (The Site has the location)
PractitionerRole.healthcareService
DefinitionThe list of healthcare services that this worker provides for this role's Organization/Location(s).
Cardinality0...*
TypeReference(HealthcareService)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: EDU-2 / AFF-3
  • rim: .player.QualifiedEntity[@classCode = 'QUAL'].code
PractitionerRole.telecom
DefinitionContact details that are specific to the role/location/service.
Cardinality0...*
TypeContactPoint
Must SupportTrue
SummaryTrue
Requirements

Often practitioners have a dedicated line for each location (or service) that they work at, and need to be able to define separate contact details for each of these.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • rim: .telecom
PractitionerRole.availableTime
DefinitionA collection of times the practitioner is available or performing this role at the location and/or healthcareservice.
Cardinality0...*
TypeBackboneElement
Comments

More detailed availability information may be provided in associated Schedule/Slot resources.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
PractitionerRole.availableTime.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
PractitionerRole.availableTime.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
PractitionerRole.availableTime.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
PractitionerRole.availableTime.daysOfWeek
DefinitionIndicates which days of the week are available between the start and end Times.
Cardinality0...*
Typecode
Binding

The days of the week.

DaysOfWeek (required)
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
PractitionerRole.availableTime.allDay
DefinitionIs this always available? (hence times are irrelevant) e.g. 24 hour service.
Cardinality0...1
Typeboolean
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
PractitionerRole.availableTime.availableStartTime
DefinitionThe opening time of day. Note: If the AllDay flag is set, then this time is ignored.
Cardinality0...1
Typetime
Comments

The timezone is expected to be for where this HealthcareService is provided at.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
PractitionerRole.availableTime.availableEndTime
DefinitionThe closing time of day. Note: If the AllDay flag is set, then this time is ignored.
Cardinality0...1
Typetime
Comments

The timezone is expected to be for where this HealthcareService is provided at.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
PractitionerRole.notAvailable
DefinitionThe practitioner is not available or performing this role during this period of time due to the provided reason.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
PractitionerRole.notAvailable.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
PractitionerRole.notAvailable.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
PractitionerRole.notAvailable.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
PractitionerRole.notAvailable.description
DefinitionThe reason that can be presented to the user as to why this time is not available.
Cardinality1...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
PractitionerRole.notAvailable.during
DefinitionService is not available (seasonally or for a public holiday) from this date.
Cardinality0...1
TypePeriod
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • rim: .effectiveTime
PractitionerRole.availabilityExceptions
DefinitionA description of site availability exceptions, e.g. public holiday availability. Succinctly describing all possible exceptions to normal site availability as details in the available Times and not available Times.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
PractitionerRole.endpoint
DefinitionTechnical endpoints providing access to services operated for the practitioner with this role.
Cardinality0...*
TypeReference(Endpoint)
Requirements

Organizations have multiple systems that provide various services and ,ay also be different for practitioners too.

So the endpoint satisfies the need to be able to define the technical connection details for how to connect to them, and for what purpose.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)


FHIRMDSHL7v2
PractitionerRole.practitionerRequestor - Full name, Requestor - Professional registration number, Requestor - Professional registration number type, Additional contact - Full name, Additional contact - Professional registration number, Additional contact - Professional registration number type, Patient - GP full name, Patient - GP GMC number, Previous genomic report - Report performer full name, Previous genomic report - Original requester full name, Previous non genomic report - Report performer full name, Previous non genomic report - Original requester full nameORC-12, ORC-12.1, ORC-12.9, PD1-4.2 and PD1-4.3, PD1-4.1, OBX-16, ORC-12
PractitionerRole.codeRequestor - Job Title, Additional contact - Job TitleCTD-1
PractitionerRole.specialtyRequestor - Current Specialty, Requestor - Department name, Additional contact - Current Specialty, Additional contact - Department nameAdditional CTD-1 segments
PractitionerRole.telecomRequestor - Phone, Requestor - Email address, Requestor - Genomic report delivery method, Requestor - Central email for address and reporting (many), Additional contact - Phone, Additional contact - Email address, Additional contact - Genomic report delivery method, Additional contact - Central email for address and reporting (many)ORC-14
PractitionerRole.organizationRequestor - Organization name, Requestor - Organization address, Requestor - Organization ODS code, Additional contact - Organization name, address and ODS code, Additional contact - Organization address, Additional contact - Organization ODS code, Patient - GP Practice ODS Code, Previous genomic report - Report performer organisation ODS code, Previous genomic report - Original requester organisation ODS code, Previous non genomic report - Report performer organisation ODS code, Previous non genomic report - Original requester organisation ODS codeORC-21, ORC-22, ORC-21.10, OBX-23.10
PractitionerRole.healthcareServicePLCM activity - ODS code of the laboratory site delivering requested test, PLCM activity - Commissioned service category codeAdditional CTD-1 segments

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_PractitionerRole_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-PractitionerRole-Genomics

Additional Guidance

practitioner

SHALL be present. Users SHOULD reference practitioners using an appropriate naming system within the NHS (defined within the NHS England IG. Display name MAY be included to aid readability and verification of included identifiers.

 "practitioner": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/sds-user-id",
            "value": "9999999999"
        },
        "display": "Dr. Gene Smith"
    },

organization

SHALL be present. Users SHOULD reference organizations using an ODS code. Display name MAY be included to aid readability and verification of included identifiers. Requester ODS codes SHOULD use the lowest level site code rather than trust code (most granular code available) where possible, to aid contact retrieval.

 "organization": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
            "value": "RGT01"
        },
        "display": "Addenbrooke's Hospital"
    },

specialty

The specialty field SHOULD be used to record department for the requesting clinician, issues with the use of this field, including issues with the bound UK Core ValueSet not representing certain departments SHOULD be reported to the NHS England Genomics Unit

"specialty":  [
        {
            "coding":  [
                {
                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-PracticeSettingCode",
                    "code": "120",
                    "display": "Ear Nose and Throat"
                }
            ]
        }
    ],

telecom

The telecom field SHOULD be used to record contact details for the practitioner. For central mailboxes, e.g. those used for providing reports back to the requester, these SHOULD be marked with an appropriate 'contactpoint-comment' extension. Additionally, where are there multiple Practitioners involved in providing care, the contact details for each Practitioners for that location (or service) SHOULD be specified.

"telecom":  [
        {
            "system": "phone",
            "value": "01223586638"
        },
        {
            "system": "email",
            "value": "gene.smith@nhs.net"
        },
        {
            "system": "email",
            "value": "Add-tr.entsecretaries@nhs.net",
            "extension":  [
                {
                    "url": "http://hl7.org/fhir/StructureDefinition/contactpoint-comment",
                    "valueString": "reporting"
                }
            ]
        }
    ]

Genomics-Procedure

Used for detailing information on procedures the patient has had performed, to aid interpretation of Genomic test results.

Assertion of an absence of a procedure being performed SHOULD be recorded using an Observation resource, as described in Genomics-Observation

At a minimum, Procedure resources are expected to contain the status, code, subject and performedDateTime, though additional information conforming to the FHIR profile below MAY be included if relevant.

Genomic Study and Genomic Study Analysis profiles on Procedure may also be used as part of structured reporting. Mandated usage of these profiles is pending data standard discovery work to identify the items required within Genomic Test Reporting. As such, elements called out, and guidance suggested on this page, may be subject to change.

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Procedure UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
instantiatesCanonicalΣ0..*canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)
instantiatesUriΣ0..*uri
basedOnΣ I0..*Reference(CarePlan | ServiceRequest)
partOfΣ I0..*Reference(Procedure | Observation | MedicationAdministration)
statusS Σ ?!1..1codeBinding
statusReasonΣ0..1CodeableConcept
categoryΣ0..1CodeableConcept
codeS Σ0..1CodeableConceptBinding
subjectS Σ I1..1Reference(Patient | Group)
encounterΣ I0..1Reference(Encounter)
performedDateTimedateTime
performedPeriodPeriod
performedStringstring
performedAgeAge
performedRangeRange
recorderΣ I0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)
asserterΣ I0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
functionΣ0..1CodeableConcept
actorΣ I1..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
onBehalfOfI0..1Reference(Organization)
locationΣ I0..1Reference(Location)
reasonCodeΣ0..*CodeableConcept
reasonReferenceΣ I0..*Reference(Condition | Observation | Procedure | DiagnosticReport | DocumentReference)
bodySiteΣ0..*CodeableConceptBinding
outcomeΣ0..1CodeableConcept
reportI0..*Reference(DiagnosticReport | DocumentReference | Composition)
complication0..*CodeableConceptBinding
complicationDetailI0..*Reference(Condition)
followUp0..*CodeableConcept
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
action0..1CodeableConceptBinding
manipulatedI1..1Reference(Device)
usedReferenceI0..*Reference(Device | Medication | Substance)
usedCode0..*CodeableConcept

Differential from Procedure

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
instantiatesCanonicalΣ0..*canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)
instantiatesUriΣ0..*uri
basedOnΣ I0..*Reference(CarePlan | ServiceRequest)
partOfΣ I0..*Reference(Procedure | Observation | MedicationAdministration)
statusS Σ ?!1..1codeBinding
statusReasonΣ0..1CodeableConcept
categoryΣ0..1CodeableConcept
codeS Σ0..1CodeableConceptBinding
subjectS Σ I1..1Reference(Patient | Group)
encounterΣ I0..1Reference(Encounter)
performedDateTimedateTime
performedPeriodPeriod
performedStringstring
performedAgeAge
performedRangeRange
recorderΣ I0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)
asserterΣ I0..1Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
functionΣ0..1CodeableConcept
actorΣ I1..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
onBehalfOfI0..1Reference(Organization)
locationΣ I0..1Reference(Location)
reasonCodeΣ0..*CodeableConcept
reasonReferenceΣ I0..*Reference(Condition | Observation | Procedure | DiagnosticReport | DocumentReference)
bodySiteΣ0..*CodeableConceptBinding
outcomeΣ0..1CodeableConcept
reportI0..*Reference(DiagnosticReport | DocumentReference | Composition)
complication0..*CodeableConceptBinding
complicationDetailI0..*Reference(Condition)
followUp0..*CodeableConcept
note0..*Annotation
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
action0..1CodeableConceptBinding
manipulatedI1..1Reference(Device)
usedReferenceI0..*Reference(Device | Medication | Substance)
usedCode0..*CodeableConcept

Procedure
DefinitionAn action that is or was performed on or for a patient. This can be a physical intervention like an operation, or less invasive like long term services, counseling, or hypnotherapy.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • rim: Procedure[moodCode=EVN]
Procedure.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Procedure.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Procedure.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Procedure.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Procedure.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Procedure.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Procedure.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Procedure.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Procedure.identifier
DefinitionBusiness identifiers assigned to this procedure by the performer or other systems which remain constant as the resource is updated and is propagated from server to server.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

Allows identification of the procedure as it is known by various participating systems and in a way that remains consistent across servers.

Comments

This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and Person resource instances might share the same social insurance number.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • v2: Some combination of ORC-2 / ORC-3 / OBR-2 / OBR-3 / IPC-1 / IPC-2 / IPC-3 / IPC-4
  • rim: .id
Procedure.instantiatesCanonical
DefinitionThe URL pointing to a FHIR-defined protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.
Cardinality0...*
Typecanonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)
SummaryTrue
Comments

see Canonical References

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.instantiatesCanonical
  • rim: .outboundRelationship[typeCode=DEFN].target
Procedure.instantiatesUri
DefinitionThe URL pointing to an externally maintained protocol, guideline, order set or other definition that is adhered to in whole or in part by this Procedure.
Cardinality0...*
Typeuri
SummaryTrue
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.instantiatesUri
  • rim: .outboundRelationship[typeCode=DEFN].target
Procedure.basedOn
DefinitionA reference to a resource that contains details of the request for this procedure.
Cardinality0...*
TypeReference(CarePlan | ServiceRequest)
SummaryTrue
Aliasfulfills
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.basedOn
  • rim: .outboundRelationship[typeCode=FLFS].target[classCode=(various e.g. PROC, OBS, PCPR, ACT, moodCode=RQO].code
Procedure.partOf
DefinitionA larger event of which this particular procedure is a component or step.
Cardinality0...*
TypeReference(Procedure | Observation | MedicationAdministration)
SummaryTrue
Aliascontainer
Comments

The MedicationAdministration resource has a partOf reference to Procedure, but this is not a circular reference. For example, the anesthesia MedicationAdministration is part of the surgical Procedure (MedicationAdministration.partOf = Procedure). For example, the procedure to insert the IV port for an IV medication administration is part of the medication administration (Procedure.partOf = MedicationAdministration).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.partOf
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=SBADM or PROC or OBS, moodCode=EVN]
Procedure.status
DefinitionA code specifying the state of the procedure. Generally, this will be the in-progress or completed state.
Cardinality1...1
Typecode
Binding

A code specifying the state of the procedure.

EventStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

The "unknown" code is not to be used to convey other statuses. The "unknown" code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the procedure.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
  • rim: statusCode
Procedure.statusReason
DefinitionCaptures the reason for the current state of the procedure.
Cardinality0...1
TypeCodeableConcept
Binding

A code that identifies the reason a procedure was not performed.

ProcedureNotPerformedReason(SNOMED-CT) (example)
SummaryTrue
AliasSuspended Reason, Cancelled Reason
Comments

This is generally only used for "exception" statuses such as "not-done", "suspended" or "aborted". The reason for performing the event at all is captured in reasonCode, not here.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.statusReason
  • rim: .reason.Observation.value
Procedure.category
DefinitionA code that classifies the procedure for searching, sorting and display purposes (e.g. "Surgical Procedure").
Cardinality0...1
TypeCodeableConcept
Binding

A code that classifies a procedure for searching, sorting and display purposes.

ProcedureCategoryCodes(SNOMEDCT) (example)
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
Procedure.code
DefinitionThe specific procedure that is performed. Use text if the exact nature of the procedure cannot be coded (e.g. "Laparoscopic Appendectomy").
Cardinality0...1
TypeCodeableConcept
Binding

A code from the SNOMED Clinical Terminology UK.

UKCoreProcedureCode (preferred)
Must SupportTrue
SummaryTrue
Aliastype
Requirements

0..1 to account for primarily narrative only resources.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.code
  • w5: FiveWs.what[x]
  • v2: OBR-44/OBR-45
  • rim: .code
Procedure.subject
DefinitionThe person, animal or group on which the procedure was performed.
Cardinality1...1
TypeReference(Patient | Group)
Must SupportTrue
SummaryTrue
Aliaspatient
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • v2: PID-3
  • rim: .participation[typeCode=SBJ].role
  • w5: FiveWs.subject
Procedure.encounter
DefinitionThe Encounter during which this Procedure was created or performed or to which the creation of this record is tightly associated.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.context
  • w5: FiveWs.context
  • v2: PV1-19
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
Procedure.performed[x]
DefinitionEstimated or actual date, date-time, period, or age when the procedure was performed. Allows a period to support complex procedures that span more than one date, and also allows for the length of the procedure to be captured.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
Comments

Age is generally used when the patient reports an age at which the procedure was performed. Range is generally used when the patient reports an age range when the procedure was performed, such as sometime between 20-25 years old. dateTime supports a range of precision due to some procedures being reported as past procedures that might not have millisecond precision while other procedures performed and documented during the encounter might have more precise UTC timestamps with timezone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • v2: OBR-7
  • rim: .effectiveTime
Procedure.recorder
DefinitionIndividual who recorded the record and takes responsibility for its content.
Cardinality0...1
TypeReference(Patient | RelatedPerson | Practitioner | PractitionerRole)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
Procedure.asserter
DefinitionIndividual who is making the procedure statement.
Cardinality0...1
TypeReference(Patient | RelatedPerson | Practitioner | PractitionerRole)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.source
  • rim: .participation[typeCode=INF].role
Procedure.performer
DefinitionLimited to "real" people rather than equipment.
Cardinality0...*
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.performer
  • rim: .participation[typeCode=PRF]
Procedure.performer.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Procedure.performer.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Procedure.performer.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Procedure.performer.function
DefinitionDistinguishes the type of involvement of the performer in the procedure. For example, surgeon, anaesthetist, endoscopist.
Cardinality0...1
TypeCodeableConcept
Binding

A code that identifies the role of a performer of the procedure.

ProcedurePerformerRoleCodes (example)
SummaryTrue
Requirements

Allows disambiguation of the types of involvement of different performers.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.performer.function
  • v2: Some combination of STF-18 / PRA-3 / PRT-4 / ROL-3 / ORC-12 / OBR-16 / PV1-7 / PV1-8 / PV1-9 / PV1-17 / OBX-25
  • rim: .functionCode
Procedure.performer.actor
DefinitionThe practitioner who was involved in the procedure.
Cardinality1...1
TypeReference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
SummaryTrue
Requirements

A reference to Device supports use cases, such as pacemakers.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • w5: FiveWs.actor
  • v2: ORC-19/PRT-5
  • rim: .role
Procedure.performer.onBehalfOf
DefinitionThe organization the device or practitioner was acting on behalf of.
Cardinality0...1
TypeReference(Organization)
Requirements

Practitioners and Devices can be associated with multiple organizations. This element indicates which organization they were acting on behalf of when performing the action.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .scoper
Procedure.location
DefinitionThe location where the procedure actually happened. E.g. a newborn at home, a tracheostomy at a restaurant.
Cardinality0...1
TypeReference(Location)
SummaryTrue
Requirements

Ties a procedure to where the records are likely kept.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.where[x]
  • rim: .participation[typeCode=LOC].role[classCode=SDLOC]
Procedure.reasonCode
DefinitionThe coded reason why the procedure was performed. This may be a coded entity of some type, or may simply be present as text.
Cardinality0...*
TypeCodeableConcept
Binding

A code that identifies the reason a procedure is required.

ProcedureReasonCodes (example)
SummaryTrue
Comments

Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.reasonCode
  • w5: FiveWs.why[x]
  • rim: .reasonCode
Procedure.reasonReference
DefinitionThe justification of why the procedure was performed.
Cardinality0...*
TypeReference(Condition | Observation | Procedure | DiagnosticReport | DocumentReference)
SummaryTrue
Comments

It is possible for a procedure to be a reason (such as C-Section) for another procedure (such as an epidural). Other examples include endoscopy for dilatation and biopsy (a combination of diagnostic and therapeutic use). Use Procedure.reasonCode when a code sufficiently describes the reason. Use Procedure.reasonReference when referencing a resource, which allows more information to be conveyed, such as onset date. Procedure.reasonCode and Procedure.reasonReference are not meant to be duplicative. For a single reason, either Procedure.reasonCode or Procedure.reasonReference can be used. Procedure.reasonCode may be a summary code, or Procedure.reasonReference may be used to reference a very precise definition of the reason using Condition | Observation | Procedure | DiagnosticReport | DocumentReference. Both Procedure.reasonCode and Procedure.reasonReference can be used if they are describing different reasons for the procedure.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.reasonReference
  • w5: FiveWs.why[x]
  • rim: .reasonCode
Procedure.bodySite
DefinitionDetailed and structured anatomical location information. Multiple locations are allowed - e.g. multiple punch biopsies of a lesion.
Cardinality0...*
TypeCodeableConcept
Binding

Codes describing anatomical locations. May include laterality.

SNOMEDCTBodyStructures (preferred)
SummaryTrue
Comments

If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension procedure-targetbodystructure.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: OBX-20
  • rim: .targetSiteCode
Procedure.outcome
DefinitionThe outcome of the procedure - did it resolve the reasons for the procedure being performed?
Cardinality0...1
TypeCodeableConcept
Binding

An outcome of a procedure - whether it was resolved or otherwise.

ProcedureOutcomeCodes(SNOMEDCT) (example)
SummaryTrue
Comments

If outcome contains narrative text only, it can be captured using the CodeableConcept.text.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .outboundRelationship[typeCode=OUT].target.text
Procedure.report
DefinitionThis could be a histology result, pathology report, surgical report, etc.
Cardinality0...*
TypeReference(DiagnosticReport | DocumentReference | Composition)
Comments

There could potentially be multiple reports - e.g. if this was a procedure which took multiple biopsies resulting in a number of anatomical pathology reports.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN]
Procedure.complication
DefinitionAny complications that occurred during the procedure, or in the immediate post-performance period. These are generally tracked separately from the notes, which will typically describe the procedure itself rather than any 'post procedure' issues.
Cardinality0...*
TypeCodeableConcept
Binding

A code from the SNOMED Clinical Terminology UK with the expression (<404684003 |Clinical finding| OR <413350009 |Finding with explicit context| OR <272379006 |Event|).

UKCoreConditionCode (preferred)
Comments

If complications are only expressed by the narrative text, they can be captured using the CodeableConcept.text.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .outboundRelationship[typeCode=OUTC].target[classCode=OBS, code="complication", moodCode=EVN].value
Procedure.complicationDetail
DefinitionAny complications that occurred during the procedure, or in the immediate post-performance period.
Cardinality0...*
TypeReference(Condition)
Requirements

This is used to document a condition that is a result of the procedure, not the condition that was the reason for the procedure.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .outboundRelationship[typeCode=OUTC].target[classCode=OBS, code="complication", moodCode=EVN].value
Procedure.followUp
DefinitionIf the procedure required specific follow up - e.g. removal of sutures. The follow up may be represented as a simple note or could potentially be more complex, in which case the CarePlan resource can be used.
Cardinality0...*
TypeCodeableConcept
Binding

Specific follow up required for a procedure e.g. removal of sutures.

ProcedureFollowUpCodes(SNOMEDCT) (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=ACT, moodCode=INT].code
Procedure.note
DefinitionAny other notes and comments about the procedure.
Cardinality0...*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Event.note
  • v2: NTE
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
Procedure.focalDevice
DefinitionA device that is implanted, removed or otherwise manipulated (calibration, battery replacement, fitting a prosthesis, attaching a wound-vac, etc.) as a focal portion of the Procedure.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .participation[typeCode=DEV].role[classCode=MANU]
Procedure.focalDevice.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Procedure.focalDevice.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Procedure.focalDevice.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Procedure.focalDevice.action
DefinitionThe kind of change that happened to the device during the procedure.
Cardinality0...1
TypeCodeableConcept
Binding

A kind of change that happened to the device during the procedure.

ProcedureDeviceActionCodes (preferred)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="procedure device action"].value=:procedure device action codes
Procedure.focalDevice.manipulated
DefinitionThe device that was manipulated (changed) during the procedure.
Cardinality1...1
TypeReference(Device)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .participation[typeCode=DEV].role[classCode=SDLOC]
Procedure.usedReference
DefinitionIdentifies medications, devices and any other substance used as part of the procedure.
Cardinality0...*
TypeReference(Device | Medication | Substance)
Requirements

Used for tracking contamination, etc.

Comments

For devices actually implanted or removed, use Procedure.device.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .participation[typeCode=DEV].role[classCode=MANU] or .participation[typeCode=CSM].role[classCode=ADMM] (for Medication or Substance)
Procedure.usedCode
DefinitionIdentifies coded items that were used as part of the procedure.
Cardinality0...*
TypeCodeableConcept
Binding

Codes describing items used during a procedure.

FHIRDeviceTypes (example)
Comments

For devices actually implanted or removed, use Procedure.device.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: participation[typeCode=Dev].role[classCode=MANU]


FHIRMDSHL7v2
ProcedurePatient - Had transplant, Patient - Had transfusion, Is patient on TKI therapy, Insulin treated within 6 months of diagnosis, Is on Ig replacementPresence of OBR segment with OBR-44 code for transplant/transfusion etc.
Procedure.performedDateTimePatient - Fetal gestation (to determine termination date), Patient - Transplant date, Patient - Transfusion dateOBR-7
Procedure.codePatient - Pregnancy type, Patient - Type of transplant, Patient - Type of transfusion, Neonatal hypoglycemia treatment details, Current exocrine pancreatic treatmentOBR segments with appropriate codes, OBR-44, OBR/RXA segments
Procedure.performedPeriod.startNeonatal hypoglycemia treatment start date, Exocrine pancreatic treatment start dateOBR-7, RXA-3
Procedure.performedPeriod.endNeonatal hypoglycemia treatment end dateOBR-8

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Procedure_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Procedure-Genomics

Additional Guidance

extension:genomic-study-analysis

TBC. From the Genomic Reporting IG Genomic Study profile. Reference to the Genomic Study Analysis resource, detailing the analyses performed as part of genomic test.

"extension" : [
    {
      "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-analysis-ext",
      "valueReference" : {
        "reference" : "Procedure/PGXGenomicStudyAnalysis"
      }
    }
  ],

Genomic Study Analysis extensions

TBC. From the Genomic Reporting IG Genomic Study Analysis profile. Various extensions covering the metadata related to a genomic test, e.g. regions studied, change types tested for etc. For the full list of extensions, please see the linked profile page.

Use of the profile and its extensions is pending further discovery of the data standards required for Genomic Reporting in the UK.

"extension" : [
    {
      "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-analysis-genome-build",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://loinc.org",
            "code" : "LA26806-2",
            "display" : "GRCh38"
          }
        ]
      }
    },
    {
      "extension" : [
        {
          "url" : "sequencing-coverage",
          "valueQuantity" : {
            "value" : 100
          }
        }
      ],
      "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-analysis-metrics"
    },
    {
      "extension" : [
        {
          "url" : "description",
          "valueString" : "protein-coding and exon-splicing regions"
        },
        {
          "url" : "studied",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://www.genenames.org",
                "code" : "HGNC:2621",
                "display" : "CYP2C19"
              }
            ]
          }
        },
        {
          "url" : "studied",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://www.genenames.org",
                "code" : "HGNC:2623",
                "display" : "CYP2C9"
              }
            ]
          }
        },
        {
          "url" : "studied",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://www.genenames.org",
                "code" : "HGNC:23663",
                "display" : "VKORC1"
              }
            ]
          }
        }
      ],
      "url" : "http://hl7.org/fhir/uv/genomics-reporting/StructureDefinition/genomic-study-analysis-regions"
    }
  ],

status

Status SHALL use the codes recommended in the base Procedure resource, appropriately tagging procedures as having been completed or in-progress etc. depending on the actual status of the procedure.

"status": "completed",

code

SHALL be present. SNOMED CT coding is preferred, though alternative codings MAY be provided subject to review of the Coding system by the NHS England Genomics Unit.

For the Genomic Study profile, expected to be from the Genomic Study Type ValueSet

"code": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "23719005",
                "display": "Transplantation of bone marrow"
            }
        ]
    },

subject

SHALL be present. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS.

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

performed[x]

performed SHOULD be provided wherever possible, using the appropriate data type, to aid in interpretation of Genomic test results.

"performedDateTime": "2020-01-19"

Genomics-Provenance

The Genomics Provenance SHOULD be provided alongside updates to controlled documents such as ServiceRequests and DiagnosticReports by integrated systems on any update operation to ensure auditability for any changes to resources.

It is not expected that updates which do not affect the clinical content of the document will need associated Provenance resources, e.g. addition of local identifiers (though for the purporses of the Genomic Order Management Alpha, all updates to ServiceRequest and DiagnosticReport resources will be expected to have accompanying Provenance resources). On material changes to controlled resources, ServiceRequest and DiagnosticReport, users SHOULD use the transaction endpoint on the server to bundle the updated resource and Provenance event into a single transaction.

The HL7 FHIR specification also provides the capability to attach a Provenance resource using a custom header parameter. Using this mechanism would allow clients to submit requests to the resource specific PUT enpoints for ServiceRequests and DiagnosticReports, while still aloowing changes to be captured within a Provenance resource using a single interaction. This mechanism will not be supported within the Genomic Order Management Alpha but will be investigated by the NHS England Genomics Unit for implementation in future phases.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/Provenance HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
targetΣ I1..*Reference(Resource)
occurredPeriodPeriod
occurredDateTimedateTime
recordedΣ1..1instant
policy0..*uri
locationI0..1Reference(Location)
reason0..*CodeableConceptBinding
activity0..1CodeableConceptBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
typeΣ0..1CodeableConceptBinding
role0..*CodeableConcept
whoΣ I1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)
onBehalfOfI0..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
roleΣ1..1codeBinding
whatΣ I1..1Reference(Resource)
agent0..*see (agent)
signature0..*Signature

Differential from Provenance

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
targetΣ I1..*Reference(Resource)
occurredPeriodPeriod
occurredDateTimedateTime
recordedΣ1..1instant
policy0..*uri
locationI0..1Reference(Location)
reason0..*CodeableConceptBinding
activity0..1CodeableConceptBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
typeΣ0..1CodeableConceptBinding
role0..*CodeableConcept
whoΣ I1..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)
onBehalfOfI0..1Reference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
roleΣ1..1codeBinding
whatΣ I1..1Reference(Resource)
agent0..*see (agent)
signature0..*Signature

Provenance
DefinitionProvenance of a resource is a record that describes entities and processes involved in producing and delivering or otherwise influencing that resource. Provenance provides a critical foundation for assessing authenticity, enabling trust, and allowing reproducibility. Provenance assertions are a form of contextual metadata and can themselves become important records with their own provenance. Provenance statement indicates clinical significance in terms of confidence in authenticity, reliability, and trustworthiness, integrity, and stage in lifecycle (e.g. Document Completion - has the artifact been legally authenticated), all of which may impact security, privacy, and trust policies.
Cardinality0...*
AliasHistory, Event, Activity
Comments

Some parties may be duplicated between the target resource and its provenance. For instance, the prescriber is usually (but not always) the author of the prescription resource. This resource is defined with close consideration for W3C Provenance.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • rim: ControlAct[isNormalAct() and subsumes(CACT, classCode) and moodCode=EVN]
  • w3c.prov: Activity
Provenance.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Provenance.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Provenance.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Provenance.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Provenance.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Provenance.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Provenance.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Provenance.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Provenance.target
DefinitionThe Reference(s) that were generated or updated by the activity described in this resource. A provenance can point to more than one target if multiple resources were created/updated by the same activity.
Cardinality1...*
TypeReference(Resource)
SummaryTrue
Comments

Target references are usually version specific, but might not be, if a version has not been assigned or if the provenance information is part of the set of resources being maintained (i.e. a document). When using the RESTful API, the identity of the resource might not be known (especially not the version specific one); the client may either submit the resource first, and then the provenance, or it may submit both using a single transaction. See the notes on transaction for further discussion.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.what[x]
  • rim: ./outboundRelationship[isNormalActRelationship() and typeCode=SUBJ]/target OR ./participation[isNormalParticipation() and typeCode=SBJ]/role OR ./participation[isNormalParticipation() and typeCode=SBJ]/role[isNormalRole()]/player
  • fhirauditevent: AuditEvent.entity.reference
  • w3c.prov: Entity Created/Updated
Provenance.occurred[x]
DefinitionThe period during which the activity occurred.
Cardinality0...1
TypePeriod
Comments

The period can be a little arbitrary; where possible, the time should correspond to human assessment of the activity time.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurred[x]
  • w5: FiveWs.done[x]
  • rim: ./effectiveTime[type=IVL_TS]
  • w3c.prov: Activity.startTime & Activity.endTime
Provenance.recorded
DefinitionThe instant of time at which the activity was recorded.
Cardinality1...1
Typeinstant
SummaryTrue
Comments

This can be a little different from the time stamp on the resource if there is a delay between recording the event and updating the provenance and target resource.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.recorded
  • rim: unique(./participation[isNormalParticipation() and typeCode=AUT]/time[type=TS])
  • fhirauditevent: AuditEvent.recorded
  • w3c.prov: Activity.when
Provenance.policy
DefinitionPolicy or plan the activity was defined by. Typically, a single activity may have multiple applicable policy documents, such as patient consent, guarantor funding, etc.
Cardinality0...*
Typeuri
Comments

For example: Where an OAuth token authorizes, the unique identifier from the OAuth token is placed into the policy element Where a policy engine (e.g. XACML) holds policy logic, the unique policy identifier is placed into the policy element.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ./inboundRelationship[isNormalActRelationship() and typeCode="SUBJ"]/source[isNormalAct and subsumes(POLICY, classCode) and moodCode=EVN]/text[typeCode='ED'/tel
  • fhirauditevent: AuditEvent.agent.policy
Provenance.location
DefinitionWhere the activity occurred, if relevant.
Cardinality0...1
TypeReference(Location)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.location
  • w5: FiveWs.where[x]
  • rim: unique(./participation[isNormalParticipation() and typeCode=LOC]/role[isNormalRole() and subsumes(SDLOC, classCode)]/player[isNormalEntity and classCode="LOC" and determinerCode="INST"]
  • fhirauditevent: AuditEvent.agent.location
  • w3c.prov: Activity.location
Provenance.reason
DefinitionThe reason that the activity was taking place.
Cardinality0...*
TypeCodeableConcept
Binding

The reason the activity took place.

v3.PurposeOfUse (extensible)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.reasonCode
  • w5: FiveWs.why[x]
  • rim: unique(./reasonCode)
  • fhirauditevent: AuditEvent.purposeOfEvent
  • w3c.prov: Activity.Activity
Provenance.activity
DefinitionAn activity is something that occurs over a period of time and acts upon or with entities; it may include consuming, processing, transforming, modifying, relocating, using, or generating entities.
Cardinality0...1
TypeCodeableConcept
Binding

The activity that took place.

ProvenanceActivityType (extensible)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.code
  • w5: FiveWs.why[x]
  • rim: Act.code
  • w3c.prov: Activity.Activity
Provenance.agent
DefinitionAn actor taking a role in an activity for which it can be assigned some degree of responsibility for the activity taking place.
Cardinality1...*
TypeBackboneElement
Requirements

An agent can be a person, an organization, software, device, or other entities that may be ascribed responsibility.

Comments

Several agents may be associated (i.e. has some responsibility for an activity) with an activity and vice-versa.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.performer
  • w5: FiveWs.who
  • rim: ./participation[isNormalParticipation()] OR ./outboundRelationship[isNormalActRelationship() and typeCode='DRIV']
  • fhirauditevent: AuditEvent.agent
  • w3c.prov: Agent
Provenance.agent.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Provenance.agent.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Provenance.agent.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Provenance.agent.type
DefinitionThe participation the agent had with respect to the activity.
Cardinality0...1
TypeCodeableConcept
Binding

The type of participation that a provenance agent played with respect to the activity.

ProvenanceParticipantType (extensible)
SummaryTrue
Comments

For example: author, performer, enterer, attester, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.performer.function
  • rim: .role
  • fhirauditevent: AuditEvent.agent.type
  • w3c.prov: Agent.Attribution
Provenance.agent.role
DefinitionThe function of the agent with respect to the activity. The security role enabling the agent with respect to the activity.
Cardinality0...*
TypeCodeableConcept
Binding

The role that a provenance agent played with respect to the activity.

SecurityRoleType (example)
Comments

For example: doctor, nurse, clerk, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .typecode
  • fhirauditevent: AuditEvent.agent.role
Provenance.agent.who
DefinitionThe individual, device or organization that participated in the event.
Cardinality1...1
TypeReference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)
SummaryTrue
Comments

whoIdentity should be used when the agent is not a Resource type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor
  • w5: FiveWs.actor
  • rim: .id
Provenance.agent.onBehalfOf
DefinitionThe individual, device, or organization for whom the change was made.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole | RelatedPerson | Patient | Device | Organization)
Comments

onBehalfOfIdentity should be used when the agent is not a Resource type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: Person, Practitioner, Organization, Device :* .role [classCode = RoleClassMutualRelationship; role.code and * .scopes[Role](classCode=IDENT) and *.plays [Role.Code]
Provenance.entity
DefinitionAn entity used in this activity.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ./subjectOf
  • fhirauditevent: AuditEvent.entity
  • w3c.prov: Entity
Provenance.entity.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Provenance.entity.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Provenance.entity.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Provenance.entity.role
DefinitionHow the entity was used during the activity.
Cardinality1...1
Typecode
Binding

How an entity was used in an activity.

ProvenanceEntityRole (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ./typeCode
  • fhirauditevent: AuditEvent.entity.lifecycle
  • w3c.prov: Entity.role
Provenance.entity.what
DefinitionIdentity of the Entity used. May be a logical or physical uri and maybe absolute or relative.
Cardinality1...1
TypeReference(Resource)
SummaryTrue
Comments

whatIdentity should be used for entities that are not a Resource type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: ./text/reference
  • fhirauditevent: AuditEvent.entity.reference
  • w3c.prov: Entity.Identity
Provenance.entity.agent
DefinitionThe entity is attributed to an agent to express the agent's responsibility for that entity, possibly along with other agents. This description can be understood as shorthand for saying that the agent was responsible for the activity which generated the entity.
Cardinality0...*
Typesee (agent)
Comments

A usecase where one Provenance.entity.agent is used where the Entity that was used in the creation/updating of the Target, is not in the context of the same custodianship as the Target, and thus the meaning of Provenance.entity.agent is to say that the entity referenced is managed elsewhere and that this Agent provided access to it. This would be similar to where the Entity being referenced is managed outside FHIR, such as through HL7 v2, v3, or XDS. This might be where the Entity being referenced is managed in another FHIR resource server. Thus it explains the Provenance of that Entity's use in the context of this Provenance activity.

Mappings
  • rim: ./author/role
Provenance.signature
DefinitionA digital signature on the target Reference(s). The signer should match a Provenance.agent. The purpose of the signature is indicated.
Cardinality0...*
TypeSignature
Comments

The elements of the Signature Resource are for ease of access of these elements. For digital signatures (Xml DigSig, JWS), the non-repudiation proof comes from the Signature validation, which includes validation of the referenced objects (e.g. Resources) (a.k.a., Content) in the XML-Signature Detached form.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: ./signatureText


FHIRMDSHL7v2

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Provenance_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Provenance-Genomics

Additional Guidance

target

SHALL be provided. This SHOULD be a reference to the resource on the central GMS system that was updated.

"target":  [
        {
            "reference": "ServiceRequest/ServiceRequest-SavedTestOrderUpdated-Example"
        }
    ],

recorded

SHALL be provided, the date/time when the update took place.

"recorded": "2023-08-10T11:10:00Z",

reason

The reason why the update took place. If the codes provided by HL7 are not granular enough, or additional notes need to be recorded detailing the reasoning behind a change, this SHOULD be added as text to 'reason.text'.

"reason":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
                    "code": "TREAT",
                    "display": "treatment"
                }
            ],
            "text": "Test inappropriate for patient"
        }
    ],

agent

SHOULD be provided where actions are user initiated. The user which performed the change, as identified through CIS2 authentication token.

"agent":  [
        {
            "type": {
                "coding":  [
                    {
                        "system": "http://terminology.hl7.org/CodeSystem/provenance-participant-type",
                        "code": "author",
                        "display": "Author"
                    }
                ]
            },
            "who": {
                "reference": "PractitionerRole/PractitionerRole-TestClinicalScientist-Example",
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/sds-user-id",
                    "value": "9999999997"
                }
            }
        }
    ],

signature

Signed, encrypted copy of the document, for validation that the document has not been tampered with (the requirement to include this field has not yet been validated).

 "signature":  [
        {
            "type":  [
                {
                    "system": "urn:iso-astm:E1762-95:2013",
                    "code": "1.2.840.10065.1.12.1.15",
                    "display": "Addendum Signature"
                }
            ],
            "when": "2023-08-10T11:10:00Z",
            "who": {
                "reference": "PractitionerRole/PractitionerRole-TestClinicalScientist-Example",
                "identifier": {
                    "system": "https://fhir.nhs.uk/Id/sds-user-id",
                    "value": "9999999997"
                }
            },
            "data": "DQo8U2lnbm...F0dXJlPg0K"
        }
    ]

Genomics-Questionnaire

The Genomics Questionnaire is currently based on the UKCore resource, without any need for profiling.

The profile for the UKCore-Questionnaire is provided below for completeness.

It is not expected that any Questionnaire resources will be submitted to the central service, instead the GMS solution will contain a library of Questionnaires relevant to Genomics that it can use to validate QuestionnaireReponses (such as the example Record of Discussion Questionnaire).

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/Questionnaire HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
urlΣ0..1uri
identifierΣ0..*Identifier
versionΣ0..1string
nameΣ I0..1string
titleΣ0..1string
derivedFrom0..*canonical(Questionnaire)
statusΣ ?!1..1codeBinding
experimentalΣ0..1boolean
subjectTypeΣ0..*codeBinding
dateΣ0..1dateTime
publisherΣ0..1string
contactΣ0..*ContactDetail
description0..1markdown
useContextΣ0..*UsageContext
jurisdictionΣ0..*CodeableConceptBinding
purpose0..1markdown
copyright0..1markdown
approvalDate0..1date
lastReviewDate0..1date
effectivePeriodΣ I0..1Period
codeΣ0..*Coding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
linkId1..1string
definition0..1uri
codeI0..*Coding
prefix0..1string
text0..1string
type1..1codeBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
question1..1string
operator1..1codeBinding
answerBooleanboolean
answerDecimaldecimal
answerIntegerinteger
answerDatedate
answerDateTimedateTime
answerTimetime
answerStringstring
answerCodingCoding
answerQuantityQuantity
answerReferenceReference(Resource)
enableBehaviorI0..1codeBinding
requiredI0..1boolean
repeatsI0..1boolean
readOnlyI0..1boolean
maxLengthI0..1integer
answerValueSetI0..1canonical(ValueSet)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
valueIntegerinteger
valueDatedate
valueTimetime
valueStringstring
valueCodingCoding
valueReferenceReference(Resource)
initialSelected0..1boolean
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
valueBooleanboolean
valueDecimaldecimal
valueIntegerinteger
valueDatedate
valueDateTimedateTime
valueTimetime
valueStringstring
valueUriuri
valueAttachmentAttachment
valueCodingCoding
valueQuantityQuantity
valueReferenceReference(Resource)
itemI0..*see (item)

Differential from Questionnaire

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
urlΣ0..1uri
identifierΣ0..*Identifier
versionΣ0..1string
nameΣ I0..1string
titleΣ0..1string
derivedFrom0..*canonical(Questionnaire)
statusΣ ?!1..1codeBinding
experimentalΣ0..1boolean
subjectTypeΣ0..*codeBinding
dateΣ0..1dateTime
publisherΣ0..1string
contactΣ0..*ContactDetail
description0..1markdown
useContextΣ0..*UsageContext
jurisdictionΣ0..*CodeableConceptBinding
purpose0..1markdown
copyright0..1markdown
approvalDate0..1date
lastReviewDate0..1date
effectivePeriodΣ I0..1Period
codeΣ0..*Coding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
linkId1..1string
definition0..1uri
codeI0..*Coding
prefix0..1string
text0..1string
type1..1codeBinding
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
question1..1string
operator1..1codeBinding
answerBooleanboolean
answerDecimaldecimal
answerIntegerinteger
answerDatedate
answerDateTimedateTime
answerTimetime
answerStringstring
answerCodingCoding
answerQuantityQuantity
answerReferenceReference(Resource)
enableBehaviorI0..1codeBinding
requiredI0..1boolean
repeatsI0..1boolean
readOnlyI0..1boolean
maxLengthI0..1integer
answerValueSetI0..1canonical(ValueSet)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
valueIntegerinteger
valueDatedate
valueTimetime
valueStringstring
valueCodingCoding
valueReferenceReference(Resource)
initialSelected0..1boolean
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
valueBooleanboolean
valueDecimaldecimal
valueIntegerinteger
valueDatedate
valueDateTimedateTime
valueTimetime
valueStringstring
valueUriuri
valueAttachmentAttachment
valueCodingCoding
valueQuantityQuantity
valueReferenceReference(Resource)
itemI0..*see (item)

Questionnaire
DefinitionA structured set of questions intended to guide the collection of answers from end-users. Questionnaires provide detailed control over order, presentation, phraseology and grouping to allow coherent, consistent data collection.
Cardinality0...*
AliasForm, CRF, Survey
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • que-2: The link ids for groups and questions must be unique within the questionnaire
    descendants().linkId.isDistinct()
  • que-0: Name should be usable as an identifier for the module by machine processing applications such as code generation
    name.matches('[A-Z]([A-Za-z0-9_]){0,254}')
Mappings
  • rim: Entity. Role, or Act
  • workflow: Definition
  • rim: Observation[moodCode=DEF]
Questionnaire.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Questionnaire.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Questionnaire.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Questionnaire.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Questionnaire.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Questionnaire.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.url
DefinitionAn absolute URI that is used to identify this questionnaire when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this questionnaire is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the questionnaire is stored on different servers.
Cardinality0...1
Typeuri
SummaryTrue
Requirements

… This is the id that will be used to link a QuestionnaireResponse to the Questionnaire the response is for.

Comments

The name of the referenced questionnaire can be conveyed using the http://hl7.org/fhir/StructureDefinition/display extension.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.url
  • w5: FiveWs.identifier
  • rim: .identifier[scope=BUSN;reliability=ISS]
Questionnaire.identifier
DefinitionA formal identifier that is used to identify this questionnaire when it is represented in other formats, or referenced in a specification, model, design or an instance.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

Allows externally provided and/or usable business identifiers to be easily associated with the module.

Comments

Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this questionnaire outside of FHIR, where it is not possible to use the logical URI.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Definition.identifier
  • w5: FiveWs.identifier
  • rim: .identifier
  • objimpl: no-gen-base
Questionnaire.version
DefinitionThe identifier that is used to identify this version of the questionnaire when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the questionnaire author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence.
Cardinality0...1
Typestring
SummaryTrue
Comments

There may be different questionnaire instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the questionnaire with the format [url]|[version].

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.version
  • w5: FiveWs.version
  • rim: N/A (to add?)
Questionnaire.name
DefinitionA natural language name identifying the questionnaire. This name should be usable as an identifier for the module by machine processing applications such as code generation.
Cardinality0...1
Typestring
SummaryTrue
Requirements

Support human navigation and code generation.

Comments

The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.title
DefinitionA short, descriptive, user-friendly title for the questionnaire.
Cardinality0...1
Typestring
SummaryTrue
Comments

This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.title
  • rim: .title
Questionnaire.derivedFrom
DefinitionThe URL of a Questionnaire that this Questionnaire is based on.
Cardinality0...*
Typecanonical(Questionnaire)
Requirements

Allows a Questionnaire to be created based on another Questionnaire.

Comments

see Canonical References

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.derivedFrom
  • rim: .outboundRelationship[typeCode=DRIV].target[classCode=OBS, moodCode=DEFN]
Questionnaire.status
DefinitionThe status of this questionnaire. Enables tracking the life-cycle of the content.
Cardinality1...1
Typecode
Binding

The lifecycle status of an artifact.

PublicationStatus (required)
ModifierTrue
SummaryTrue
Comments

Allows filtering of questionnaires that are appropriate for use versus not.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.status
  • w5: FiveWs.status
  • rim: .status
Questionnaire.experimental
DefinitionA Boolean value to indicate that this questionnaire is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.
Cardinality0...1
Typeboolean
SummaryTrue
Requirements

Enables experimental content to be developed following the same lifecycle that would be used for a production-level questionnaire.

Comments

Allows filtering of questionnaires that are appropriate for use versus not.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.experimental
  • w5: FiveWs.class
  • rim: N/A
Questionnaire.subjectType
DefinitionThe types of subjects that can be the subject of responses created for the questionnaire.
Cardinality0...*
Typecode
Binding

One of the resource types defined as part of this version of FHIR.

ResourceType (required)
SummaryTrue
Comments

If none are specified, then the subject is unlimited.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.subject[x]
  • rim: .outboundRelationship[typeCode=META].target[classCode=OBS, moodCode=DEFN, isCriterion=true].participation.role.classCode
Questionnaire.date
DefinitionThe date (and optionally time) when the questionnaire was published. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the questionnaire changes.
Cardinality0...1
TypedateTime
SummaryTrue
AliasRevision Date
Comments

Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the questionnaire. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.date
  • w5: FiveWs.recorded
  • rim: .participation[typeCode=AUT].time
Questionnaire.publisher
DefinitionThe name of the organization or individual that published the questionnaire.
Cardinality0...1
Typestring
SummaryTrue
Requirements

Helps establish the "authority/credibility" of the questionnaire. May also allow for contact.

Comments

Usually an organization but may be an individual. The publisher (or steward) of the questionnaire is the organization or individual primarily responsible for the maintenance and upkeep of the questionnaire. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the questionnaire. This item SHOULD be populated unless the information is available from context.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.publisher
  • w5: FiveWs.witness
  • rim: .participation[typeCode=AUT].role
Questionnaire.contact
DefinitionContact details to assist a user in finding and communicating with the publisher.
Cardinality0...*
TypeContactDetail
SummaryTrue
Comments

May be a web site, an email address, a telephone number, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.contact
  • rim: .participation[typeCode=CALLBCK].role
Questionnaire.description
DefinitionA free text natural language description of the questionnaire from a consumer's perspective.
Cardinality0...1
Typemarkdown
Comments

This description can be used to capture details such as why the questionnaire was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the questionnaire as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the questionnaire is presumed to be the predominant language in the place the questionnaire was created).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.description
  • rim: .text
Questionnaire.useContext
DefinitionThe content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate questionnaire instances.
Cardinality0...*
TypeUsageContext
SummaryTrue
Requirements

Assist in searching for appropriate content.

Comments

When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.useContext
  • rim: N/A (to add?)
Questionnaire.jurisdiction
DefinitionA legal or geographic region in which the questionnaire is intended to be used.
Cardinality0...*
TypeCodeableConcept
Binding

Countries and regions within which this artifact is targeted for use.

Jurisdiction ValueSet (extensible)
SummaryTrue
Comments

It may be possible for the questionnaire to be used in jurisdictions other than those for which it was originally designed or intended.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Definition.jurisdiction
  • rim: N/A (to add?)
Questionnaire.purpose
DefinitionExplanation of why this questionnaire is needed and why it has been designed as it has.
Cardinality0...1
Typemarkdown
Comments

This element does not describe the usage of the questionnaire. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this questionnaire.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.purpose
  • w5: FiveWs.why[x]
  • rim: .reasonCode.text
  • objimpl: no-gen-base
Questionnaire.copyright
DefinitionA copyright statement relating to the questionnaire and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the questionnaire.
Cardinality0...1
Typemarkdown
AliasLicense, Restrictions
Requirements

Consumers must be able to determine any legal restrictions on the use of the questionnaire and/or its content.

Comments

Systems are not required to have markdown support, so the text should be readable without markdown processing. The markdown syntax is GFM - see https://github.github.com/gfm/

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.copyright
  • rim: N/A (to add?)
  • objimpl: no-gen-base
Questionnaire.approvalDate
DefinitionThe date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.
Cardinality0...1
Typedate
Comments

The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.approvalDate
  • rim: .outboundRelationship[typeCode="SUBJ"].act[classCode=CACT;moodCode=EVN;code="approval"].effectiveTime
  • objimpl: no-gen-base
Questionnaire.lastReviewDate
DefinitionThe date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.
Cardinality0...1
Typedate
Requirements

Gives a sense of how "current" the content is. Resources that have not been reviewed in a long time may have a risk of being less appropriate/relevant.

Comments

If specified, this date follows the original approval date.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Definition.lastReviewDate
  • rim: .outboundRelationship[typeCode="SUBJ"; subsetCode="RECENT"].act[classCode=CACT;moodCode=EVN;code="review"].effectiveTime
  • objimpl: no-gen-base
Questionnaire.effectivePeriod
DefinitionThe period during which the questionnaire content was or is planned to be in active use.
Cardinality0...1
TypePeriod
SummaryTrue
Requirements

Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of the questionnaire are or are expected to be used instead.

Comments

The effective period for a questionnaire determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • workflow: Definition.effectivePeriod
  • rim: N/A (to add?)
  • objimpl: no-gen-base
Questionnaire.code
DefinitionAn identifier for this question or group of questions in a particular terminology such as LOINC.
Cardinality0...*
TypeCoding
Binding

Codes for questionnaires, groups and individual questions.

QuestionnaireQuestionCodes (example)
SummaryTrue
Requirements

Allows linking of the complete Questionnaire resources to formal terminologies. It's common for "panels" of questions to be identified by a code.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • rim: .code
Questionnaire.item
DefinitionA particular question, question grouping or display text that is part of the questionnaire.
Cardinality0...*
TypeBackboneElement
Comments

The content of the questionnaire is constructed from an ordered, hierarchical collection of items.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • que-9: Read-only can't be specified for "display" items
    type!='display' or readOnly.empty()
  • que-8: Initial values can't be specified for groups or display items
    (type!='group' and type!='display') or initial.empty()
  • que-6: Required and repeat aren't permitted for display items
    type!='display' or (required.empty() and repeats.empty())
  • que-5: Only 'choice' and 'open-choice' items can have answerValueSet
    (type ='choice' or type = 'open-choice' or type = 'decimal' or type = 'integer' or type = 'date' or type = 'dateTime' or type = 'time' or type = 'string' or type = 'quantity') or (answerValueSet.empty() and answerOption.empty())
  • que-4: A question cannot have both answerOption and answerValueSet
    answerOption.empty() or answerValueSet.empty()
  • que-3: Display items cannot have a "code" asserted
    type!='display' or code.empty()
  • que-10: Maximum length can only be declared for simple question types
    (type in ('boolean' | 'decimal' | 'integer' | 'string' | 'text' | 'url' | 'open-choice')) or maxLength.empty()
  • que-1: Group items must have nested items, display items cannot have nested items
    (type='group' implies item.empty().not()) and (type.trace('type')='display' implies item.trace('item').empty())
  • que-13: Can only have multiple initial values for repeating items
    repeats=true or initial.count() <= 1
  • que-11: If one or more answerOption is present, initial[x] must be missing
    answerOption.empty() or initial.empty()
  • que-12: If there are more than one enableWhen, enableBehavior must be specified
    enableWhen.count() > 2 implies enableBehavior.exists()
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=DEF]
Questionnaire.item.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Questionnaire.item.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.item.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.item.linkId
DefinitionAn identifier that is unique within the Questionnaire allowing linkage to the equivalent item in a QuestionnaireResponse resource.
Cardinality1...1
Typestring
Requirements

QuestionnaireResponse does not require omitted items to be included and may have some items that repeat, so linkage based on position alone is not sufficient.

Comments

This ''can'' be a meaningful identifier (e.g. a LOINC code) but is not intended to have any meaning. GUIDs or sequential numbers are appropriate here.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .id
Questionnaire.item.definition
DefinitionThis element is a URI that refers to an [ElementDefinition](elementdefinition.html) that provides information about this item, including information that might otherwise be included in the instance of the Questionnaire resource. A detailed description of the construction of the URI is shown in Comments, below. If this element is present then the following element values MAY be derived from the Element Definition if the corresponding elements of this Questionnaire resource instance have no value: * code (ElementDefinition.code) * type (ElementDefinition.type) * required (ElementDefinition.min) * repeats (ElementDefinition.max) * maxLength (ElementDefinition.maxLength) * answerValueSet (ElementDefinition.binding) * options (ElementDefinition.binding).
Cardinality0...1
Typeuri
Requirements

A common pattern is to define a set of data elements and then build multiple questionnaires for different circumstances to gather the data. This element provides traceability to the common definition and allows the content for the question to come from the underlying definition.

Comments

The uri refers to an ElementDefinition in a StructureDefinition and always starts with the canonical URL for the target resource. When referring to a StructureDefinition, a fragment identifier is used to specify the element definition by its id Element.id. E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x]. In the absence of a fragment identifier, the first/root element definition in the target is the matching element definition.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=INST].target[classCode=OBS, moodCode=DEF]
Questionnaire.item.code
DefinitionA terminology code that corresponds to this group or question (e.g. a code from LOINC, which defines many questions and answers).
Cardinality0...*
TypeCoding
Binding

Codes for questionnaires, groups and individual questions.

QuestionnaireQuestionCodes (example)
Requirements

Allows linking of groups of questions to formal terminologies.

Comments

The value may come from the ElementDefinition referred to by .definition.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • rim: .code
Questionnaire.item.prefix
DefinitionA short label for a particular group, question or set of display text within the questionnaire used for reference by the individual completing the questionnaire.
Cardinality0...1
Typestring
Aliaslabel
Requirements

Separating the label from the question text allows improved rendering. Also, instructions will often refer to specific prefixes, so there's a need for the questionnaire design to have control over what labels are used.

Comments

These are generally unique within a questionnaire, though this is not guaranteed. Some questionnaires may have multiple questions with the same label with logic to control which gets exposed. Typically, these won't be used for "display" items, though such use is not prohibited. Systems SHOULD NOT generate their own prefixes if prefixes are defined for any items within a Questionnaire.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: Not supported
Questionnaire.item.text
DefinitionThe name of a section, the text of a question or text content for a display item.
Cardinality0...1
Typestring
Comments

When using this element to represent the name of a section, use group type item and also make sure to limit the text element to a short string suitable for display as a section heading. Group item instructions should be included as a display type item within the group.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .text
Questionnaire.item.type
DefinitionThe type of questionnaire item this is - whether text for display, a grouping of other items or a particular type of data to be captured (string, integer, coded choice, etc.).
Cardinality1...1
Typecode
Binding

Distinguishes groups from questions and display text and indicates data type for questions.

QuestionnaireItemType (required)
Requirements

Defines the format in which the user is to be prompted for the answer.

Comments

Additional constraints on the type of answer can be conveyed by extensions. The value may come from the ElementDefinition referred to by .definition.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.enableWhen
DefinitionA constraint indicating that this item should only be enabled (displayed/allow answers to be captured) when the specified condition is true.
Cardinality0...*
TypeBackboneElement
ModifierTrue
Requirements

Allows questionnaires to adapt based on answers to other questions. E.g. If physical gender is specified as a male, no need to capture pregnancy history. Also allows conditional display of instructions or groups of questions.

Comments

If multiple repetitions of this extension are present, the item should be enabled when the condition for any of the repetitions is true. I.e. treat "enableWhen"s as being joined by an "or" clause. This element is a modifier because if enableWhen is present for an item, "required" is ignored unless one of the enableWhen conditions is met. When an item is disabled, all of its descendants are disabled, regardless of what their own enableWhen logic might evaluate to.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • que-7: If the operator is 'exists', the value must be a boolean
    operator = 'exists' implies (answer is Boolean)
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.enableWhen.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Questionnaire.item.enableWhen.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.item.enableWhen.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.item.enableWhen.question
DefinitionThe linkId for the question whose answer (or lack of answer) governs whether this item is enabled.
Cardinality1...1
Typestring
Comments

If multiple question occurrences are present for the same question (same linkId), then this refers to the nearest question occurrence reachable by tracing first the "ancestor" axis and then the "preceding" axis and then the "following" axis.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.enableWhen.operator
DefinitionSpecifies the criteria by which the question is enabled.
Cardinality1...1
Typecode
Binding

The criteria by which a question is enabled.

QuestionnaireItemOperator (required)
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.enableWhen.answer[x]
DefinitionA value that the referenced question is tested using the specified operator in order for the item to be enabled.
Cardinality1...1
Typeboolean
Binding

Allowed values to answer questions.

QuestionnaireAnswerCodes (example)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.enableBehavior
DefinitionControls how multiple enableWhen values are interpreted - whether all or any must be true.
Cardinality0...1
Typecode
Binding

Controls how multiple enableWhen values are interpreted - whether all or any must be true.

EnableWhenBehavior (required)
Comments

This element must be specified if more than one enableWhen value is provided.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.required
DefinitionAn indication, if true, that the item must be present in a "completed" QuestionnaireResponse. If false, the item may be skipped when answering the questionnaire.
Cardinality0...1
Typeboolean
Comments

Questionnaire.item.required only has meaning for elements that are conditionally enabled with enableWhen if the condition evaluates to true. If an item that contains other items is marked as required, that does not automatically make the contained elements required (though required groups must contain at least one child element). The value may come from the ElementDefinition referred to by .definition.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.repeats
DefinitionAn indication, if true, that the item may occur multiple times in the response, collecting multiple answers for questions or multiple sets of answers for groups.
Cardinality0...1
Typeboolean
Requirements

Items may be used to create set of (related) questions that can be repeated to give multiple answers to such a set.

Comments

If a question is marked as repeats=true, then multiple answers can be provided for the question in the corresponding QuestionnaireResponse. When rendering the questionnaire, it is up to the rendering software whether to render the question text for each answer repetition (i.e. "repeat the question") or to simply allow entry/selection of multiple answers for the question (repeat the answers). Which is most appropriate visually may depend on the type of answer as well as whether there are nested items.

The resulting QuestionnaireResponse will be populated the same way regardless of rendering - one 'question' item with multiple answer values.

The value may come from the ElementDefinition referred to by .definition.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.readOnly
DefinitionAn indication, when true, that the value cannot be changed by a human respondent to the Questionnaire.
Cardinality0...1
Typeboolean
Requirements

Allows certain information to be phrased (and rendered) as a question and an answer, while keeping users from changing it. May also be useful for preventing changes to pre-populated portions of a questionnaire, for calculated values, etc.

Comments

The value of readOnly elements can be established by asserting extensions for defaultValues, linkages that support pre-population and/or extensions that support calculation based on other answers.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.maxLength
DefinitionThe maximum number of characters that are permitted in the answer to be considered a "valid" QuestionnaireResponse.
Cardinality0...1
Typeinteger
Comments

For base64binary, reflects the number of characters representing the encoded data, not the number of bytes of the binary data. The value may come from the ElementDefinition referred to by .definition.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.answerValueSet
DefinitionA reference to a value set containing a list of codes representing permitted answers for a "choice" or "open-choice" question.
Cardinality0...1
Typecanonical(ValueSet)
Comments

LOINC defines many useful value sets for questionnaire responses. See LOINC Answer Lists. The value may come from the ElementDefinition referred to by .definition.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.answerOption
DefinitionOne of the permitted answers for a "choice" or "open-choice" question.
Cardinality0...*
TypeBackboneElement
Comments

This element can be used when the value set machinery of answerValueSet is deemed too cumbersome or when there's a need to capture possible answers that are not codes.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.answerOption.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Questionnaire.item.answerOption.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.item.answerOption.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.item.answerOption.value[x]
DefinitionA potential answer that's allowed as the answer to this question.
Cardinality1...1
Typeinteger
Binding

Allowed values to answer questions.

QuestionnaireAnswerCodes (example)
Comments

The data type of the value must agree with the item.type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.answerOption.initialSelected
DefinitionIndicates whether the answer value is selected when the list of possible answers is initially shown.
Cardinality0...1
Typeboolean
Comments

Use this instead of initial[v] if answerValueSet is present.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.initial
DefinitionOne or more values that should be pre-populated in the answer when initially rendering the questionnaire for user input.
Cardinality0...*
TypeBackboneElement
Requirements

In some workflows, having defaults saves time.

Comments

The user is allowed to change the value and override the default (unless marked as read-only). If the user doesn't change the value, then this initial value will be persisted when the QuestionnaireResponse is initially created. Note that initial values can influence results. The data type of initial[x] must agree with the item.type, and only repeating items can have more then one initial value.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.initial.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Questionnaire.item.initial.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.item.initial.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Questionnaire.item.initial.value[x]
DefinitionThe actual value to for an initial answer.
Cardinality1...1
Typeboolean
Binding

Allowed values to answer questions.

QuestionnaireAnswerCodes (example)
Comments

The type of the initial value must be consistent with the type of the item.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A - MIF rather than RIM level
Questionnaire.item.item
DefinitionText, questions and other groups to be nested beneath a question or group.
Cardinality0...*
Typesee (item)
Requirements

Reports can consist of complex nested groups.

Comments

There is no specified limit to the depth of nesting. However, Questionnaire authors are encouraged to consider the impact on the user and user interface of overly deep nesting.

Mappings
  • rim: .outboundRelationship[typeCode=COMP].target


FHIRMDSHL7v2
QuestionnaireRoD Questionnaire Schema

Genomics-QuestionnaireResponse

The Genomics QuestionnaireResponse is currently based on the UKCore resource, without any need for profiling.

The profile for the UKCore-QuestionnaireResponse is provided below for completeness.

No additional guidance has been provided on this page as there are no Genomic-specific considerations which need to be made. However, all QuestionnaireResponses submitted to the central service SHALL reference a Questionnaire definition in order to aid validation and presentation of the response content.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..1Identifier
basedOnΣ I0..*Reference(CarePlan | ServiceRequest)
partOfΣ I0..*Reference(Observation | Procedure)
questionnaireΣ0..1canonical(Questionnaire)
statusΣ ?!1..1codeBinding
subjectΣ I0..1Reference(Resource)
encounterΣ I0..1Reference(Encounter)
authoredΣ0..1dateTime
authorΣ I0..1Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)
sourceΣ I0..1Reference(Patient | Practitioner | PractitionerRole | RelatedPerson)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
linkId1..1string
definition0..1uri
text0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
valueBooleanboolean
valueDecimaldecimal
valueIntegerinteger
valueDatedate
valueDateTimedateTime
valueTimetime
valueStringstring
valueUriuri
valueAttachmentAttachment
valueCodingCoding
valueQuantityQuantity
valueReferenceReference(Resource)
item0..*see (item)
item0..*see (item)

Differential from QuestionnaireResponse

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..1Identifier
basedOnΣ I0..*Reference(CarePlan | ServiceRequest)
partOfΣ I0..*Reference(Observation | Procedure)
questionnaireΣ0..1canonical(Questionnaire)
statusΣ ?!1..1codeBinding
subjectΣ I0..1Reference(Resource)
encounterΣ I0..1Reference(Encounter)
authoredΣ0..1dateTime
authorΣ I0..1Reference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)
sourceΣ I0..1Reference(Patient | Practitioner | PractitionerRole | RelatedPerson)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
linkId1..1string
definition0..1uri
text0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
valueBooleanboolean
valueDecimaldecimal
valueIntegerinteger
valueDatedate
valueDateTimedateTime
valueTimetime
valueStringstring
valueUriuri
valueAttachmentAttachment
valueCodingCoding
valueQuantityQuantity
valueReferenceReference(Resource)
item0..*see (item)
item0..*see (item)

QuestionnaireResponse
DefinitionA structured set of questions and their answers. The questions are ordered and grouped into coherent subsets, corresponding to the structure of the grouping of the questionnaire being responded to.
Cardinality0...*
AliasForm, QuestionnaireAnswers
Comments

The QuestionnaireResponse contains enough information about the questions asked and their organization that it can be interpreted somewhat independently from the Questionnaire it is based on. I.e. You don't need access to the Questionnaire in order to extract basic information from a QuestionnaireResponse.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • rim: Observation[moodCode=EVN]
QuestionnaireResponse.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

QuestionnaireResponse.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
QuestionnaireResponse.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
QuestionnaireResponse.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
QuestionnaireResponse.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
QuestionnaireResponse.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
QuestionnaireResponse.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
QuestionnaireResponse.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
QuestionnaireResponse.identifier
DefinitionA business identifier assigned to a particular completed (or partially completed) questionnaire.
Cardinality0...1
TypeIdentifier
SummaryTrue
Requirements

Used for tracking, registration and other business purposes.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • rim: .id
QuestionnaireResponse.basedOn
DefinitionThe order, proposal or plan that is fulfilled in whole or in part by this QuestionnaireResponse. For example, a ServiceRequest seeking an intake assessment or a decision support recommendation to assess for post-partum depression.
Cardinality0...*
TypeReference(CarePlan | ServiceRequest)
SummaryTrue
Aliasorder
Requirements

Supports traceability of responsibility for the action and allows linkage of an action to the recommendations acted upon.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.basedOn
  • rim: .outboundRelationship[typeCode=FLFS].target
QuestionnaireResponse.partOf
DefinitionA procedure or observation that this questionnaire was performed as part of the execution of. For example, the surgery a checklist was executed as part of.
Cardinality0...*
TypeReference(Observation | Procedure)
SummaryTrue
Comments

Composition of questionnaire responses will be handled by the parent questionnaire having answers that reference the child questionnaire. For relationships to referrals, and other types of requests, use basedOn.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.partOf
  • rim: .inboundRelationship[typeCode=COMP].source[moodCode=EVN]
QuestionnaireResponse.questionnaire
DefinitionThe Questionnaire that defines and organizes the questions for which answers are being provided.
Cardinality0...1
Typecanonical(Questionnaire)
SummaryTrue
AliasForm
Requirements

Needed to allow editing of the questionnaire response in a manner that enforces the constraints of the original form.

Comments

If a QuestionnaireResponse references a Questionnaire, then the QuestionnaireResponse structure must be consistent with the Questionnaire (i.e. questions must be organized into the same groups, nested questions must still be nested, etc.).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.instantiates
  • rim: ./outboundRelationship[typeCode=INST]/target[classCode=OBS, moodCode=DEFN]
QuestionnaireResponse.status
DefinitionThe position of the questionnaire response within its overall lifecycle.
Cardinality1...1
Typecode
Binding

Lifecycle status of the questionnaire response.

QuestionnaireResponseStatus (required)
ModifierTrue
SummaryTrue
Requirements

The information on Questionnaire resources may possibly be gathered during multiple sessions and altered after considered being finished.

Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.status
  • w5: FiveWs.status
  • rim: .statusCode (also whether there's a revisionControlAct - and possibly mood to distinguish "in-progress" from "published)
QuestionnaireResponse.subject
DefinitionThe subject of the questionnaire response. This could be a patient, organization, practitioner, device, etc. This is who/what the answers apply to, but is not necessarily the source of information.
Cardinality0...1
TypeReference(Resource)
SummaryTrue
AliasPatient, Focus
Requirements

Allows linking the answers to the individual the answers describe. May also affect access control.

Comments

If the Questionnaire declared a subjectType, the resource pointed to by this element must be an instance of one of the listed types.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • rim: .participation[typeCode=SBJ].role
  • w5: FiveWs.subject
QuestionnaireResponse.encounter
DefinitionThe Encounter during which this questionnaire response was created or to which the creation of this record is tightly associated.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
Requirements

Provides context for the information that was captured. May also affect access control.

Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. A questionnaire that was initiated during an encounter but not fully completed during the encounter would still generally be associated with the encounter.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.encounter
  • w5: FiveWs.context
  • rim: .inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]
QuestionnaireResponse.authored
DefinitionThe date and/or time that this set of answers were last changed.
Cardinality0...1
TypedateTime
SummaryTrue
AliasDate Created, Date published, Date Issued, Date updated
Requirements

Clinicians need to be able to check the date that the information in the questionnaire was collected, to derive the context of the answers.

Comments

May be different from the lastUpdateTime of the resource itself, because that reflects when the data was known to the server, not when the data was captured.

This element is optional to allow for systems that might not know the value, however it SHOULD be populated if possible.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.occurrence[x]
  • w5: FiveWs.recorded
  • rim: .participation[typeCode=AUT].time
QuestionnaireResponse.author
DefinitionPerson who received the answers to the questions in the QuestionnaireResponse and recorded them in the system.
Cardinality0...1
TypeReference(Device | Practitioner | PractitionerRole | Patient | RelatedPerson | Organization)
SummaryTrue
AliasLaboratory, Service, Practitioner, Department, Company, Performer
Requirements

Need to know who interpreted the subject's answers to the questions in the questionnaire, and selected the appropriate options for answers.

Comments

Mapping a subject's answers to multiple choice options and determining what to put in the textual answer is a matter of interpretation. Authoring by device would indicate that some portion of the questionnaire had been auto-populated.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
QuestionnaireResponse.source
DefinitionThe person who answered the questions about the subject.
Cardinality0...1
TypeReference(Patient | Practitioner | PractitionerRole | RelatedPerson)
SummaryTrue
Requirements

When answering questions about a subject that is minor, incapable of answering or an animal, another human source may answer the questions.

Comments

If not specified, no inference can be made about who provided the data.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.source
  • rim: .participation[typeCode=INF].role
QuestionnaireResponse.item
DefinitionA group or question item from the original questionnaire for which answers are provided.
Cardinality0...*
TypeBackboneElement
Comments

Groups cannot have answers and therefore must nest directly within item. When dealing with questions, nesting must occur within each answer because some questions may have multiple answers (and the nesting occurs for each answer).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qrs-1: Nested item can't be beneath both item and answer
    (answer.exists() and item.exists()).not()
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]
QuestionnaireResponse.item.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
QuestionnaireResponse.item.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
QuestionnaireResponse.item.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
QuestionnaireResponse.item.linkId
DefinitionThe item from the Questionnaire that corresponds to this item in the QuestionnaireResponse resource.
Cardinality1...1
Typestring
Requirements

Items can repeat in the answers, so a direct 1..1 correspondence by position might not exist - requiring correspondence by identifier.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].id
QuestionnaireResponse.item.definition
DefinitionA reference to an [ElementDefinition](elementdefinition.html) that provides the details for the item.
Cardinality0...1
Typeuri
Requirements

A common pattern is to define a set of data elements, and then build multiple different questionnaires for different circumstances to gather the data. This element provides traceability to the common definition.

Comments

The ElementDefinition must be in a StructureDefinition, and must have a fragment identifier that identifies the specific data element by its id (Element.id). E.g. http://hl7.org/fhir/StructureDefinition/Observation#Observation.value[x].

There is no need for this element if the item pointed to by the linkId has a definition listed.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .outboundRelationship[typeCode=DEFN].target[classCode=OBS, moodCode=DEFN].code
QuestionnaireResponse.item.text
DefinitionText that is displayed above the contents of the group or as the text of the question being answered.
Cardinality0...1
Typestring
Requirements

Allows the questionnaire response to be read without access to the questionnaire.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .text
QuestionnaireResponse.item.answer
DefinitionThe respondent's answer(s) to the question.
Cardinality0...*
TypeBackboneElement
Comments

The value is nested because we cannot have a repeating structure that has variable type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .value[type=LIST_ANY]
QuestionnaireResponse.item.answer.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
QuestionnaireResponse.item.answer.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
QuestionnaireResponse.item.answer.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
QuestionnaireResponse.item.answer.value[x]
DefinitionThe answer (or one of the answers) provided by the respondent to the question.
Cardinality0...1
Typeboolean
Binding

Code indicating the response provided for a question.

QuestionnaireAnswerCodes (example)
Requirements

Ability to retain a single-valued answer to a question.

Comments

More complex structures (Attachment, Resource and Quantity) will typically be limited to electronic forms that can expose an appropriate user interface to capture the components and enforce the constraints of a complex data type. Additional complex types can be introduced through extensions. Must match the datatype specified by Questionnaire.item.type in the corresponding Questionnaire.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .item
QuestionnaireResponse.item.answer.item
DefinitionNested groups and/or questions found within this particular answer.
Cardinality0...*
Typesee (item)
Requirements

It is useful to have "sub-questions", questions which normally appear when certain answers are given and which collect additional details.

Mappings
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]
QuestionnaireResponse.item.item
DefinitionQuestions or sub-groups nested beneath a question or group.
Cardinality0...*
Typesee (item)
Requirements

Reports can consist of complex nested groups.

Mappings
  • rim: .outboundRelationship[typeCode=COMP].target[classCode=OBS, moodCode=EVN]


FHIRMDSHL7v2
QuestionnaireResponseRecord of DiscussionCON segments
QuestionnaireResponse.item.answerRoD questions with appropriate linkId: RoD - Patient category, Test type, RoD - Research opt out reason, RoD - Remote consent, RoD - Recording clinician, RoD - Responsible clinician, RoD - Patient choice status, RoD - Has research participation been discussed, RoD - SignatureCON (for OML, included in RoD, referenced from NTE-3)

Genomics-RelatedPerson

Used for linking Patients with other participants of a test order, e.g. in the case of proband and consultand within duo and trio testing.

For instances where clinical/demographic information for the related person are required, a Patient resource for the related person (consultand) SHOULD be included, with the Patient.link field referencing the RelatedPerson resource for the same individual. Elements duplicated across both the Patient and RelatedPerson for the same individual SHOULD in this case be captured within the Patient resource only. The RelatedPerson resource then references the proband Patient resource through the RelatedPerson.patient field.

A diagram illustrating the links between resources is provided below (Duo Scenario):

Further use cases surrounding the use of RelatedPerson are pending further Duo/Trio scenarios.

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-RelatedPerson UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
contactPreferenceI0..1Extension(Complex)
copyCorrespondenceIndicatorI0..1Extension(boolean)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
activeS Σ ?!0..1boolean
patientS Σ I1..1Reference(Patient)
relationshipS Σ0..*CodeableConceptBinding
nameS Σ0..*HumanName
id0..1string
extensionI0..*Extension
id0..1string
otherContactSystemI0..1Extension(CodeableConcept)
value0..1System.String
valueΣ0..1string
useΣ ?!0..1codeBinding
rankΣ0..1positiveInt
periodΣ I0..1Period
genderΣ0..1codeBinding
birthDateΣ0..1date
addressS Σ0..*Address
photoI0..*Attachment
periodI0..1Period
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
language1..1CodeableConceptBinding
preferred0..1boolean

Differential from RelatedPerson

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
contactPreferenceI0..1Extension(Complex)
copyCorrespondenceIndicatorI0..1Extension(boolean)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
activeS Σ ?!0..1boolean
patientS Σ I1..1Reference(Patient)
relationshipS Σ0..*CodeableConceptBinding
nameS Σ0..*HumanName
id0..1string
extensionI0..*Extension
id0..1string
otherContactSystemI0..1Extension(CodeableConcept)
value0..1System.String
valueΣ0..1string
useΣ ?!0..1codeBinding
rankΣ0..1positiveInt
periodΣ I0..1Period
genderΣ0..1codeBinding
birthDateΣ0..1date
addressS Σ0..*Address
photoI0..*Attachment
periodI0..1Period
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
language1..1CodeableConceptBinding
preferred0..1boolean

RelatedPerson
DefinitionInformation about a person that is involved in the care for a patient, but who is not the target of healthcare, nor has a formal responsibility in the care process.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • rim: role
RelatedPerson.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

RelatedPerson.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
RelatedPerson.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
RelatedPerson.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
RelatedPerson.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
RelatedPerson.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.extension:contactPreference
DefinitionThe preferred method of contact, contact times and written communication format given by a Patient or Related Person.
Cardinality0...1
TypeExtension(Complex)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.extension:copyCorrespondenceIndicator
DefinitionExtension carrying a boolean indicator showing that a patient's contact or related person SHALL be copied in to patient correspondence.
Cardinality0...1
TypeExtension(boolean)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.identifier
DefinitionIdentifier for a person within a particular scope.
Cardinality0...*
TypeIdentifier
SummaryTrue
Requirements

People are known by a variety of ids. Some institutions maintain several, and most collect identifiers for exchange with other organizations concerning the patient. Examples are national person identifier and local identifier.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: NK1-33
  • rim: .id
RelatedPerson.active
DefinitionWhether this related person record is in active use.
Cardinality0...1
Typeboolean
Must SupportTrue
ModifierTrue
SummaryTrue
Requirements

Need to be able to mark a related person record as not to be used, such as if it was created in error.

Comments

This element is labeled as a modifier because it may be used to mark that the resource was created in error.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • rim: .statusCode
RelatedPerson.patient
DefinitionThe patient this person is related to.
Cardinality1...1
TypeReference(Patient)
Must SupportTrue
SummaryTrue
Requirements

We need to know which patient this RelatedPerson is related to.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: PID-3
  • rim: scoper[classCode=PSN|ANM and determinerCode='INSTANCE']/playedRole[classCode='PAT']/id
RelatedPerson.relationship
DefinitionThe nature of the relationship between a patient and the related person.
Cardinality0...*
TypeCodeableConcept
Binding

The nature of the relationship between a patient and the related person.

UKCorePersonRelationshipType (extensible)
Must SupportTrue
SummaryTrue
Requirements

We need to know the relationship with the patient since it influences the interpretation of the information attributed to this person.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • v2: NK1-3
  • rim: code
RelatedPerson.name
DefinitionA name associated with the person.
Cardinality0...*
TypeHumanName
Must SupportTrue
SummaryTrue
Requirements

Related persons need to be identified by name, but it is uncommon to need details about multiple other names for that person.

Comments

Names may be changed, or repudiated, or people may have different names in different contexts. Names may be divided into parts of different type that have variable significance depending on context, though the division into parts does not always matter. With personal names, the different parts might or might not be imbued with some implicit meaning; various cultures associate different importance with the name parts and the degree to which systems must care about name parts around the world varies widely.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XPN
  • rim: EN (actually, PN)
  • servd: ProviderName
  • v2: NK1-2
  • rim: name
RelatedPerson.telecom
DefinitionA contact detail for the person, e.g. a telephone number or an email address.
Cardinality0...*
TypeContactPoint
Must SupportTrue
SummaryTrue
Requirements

People have (primary) ways to contact them in some way such as phone, email.

Comments

Person may have multiple ways to be contacted with different uses or applicable periods. May need to have options for contacting the person urgently, and also to help with identification.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • v2: NK1-5 / NK1-6 / NK1-40
  • rim: telecom
RelatedPerson.telecom.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
RelatedPerson.telecom.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.telecom.system
DefinitionTelecommunications form for contact point - what communications system is required to make use of the contact.
Cardinality0...1
Typecode
Binding

Telecommunications form for contact point.

ContactPointSystem (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.3
  • rim: ./scheme
  • servd: ./ContactPointType
RelatedPerson.telecom.system.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
RelatedPerson.telecom.system.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.telecom.system.extension:otherContactSystem
DefinitionOther contact system value which extends the system element in the ContactPoint datatype.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.telecom.system.value
DefinitionPrimitive value for code
Cardinality0...1
TypeSystem.String
RelatedPerson.telecom.value
DefinitionThe actual contact point details, in a form that is meaningful to the designated communication system (i.e. phone number or email address).
Cardinality0...1
Typestring
SummaryTrue
Requirements

Need to support legacy numbers that are not in a tightly controlled format.

Comments

Additional text data such as phone extension numbers, or notes about use of the contact are sometimes included in the value.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.1 (or XTN.12)
  • rim: ./url
  • servd: ./Value
RelatedPerson.telecom.use
DefinitionIdentifies the purpose for the contact point.
Cardinality0...1
Typecode
Binding

Use of contact point.

ContactPointUse (required)
ModifierTrue
SummaryTrue
Requirements

Need to track the way a person uses this contact, so a user can choose which is appropriate for their purpose.

Comments

Applications can assume that a contact is current unless it explicitly says that it is temporary or old.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XTN.2 - but often indicated by field
  • rim: unique(./use)
  • servd: ./ContactPointPurpose
RelatedPerson.telecom.rank
DefinitionSpecifies a preferred order in which to use a set of contacts. ContactPoints with lower rank values are more preferred than those with higher rank values.
Cardinality0...1
TypepositiveInt
SummaryTrue
Comments

Note that rank does not necessarily follow the order in which the contacts are represented in the instance.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: n/a
RelatedPerson.telecom.period
DefinitionTime period when the contact point was/is in use.
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • v2: N/A
  • rim: ./usablePeriod[type="IVL<TS>"]
  • servd: ./StartDate and ./EndDate
RelatedPerson.gender
DefinitionAdministrative Gender - the gender that the person is considered to have for administration and record keeping purposes.
Cardinality0...1
Typecode
Binding

The gender of a person used for administrative purposes.

AdministrativeGender (required)
SummaryTrue
Requirements

Needed for identification of the person, in combination with (at least) name and birth date.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: NK1-15
  • rim: administrativeGender
RelatedPerson.birthDate
DefinitionThe date on which the related person was born.
Cardinality0...1
Typedate
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: player.birthTime
RelatedPerson.address
DefinitionAddress where the related person can be contacted or visited.
Cardinality0...*
TypeAddress
Must SupportTrue
SummaryTrue
Requirements

Need to keep track where the related person can be contacted per postal mail or visited.

Comments

Note: address is intended to describe postal addresses for administrative purposes, not to describe absolute geographical coordinates. Postal addresses are often used as proxies for physical locations (also see the Location resource).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: XAD
  • rim: AD
  • servd: Address
  • v2: NK1-4
  • rim: addr
RelatedPerson.photo
DefinitionImage of the person.
Cardinality0...*
TypeAttachment
Requirements

Many EHR systems have the capability to capture an image of persons. Fits with newer social media usage too.

Comments

When providing a summary view (for example with Observation.value[x]) Attachment should be represented with a brief display text such as "Signed Procedure Consent".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • att-1: If the Attachment has data, it SHALL have a contentType
    data.empty() or contentType.exists()
Mappings
  • rim: n/a
  • v2: ED/RP
  • rim: ED
  • v2: OBX-5 - needs a profile
  • rim: player[classCode='PSN' and determinerCode='INSTANCE']/desc
RelatedPerson.period
DefinitionThe period of time during which this relationship is or was active. If there are no dates defined, then the interval is unknown.
Cardinality0...1
TypePeriod
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • w5: FiveWs.done[x]
  • rim: .effectiveTime
RelatedPerson.communication
DefinitionA language which may be used to communicate with about the patient's health.
Cardinality0...*
TypeBackboneElement
Requirements

If a related person does not speak the local language, interpreters may be required, so languages spoken and proficiency is an important things to keep track of both for patient and other persons of interest.

Comments

If no language is specified, this implies that the default local language is spoken. If you need to convey proficiency for multiple modes, then you need multiple RelatedPerson.Communication associations. If the RelatedPerson does not speak the default local language, then the Interpreter Required Standard can be used to explicitly declare that an interpreter is required.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: LanguageCommunication
RelatedPerson.communication.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
RelatedPerson.communication.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.communication.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
RelatedPerson.communication.language
DefinitionThe ISO-639-1 alpha 2 code in lower case for the language, optionally followed by a hyphen and the ISO-3166-1 alpha 2 code for the region in upper case; e.g. "en" for English, or "en-US" for American English versus "en-EN" for England English.
Cardinality1...1
TypeCodeableConcept
Binding

A language which may be used to communicate with the related person about the patient's health.

AllLanguages (required)
Requirements

Most systems in multilingual countries will want to convey language. Not all systems actually need the regional dialect.

Comments

The structure aa-BB with this exact casing is one the most widely used notations for locale. However not all systems actually code this but instead have it as free text. Hence CodeableConcept instead of code as the data type.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: player[classCode=PSN|ANM and determinerCode=INSTANCE]/languageCommunication/code
RelatedPerson.communication.preferred
DefinitionIndicates whether or not the patient prefers this language (over other languages he masters up a certain level).
Cardinality0...1
Typeboolean
Requirements

People that master multiple languages up to certain level may prefer one or more, i.e. feel more confident in communicating in a particular language making other languages sort of a fall back method.

Comments

This language is specifically identified for communicating healthcare information.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: preferenceInd


FHIRMDSHL7v2
RelatedPerson.relationshipPatient - Relationship to proband, Previous genomic report - Patient's relationship to requesting patientNK1-3

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_RelatedPerson_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-RelatedPerson-Genomics

Additional Guidance

patient

SHALL be provided. This SHOULD be a reference to the Patient resource and/or the identifier, e.g. NHS number, for the patient constituting the target of the relationship. This can be visualised using the nomenclature:

{Source (identifier)} is the {Relationship type (relationship)} of {Target (patient)}
'Ryanne Boulder' is the 'natural mother' of 'Fetus of Ryanne Boulder'

In this case the fetal identifier should be used in the patient element.

"patient": {
    "reference": "Patient/Patient-FoetusOfRyanneBoulder-Example",
    "identifier": {
      "system": "urn:oid:2.16.840.1.113883.2.1.3.2.4.18.24",
      "value": "FT-RWT13521",
      "assigner": {
        "identifier": {
          "system": "https://fhir.nhs.uk/Id/ods-organization-code",
          "value": "RAX"
        }
      }
    }
  },

identifier

SHALL be provided. This SHOULD be NHS number or local identifier (if NHS number is unavailable e.g. for non UK residents) for the source of the relationship. This can be visualised using the nomenclature:

{Source (identifier)} is the {Relationship type (relationship)} of {Target (patient)}
'Ryanne Boulder' is the 'natural mother' of 'Fetus of Ryanne Boulder'

In this case the Ryanne Boulder's identifier should be used for the RelatedPerson.identifier.

If a local identifier is used, an assigner SHALL be provided. The RelatedPerson.identifier field SHALL match the identifier used for a FamilyMemberHistory or Patient resource if these resources are about the same person.

   "identifier": [
      {
        "system": "https://fhir.nhs.uk/Id/nhs-number",
        "value": "9999999999"
      }
    ],

relationship

SHOULD use the UK Core bound ValueSet and SHOULD be present in all instances of RelatedPerson wherever possible.

"relationship":  [
        {
            "coding":  [
                {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                    "code": "SIS",
                    "display": "sister"
                }
            ]
        }
    ]

Genomics-ServiceRequest

Focal resource for test order messages. All additional information or resources SHOULD be linked back to the ServiceRequest or be referenced from the ServiceRequest directly.

ServiceRequests which have been updated post submission SHALL be accompanied by Provenance resources, referencing the ServiceRequest which detail when the resource was changed, who made the change and why.

An illustrative diagram of the links between ServiceRequests and other resources is provided below. Note: not all resource links are represented, to increase legibility of the diagram.

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-ServiceRequest UKCore trial-use

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
sourceOfServiceRequestI0..1Extension(CodeableConcept)
additionalContactI0..*Extension(Reference(Organization | Practitioner | PractitionerRole))
coverageI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
instantiatesCanonicalΣ0..*canonical(ActivityDefinition | PlanDefinition)
instantiatesUriΣ0..*uri
basedOnS Σ I0..*Reference(CarePlan | ServiceRequest | MedicationRequest)
replacesΣ I0..*Reference(ServiceRequest)
requisitionΣ0..1Identifier
statusS Σ ?!1..1codeBinding
intentS Σ ?!1..1codeBinding
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ0..1uriFixed Value
versionΣ0..1string
codeΣ0..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
priorityReasonI0..*Extension(CodeableConcept)
value0..1System.String
doNotPerformΣ ?!0..1boolean
codeS Σ0..1CodeableConceptBinding
orderDetailΣ I0..*CodeableConceptBinding
quantityQuantityQuantity
quantityRatioRatio
quantityRangeRange
subjectS Σ I1..1Reference(Patient | Group | Location | Device)
encounterΣ I0..1Reference(Encounter)
occurrenceDateTimedateTime
occurrencePeriodPeriod
occurrenceTimingTiming
asNeededBooleanboolean
asNeededCodeableConceptCodeableConcept
authoredOnS Σ0..1dateTime
requesterS Σ I0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
performerTypeΣ0..1CodeableConcept
performerΣ I0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)
locationCodeΣ0..*CodeableConcept
locationReferenceΣ I0..*Reference(Location)
reasonCodeΣ0..*CodeableConceptBinding
reasonReferenceΣ I0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)
insuranceI0..*Reference(Coverage | ClaimResponse)
supportingInfoI0..*Reference(Resource)
specimenΣ I0..*Reference(Specimen)
bodySiteΣ0..*CodeableConceptBinding
note0..*Annotation
patientInstructionΣ0..1string
relevantHistoryI0..*Reference(Provenance)

Differential from ServiceRequest

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
sourceOfServiceRequestI0..1Extension(CodeableConcept)
additionalContactI0..*Extension(Reference(Organization | Practitioner | PractitionerRole))
coverageI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
instantiatesCanonicalΣ0..*canonical(ActivityDefinition | PlanDefinition)
instantiatesUriΣ0..*uri
basedOnS Σ I0..*Reference(CarePlan | ServiceRequest | MedicationRequest)
replacesΣ I0..*Reference(ServiceRequest)
requisitionΣ0..1Identifier
statusS Σ ?!1..1codeBinding
intentS Σ ?!1..1codeBinding
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ0..1uriFixed Value
versionΣ0..1string
codeΣ0..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
id0..1string
priorityReasonI0..*Extension(CodeableConcept)
value0..1System.String
doNotPerformΣ ?!0..1boolean
codeS Σ0..1CodeableConceptBinding
orderDetailΣ I0..*CodeableConceptBinding
quantityQuantityQuantity
quantityRatioRatio
quantityRangeRange
subjectS Σ I1..1Reference(Patient | Group | Location | Device)
encounterΣ I0..1Reference(Encounter)
occurrenceDateTimedateTime
occurrencePeriodPeriod
occurrenceTimingTiming
asNeededBooleanboolean
asNeededCodeableConceptCodeableConcept
authoredOnS Σ0..1dateTime
requesterS Σ I0..1Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
performerTypeΣ0..1CodeableConcept
performerΣ I0..*Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)
locationCodeΣ0..*CodeableConcept
locationReferenceΣ I0..*Reference(Location)
reasonCodeΣ0..*CodeableConceptBinding
reasonReferenceΣ I0..*Reference(Condition | Observation | DiagnosticReport | DocumentReference)
insuranceI0..*Reference(Coverage | ClaimResponse)
supportingInfoI0..*Reference(Resource)
specimenΣ I0..*Reference(Specimen)
bodySiteΣ0..*CodeableConceptBinding
note0..*Annotation
patientInstructionΣ0..1string
relevantHistoryI0..*Reference(Provenance)

ServiceRequest
DefinitionA record of a request for service such as diagnostic investigations, treatments, or operations to be performed.
Cardinality0...*
Aliasdiagnostic request, referral, referral request, transfer of care request
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • prr-1: orderDetail SHALL only be present if code is present
    orderDetail.empty() or code.exists()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Request
  • v2: ORC
  • rim: Act[moodCode<=INT]
ServiceRequest.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

ServiceRequest.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
ServiceRequest.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
ServiceRequest.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
ServiceRequest.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
ServiceRequest.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.extension:sourceOfServiceRequest
DefinitionThis represents the source of referral.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.extension:additionalContact
DefinitionDetails of an additional contact, who should be contacted regarding questions arising from the service request.
Cardinality0...*
TypeExtension(Reference(Organization | Practitioner | PractitionerRole))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.extension:coverage
DefinitionThe funding category for the Service Request.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.identifier
DefinitionIdentifiers assigned to this order instance by the orderer and/or the receiver and/or order fulfiller.
Cardinality0...*
TypeIdentifier
SummaryTrue
Comments

The identifier.type element is used to distinguish between the identifiers assigned by the orderer (known as the 'Placer' in HL7 v2) and the producer of the observations in response to the order (known as the 'Filler' in HL7 v2). For further discussion and examples see the resource notes section below.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.identifier
  • w5: FiveWs.identifier
  • v2: ORC.2, ORC.3, RF1-6 / RF1-11,
  • rim: .identifier
  • quick: ClinicalStatement.identifier
ServiceRequest.instantiatesCanonical
DefinitionThe URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Cardinality0...*
Typecanonical(ActivityDefinition | PlanDefinition)
SummaryTrue
Comments

Note: This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.instantiatesCanonical
  • v2: Varies by domain
  • rim: .outboundRelationship[typeCode=DEFN].target
ServiceRequest.instantiatesUri
DefinitionThe URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this ServiceRequest.
Cardinality0...*
Typeuri
SummaryTrue
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.instantiatesUri
  • v2: Varies by domain
  • rim: .outboundRelationship[typeCode=DEFN].target
ServiceRequest.basedOn
DefinitionPlan/proposal/order fulfilled by this request.
Cardinality0...*
TypeReference(CarePlan | ServiceRequest | MedicationRequest)
Must SupportTrue
SummaryTrue
Aliasfulfills
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.basedOn
  • v2: ORC.8 (plus others)
  • rim: .outboundRelationship[typeCode=FLFS].target
ServiceRequest.replaces
DefinitionThe request takes the place of the referenced completed or terminated request(s).
Cardinality0...*
TypeReference(ServiceRequest)
SummaryTrue
Aliassupersedes, prior, renewed order
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.replaces
  • v2: Handled by message location of ORC (ORC.1=RO or RU)
  • rim: .outboundRelationship[typeCode=RPLC].target
ServiceRequest.requisition
DefinitionA shared identifier common to all service requests that were authorized more or less simultaneously by a single author, representing the composite or group identifier.
Cardinality0...1
TypeIdentifier
SummaryTrue
AliasgrouperId, groupIdentifier
Requirements

Some business processes need to know if multiple items were ordered as part of the same "requisition" for billing or other purposes.

Comments

Requests are linked either by a "basedOn" relationship (i.e. one request is fulfilling another) or by having a common requisition. Requests that are part of the same requisition are generally treated independently from the perspective of changing their state or maintaining them after initial creation.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.groupIdentifier
  • v2: ORC.4
  • rim: .inboundRelationship(typeCode=COMP].source[moodCode=INT].identifier
ServiceRequest.status
DefinitionThe status of the order.
Cardinality1...1
Typecode
Binding

The status of a service order.

RequestStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

The status is generally fully in the control of the requester - they determine whether the order is draft or active and, after it has been activated, competed, cancelled or suspended. States relating to the activities of the performer are reflected on either the corresponding event (see Event Pattern for general discussion) or using the Task resource.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.status
  • w5: FiveWs.status
  • v2: ORC.5,RF1-1
  • rim: .status
  • quick: Action.currentStatus
ServiceRequest.intent
DefinitionWhether the request is a proposal, plan, an original order or a reflex order.
Cardinality1...1
Typecode
Binding

The kind of service request.

RequestIntent (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.intent
  • w5: FiveWs.class
  • v2: N/A
  • rim: .moodCode (nuances beyond PRP/PLAN/RQO would need to be elsewhere)
ServiceRequest.category
DefinitionA code that classifies the service for searching, sorting and display purposes (e.g. "Surgical Procedure").
Cardinality0...*
TypeCodeableConcept
Binding

Classification of the requested service.

ServiceRequestCategoryCodes (example)
Must SupportTrue
SummaryTrue
Requirements

Used for filtering what service request are retrieved and displayed.

Comments

There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.

SlicingUnordered, Open, by coding.system(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • v2: RF1-5
  • rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="INT"].code
ServiceRequest.category:genomicsWholeCaseSequencing
DefinitionA code that classifies the service for Genomics, whether it is a Whole Case Genome Sequencing or non-Whole Genome Sequencing for cancer or rare diseases
Cardinality0...*
TypeCodeableConcept
Binding

Classification of the requested service.

UKCoreGenomeSequencingCategory (extensible)
SummaryTrue
Requirements

Used for filtering what service request are retrieved and displayed.

Comments

There may be multiple axis of categorization depending on the context or use case for retrieving or displaying the resource. The level of granularity is defined by the category concepts in the value set.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.class
  • v2: RF1-5
  • rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="INT"].code
ServiceRequest.category:genomicsWholeCaseSequencing.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
ServiceRequest.category:genomicsWholeCaseSequencing.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.category:genomicsWholeCaseSequencing.coding
DefinitionA reference to a code defined by a terminology system.
Cardinality0...*
TypeCoding
SummaryTrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

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. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • v2: C*E.1-8, C*E.10-22
  • rim: union(., ./translation)
  • orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
ServiceRequest.category:genomicsWholeCaseSequencing.coding.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
ServiceRequest.category:genomicsWholeCaseSequencing.coding.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.category:genomicsWholeCaseSequencing.coding.system
DefinitionThe identification of the code system that defines the meaning of the symbol in the code.
Cardinality0...1
Typeuri
SummaryTrue
Requirements

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

Comments

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 reference to some definition that establishes the system clearly and unambiguously.

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

https://fhir.hl7.org.uk/CodeSystem/UKCore-GenomeSequencingCategory

Mappings
  • rim: n/a
  • v2: C*E.3
  • rim: ./codeSystem
  • orim: fhir:Coding.system rdfs:subPropertyOf dt:CDCoding.codeSystem
ServiceRequest.category:genomicsWholeCaseSequencing.coding.version
DefinitionThe version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.
Cardinality0...1
Typestring
SummaryTrue
Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: C*E.7
  • rim: ./codeSystemVersion
  • orim: fhir:Coding.version rdfs:subPropertyOf dt:CDCoding.codeSystemVersion
ServiceRequest.category:genomicsWholeCaseSequencing.coding.code
DefinitionA symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).
Cardinality0...1
Typecode
SummaryTrue
Requirements

Need to refer to a particular code in the system.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: C*E.1
  • rim: ./code
  • orim: fhir:Coding.code rdfs:subPropertyOf dt:CDCoding.code
ServiceRequest.category:genomicsWholeCaseSequencing.coding.display
DefinitionA representation of the meaning of the code in the system, following the rules of the system.
Cardinality0...1
Typestring
SummaryTrue
Requirements

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

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • 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
ServiceRequest.category:genomicsWholeCaseSequencing.coding.userSelected
DefinitionIndicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).
Cardinality0...1
Typeboolean
SummaryTrue
Requirements

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.

Comments

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.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • 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 ]
ServiceRequest.category:genomicsWholeCaseSequencing.text
DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Cardinality0...1
Typestring
SummaryTrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: C*E.9. But note many systems use C*E.2 for this
  • rim: ./originalText[mediaType/code="text/plain"]/data
  • orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
ServiceRequest.priority
DefinitionIndicates how quickly the ServiceRequest should be addressed with respect to other requests.
Cardinality0...1
Typecode
Binding

Identifies the level of importance to be assigned to actioning the request.

RequestPriority (required)
Must SupportTrue
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.priority
  • w5: FiveWs.grade
  • v2: TQ1.9, RF1-2
  • rim: .priorityCode
ServiceRequest.priority.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
ServiceRequest.priority.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.priority.extension:priorityReason
DefinitionA SNOMED CT concept representing the reason a Service Request is urgent
Cardinality0...*
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ServiceRequest.priority.value
DefinitionPrimitive value for code
Cardinality0...1
TypeSystem.String
ServiceRequest.doNotPerform
DefinitionSet this to true if the record is saying that the service/procedure should NOT be performed.
Cardinality0...1
Typeboolean
ModifierTrue
SummaryTrue
Requirements

Used for do not ambulate, do not elevate head of bed, do not flush NG tube, do not take blood pressure on a certain arm, etc.

Comments

In general, only the code and timeframe will be present, though occasional additional qualifiers such as body site or even performer could be included to narrow the scope of the prohibition. If the ServiceRequest.code and ServiceRequest.doNotPerform both contain negation, that will reinforce prohibition and should not have a double negative interpretation.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.doNotPerform
  • rim: .actionNegationInd
ServiceRequest.code
DefinitionA code that identifies a particular service (i.e., procedure, diagnostic investigation, or panel of investigations) that have been requested.
Cardinality0...1
TypeCodeableConcept
Binding

A set of codes that define a procedure or a procedure with explicit context. Selected from the SNOMED CT UK coding system.

UKCoreProcedureCode (preferred)
Must SupportTrue
SummaryTrue
Aliasservice requested
Comments

Many laboratory and radiology procedure codes embed the specimen/organ system in the test order name, for example, serum or serum/plasma glucose, or a chest x-ray. The specimen might not be recorded separately from the test code.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.code
  • w5: FiveWs.what[x]
  • v2: PR1-3 / OBR-4 (varies by domain)
  • rim: .code
  • quick: Procedure.procedureCode
ServiceRequest.orderDetail
DefinitionAdditional details and instructions about the how the services are to be delivered. For example, and order for a urinary catheter may have an order detail for an external or indwelling catheter, or an order for a bandage may require additional instructions specifying how the bandage should be applied.
Cardinality0...*
TypeCodeableConcept
Binding

Codified order entry details which are based on order context.

UKCoreProcedureCode (preferred)
SummaryTrue
Aliasdetailed instructions
Comments

For information from the medical record intended to support the delivery of the requested services, use the supportingInformation element.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: NTE
  • rim: .code
  • quick: Procedure.procedureCode
ServiceRequest.quantity[x]
DefinitionAn amount of service being requested which can be a quantity ( for example $1,500 home modification), a ratio ( for example, 20 half day visits per month), or a range (2.0 to 1.8 Gy per fraction).
Cardinality0...1
TypeQuantity
SummaryTrue
Requirements

When ordering a service the number of service items may need to be specified separately from the the service item.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: NTE
  • rim: .quantity
ServiceRequest.subject
DefinitionOn whom or what the service is to be performed. This is usually a human patient, but can also be requested on animals, groups of humans or animals, devices such as dialysis machines, or even locations (typically for environmental scans).
Cardinality1...1
TypeReference(Patient | Group | Location | Device)
Must SupportTrue
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.subject
  • w5: FiveWs.subject[x]
  • v2: PID
  • rim: .participation[typeCode=SBJ].role
  • quick: ClinicalStatement.subject
  • w5: FiveWs.subject
ServiceRequest.encounter
DefinitionAn encounter that provides additional information about the healthcare context in which this request is made.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
Aliascontext
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.encounter
  • w5: FiveWs.context
  • v2: PV1
  • rim: .inboundRelationship(typeCode=COMP].source[classCode<=PCPR, moodCode=EVN]
  • quick: ClinicalStatement.encounter
ServiceRequest.occurrence[x]
DefinitionThe date/time at which the requested service should occur.
Cardinality0...1
TypedateTime
SummaryTrue
Aliasschedule
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.occurrence[x]
  • w5: FiveWs.planned
  • v2: TQ1/TQ2, OBR-7/OBR-8
  • rim: .effectiveTime
  • quick: Procedure.procedureSchedule
ServiceRequest.asNeeded[x]
DefinitionIf a CodeableConcept is present, it indicates the pre-condition for performing the service. For example "pain", "on flare-up", etc.
Cardinality0...1
Typeboolean
Binding

A coded concept identifying the pre-condition that should hold prior to performing a procedure. For example "pain", "on flare-up", etc.

SNOMEDCTMedicationAsNeededReasonCodes (example)
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: boolean: precondition.negationInd (inversed - so negationInd = true means asNeeded=false CodeableConcept: precondition.observationEventCriterion[code="Assertion"].value
  • quick: Proposal.prnReason.reason
ServiceRequest.authoredOn
DefinitionWhen the request transitioned to being actionable.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
AliasorderedOn
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.authoredOn
  • w5: FiveWs.recorded
  • v2: ORC.9, RF1-7 / RF1-9
  • rim: .participation[typeCode=AUT].time
  • quick: Proposal.proposedAtTime
ServiceRequest.requester
DefinitionThe individual who initiated the request and has responsibility for its activation.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)
Must SupportTrue
SummaryTrue
Aliasauthor, orderer
Comments

This not the dispatcher, but rather who is the authorizer. This element is not intended to handle delegation which would generally be managed through the Provenance resource.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.requester
  • w5: FiveWs.author
  • v2: ORC.12, PRT
  • rim: .participation[typeCode=AUT].role
  • quick: ClinicalStatement.statementAuthor
ServiceRequest.performerType
DefinitionDesired type of performer for doing the requested service.
Cardinality0...1
TypeCodeableConcept
Binding

Indicates specific responsibility of an individual within the care team, such as "Primary physician", "Team coordinator", "Caregiver", etc.

ParticipantRoles (example)
SummaryTrue
Aliasspecialty
Comments

This is a role, not a participation type. In other words, does not describe the task but describes the capacity. For example, “compounding pharmacy”, “psychiatrist” or “internal referral”.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.performerType
  • w5: FiveWs.actor
  • v2: PRT, RF!-3
  • rim: .participation[typeCode=PRF].role[scoper.determinerCode=KIND].code
ServiceRequest.performer
DefinitionThe desired performer for doing the requested service. For example, the surgeon, dermatopathologist, endoscopist, etc.
Cardinality0...*
TypeReference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)
SummaryTrue
Aliasrequest recipient
Comments

If multiple performers are present, it is interpreted as a list of alternative performers without any preference regardless of order. If order of preference is needed use the request-performerOrder extension. Use CareTeam to represent a group of performers (for example, Practitioner A and Practitioner B).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.performer
  • w5: FiveWs.actor
  • v2: PRT, Practitioner: PRD-2/PRD-7 where PRD-3 = RT; Organization: PRD-10 where PRD-3 = RT
  • rim: .participation[typeCode=PRF].role[scoper.determinerCode=INSTANCE]
ServiceRequest.locationCode
DefinitionThe preferred location(s) where the procedure should actually happen in coded or free text form. E.g. at home or nursing day care center.
Cardinality0...*
TypeCodeableConcept
Binding

A location type where services are delivered.

v3.ServiceDeliveryLocationRoleType (example)
SummaryTrue
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.actor
  • rim: .participation[typeCode=LOC].role[scoper.determinerCode=KIND].code
ServiceRequest.locationReference
DefinitionA reference to the the preferred location(s) where the procedure should actually happen. E.g. at home or nursing day care center.
Cardinality0...*
TypeReference(Location)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.actor
  • rim: .participation[typeCode=LOC].role[scoper.determinerCode=INSTANCE]
ServiceRequest.reasonCode
DefinitionAn explanation or justification for why this service is being requested in coded or textual form. This is often for billing purposes. May relate to the resources referred to in `supportingInfo`.
Cardinality0...*
TypeCodeableConcept
Binding

A set of codes that define a reason for a service request.

UKCoreServiceRequestReasonCode (preferred)
SummaryTrue
Comments

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. Use CodeableConcept.text element if the data is free (uncoded) text as shown in the CT Scan example.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.reasonCode
  • w5: FiveWs.why[x]
  • v2: ORC.16, RF1-10
  • rim: .reasonCode
ServiceRequest.reasonReference
DefinitionIndicates another resource that provides a justification for why this service is being requested. May relate to the resources referred to in `supportingInfo`.
Cardinality0...*
TypeReference(Condition | Observation | DiagnosticReport | DocumentReference)
SummaryTrue
Comments

This element represents why the referral is being made and may be used to decide how the service will be performed, or even if it will be performed at all. To be as specific as possible, a reference to Observation or Condition should be used if available. Otherwise when referencing DiagnosticReport it should contain a finding in DiagnosticReport.conclusion and/or DiagnosticReport.conclusionCode. When using a reference to DocumentReference, the target document should contain clear findings language providing the relevant reason for this service request. Use the CodeableConcept text element in ServiceRequest.reasonCode if the data is free (uncoded) text as shown in the CT Scan example.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.reasonReference
  • w5: FiveWs.why[x]
  • v2: ORC.16
  • rim: .outboundRelationship[typeCode=RSON].target
ServiceRequest.insurance
DefinitionInsurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be needed for delivering the requested service.
Cardinality0...*
TypeReference(Coverage | ClaimResponse)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.insurance
  • v2: IN1/IN2
  • rim: .outboundRelationship[typeCode=COVBY].target
ServiceRequest.supportingInfo
DefinitionAdditional clinical information about the patient or specimen that may influence the services or their interpretations. This information includes diagnosis, clinical findings and other observations. In laboratory ordering these are typically referred to as "ask at order entry questions (AOEs)". This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the amount of inspired oxygen for blood gas measurements.
Cardinality0...*
TypeReference(Resource)
AliasAsk at order entry question, AOE
Comments

To represent information about how the services are to be delivered use the instructions element.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.supportingInfo
  • v2: Accompanying segments
  • rim: .outboundRelationship[typeCode=PERT].target
ServiceRequest.specimen
DefinitionOne or more specimens that the laboratory procedure will use.
Cardinality0...*
TypeReference(Specimen)
SummaryTrue
Comments

Many diagnostic procedures need a specimen, but the request itself is not actually about the specimen. This element is for when the diagnostic is requested on already existing specimens and the request points to the specimen it applies to. Conversely, if the request is entered first with an unknown specimen, then the Specimen resource points to the ServiceRequest.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: SPM
  • rim: .participation[typeCode=SPC].role
ServiceRequest.bodySite
DefinitionAnatomic location where the procedure should be performed. This is the target site.
Cardinality0...*
TypeCodeableConcept
Binding

Codes describing anatomical locations. May include laterality.

SNOMEDCTBodyStructures (preferred)
SummaryTrue
Aliaslocation
Requirements

Knowing where the procedure is performed is important for tracking if multiple sites are possible.

Comments

Only used if not implicit in the code found in ServiceRequest.code. If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension procedure-targetBodyStructure.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM
  • rim: targetSiteCode
  • quick: Procedure.targetBodySite
ServiceRequest.note
DefinitionAny other notes and comments made about the service request. For example, internal billing notes.
Cardinality0...*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Request.note
  • v2: NTE
  • rim: .inboundRelationship(typeCode=SUBJ].source[classCode=ANNGEN, moodCode=EVN].value[xsi:type=ST]
  • quick: ClinicalStatement.additionalText
ServiceRequest.patientInstruction
DefinitionInstructions in terms that are understood by the patient or consumer.
Cardinality0...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: NTE
  • rim: .text
ServiceRequest.relevantHistory
DefinitionKey events in the history of the request.
Cardinality0...*
TypeReference(Provenance)
Comments

This might not include provenances for all versions of the request – only those deemed “relevant” or important. This SHALL NOT include the Provenance associated with this current version of the resource. (If that provenance is deemed to be a “relevant” change, it will need to be added as part of a later update. Until then, it can be queried directly as the Provenance that points to this version using _revinclude All Provenances should have some historical version of this Request as their subject.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.relevantHistory
  • v2: N/A
  • rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]

keyhumanseverityexpression
gen-1Extension must be present if priority is not routineerror(ServiceRequest.extension(priorityReason).exists() and ServiceRequest.priority!=routine) or ServiceRequest.priority=routine

FHIRMDSHL7v2
ServiceRequest.requesterRequester (more details in PractitionerRole resource mappings), PLCM activity - Commissioned service category code, Previous genomic report - Original requester full name, Previous genomic report - Original requester organisation ODS code, Previous genomic report - Original requester reason for request, Previous non genomic report - Original requester full name, Previous non genomic report - Original requester organisation ODS code, Previous non genomic report - Original requester reason for requestVarious ORC/STF segments
ServiceRequest.extension:additionalContactAdditional Contact (more details in PractitionerRole resource mappings)Various STF segments
ServiceRequest.subjectPatient (more details in Patient resource mappings), Patient - Is relativeFirst PID segment in OML message, relatives referenced through NK1 segments
ServiceRequest.identifierTest request - Test request id, PLCM activity - NGIS referral identifier, Previous genomic report - Report lab test numberORC-2, ORC-3
ServiceRequest.extension:coverageTest request - Payment statusIN1-15
ServiceRequest.authoredOnTest request - Date and time request sent, PLCM activity - Financial month, PLCM activity - Financial year, PLCM activity - Turnaround time (calendar days)ORC-9 (for TAT subtracted from OBR-7)
ServiceRequest.priorityTest request - Is urgentTQ1-9
ServiceRequest.extension:priorityReasonTest request - Urgency reasonN/A could possibly use TQ1-10
ServiceRequest.code.coding.systemTest request - Test Directory versionOBR-4.3
ServiceRequest.codeTest request - CI code, Test request - CITT code, PLCM activity - Service code, PLCM activity - Point of delivery code, PLCM activity - Local point of delivery code, PLCM activity - Test method codeOBR-4
ServiceRequest.orderDetailTest request - CI code for multipurpose CITT, Test request - Type of reanalysis, Test request - DNA storage informationNTE segment attached to OBR
ServiceRequest.reasonCodeTest request - Reason for testing, Test request - Reason for reanalysisOBR-13 segment linked to ORC
ServiceRequest.supportingInfoTest request - Detail of reason for reanalysis, Test request - Further informationNTE segments linked to OBR segment for reanalysis reason, Additional segments attached to ORC/OBR
ServiceRequest.occurrenceDateTimeTest request - Date report required byOBR-8
ServiceRequest.performerPLCM activity - ODS code of organisation commissioned to deliver requested testPRD-7 where PRD-1=RT
ServiceRequest.noteRaw specimen/biopsy - Sample to follow reasonNTE segment attached to ORC

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_ServiceRequest_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-ServiceRequest-Genomics

Additional Guidance

extension:additionalContact

Extension used for recording additional personnel who should be contacted regarding questions related to a test order. This is separate from the requester or reporting address.

The additional contact SHOULD be a reference to a PractitionerRole resource wherever possible and SHALL contain contact details for the practitioner.

Additionally, where are there multiple practitioners involved in providing care who need to be listed as contacts, the contact details for each practitioner (or service) SHOULD be specified through additional additionalContact entries.

{
    "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-AdditionalContact",
    "valueReference": {
        "reference": "PractitionerRole/PractitionerRole-AdditionalContact-Example"
    }
},

extension:coverage

SHALL be present for Genomic Order Management test orders. Extension for recording how work against the test order is being funded. The ValueSet bound to this extension is currently under review by the NHS England Genomics Informatics Working Advisory Group and subject to change.

{
    "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-Coverage",
    "valueCoding": {
        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-FundingCategory",
        "code": "nhs",
        "display": "NHS"
    }
}

identifier

Automatically assigned by the central service, though source systems MAY provide a local identifier for tracking within their own system, in which case the central order number is appended to the identifiers array.

    "identifier":  [
        {
            "system": "https://fhir.nhs.uk/Id/GMSOrder",
            "value": "ROA43728"
        }
    ],

basedOn

SHALL reference a parent request where this ServiceRequest is based on a previous request, e.g. in the case of reanalysis and cascade testing, or Germline Late tests in the Tumour First/Germline Late scenario.

"basedOn":  [
        {
            "reference": "ServiceRequest/ServiceRequest-NonWGSTestOrderForm-FatherOfFayMutlow-Example"
        }
    ],

status

SHALL be provided. ServiceRequests SHOULD be marked as 'draft' until submitted, after which they will be marked as 'active' automatically by the central GMS system.

A ServiceRequest may be marked as 'on-hold' if work against it cannot continue temporarily, e.g. due to certain prerequisite information not being provided. A ServiceRequest SHOULD be marked as 'revoked' if cancelled, either by the lab performing work against the order or at the request of the requesting clinician, though in each case a Provenance resource SHALL be provided to capture why the state change has occurred. The requesting clinician may also mark the ServiceRequest as entered-in-error, though implications for work already in progress needs to be investigated further.

A ServiceRequest SHOULD only be marked as completed by the requesting clinician upon receipt and review of the resulting DiagnosticReport.

For the full list of expected/supported ServiceRequest statuses, please see the table below:

Status Description Genomic workflow usage
Draft The request has been created but is not yet complete or ready for action. Saved but not submitted to central service (out of scope for Alpha).
Active The request is in force and ready to be acted upon. Submitted to central service.
On Hold The request (and any implicit authorization to act) has been temporarily withdrawn but is expected to resume in the future. Issue with the authorization for the test (potentially recoverable), not expected to be driven by on-hold statuses of Tasks.
Revoked The request (and any implicit authorization to act) has been terminated prior to the known full completion of the intended actions. No further activity should occur. Unrecoverable issue with order. Either used when the test is no longer needed or there is an is an unrecoverable failure with its fulfillment (driven by the requesting clinician). This status will propagate down to any Tasks which have not already moved into in-progress, Tasks not started will be marked with the status of cancelled.
Completed The activity described by the request has been fully performed. No further activity will occur. Completed order, marked by requestor once DiagnosticReport is received and accepted.
Entered in Error This request should never have existed and should be considered 'void'. (It is possible that real-world decisions were based on it. If real-world activity has occurred, the status should be "revoked" rather than "entered-in-error".) MAY be used for ServiceRequests created in error, can only be set if no Tasks have been started. If a Task has been moved out of its initial state, the status of Revoked SHOULD be used instead. This status will propagate down to Tasks, marking the tasks as entered-in-error.
Unknown The authoring/source system does not know which of the status values currently applies for this request. Note: This concept is not to be used for "other" - one of the listed statuses is presumed to apply, but the authoring/source system does not know which. Should not be used.
"status": "active",

intent

SHALL be provided. ServiceRequests SHOULD be marked as 'order' unless they have been raised by a lab in response to an existing ServiceRequest, in which case they SHOULD be marked as 'reflex-order'. For reflex orders, the ServiceRequest.basedOn field SHALL be populated with the original ServiceRequest, for traceability.

"intent": "order",

category

ServiceRequests SHOULD use the Genomics Sequencing Category ValueSet when categorising the test order in order to aid analytics (e.g. PLCM). This list is pending review from the Informatics Working Advisory Group, after which a full list of possible categorisations will be finalised.

"category":  [
        {
            "coding":  [
                {
                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-GenomeSequencingCategory",
                    "code": "rare-disease-non-wgs",
                    "display": "Rare Disease - Non-WGS"
                }
            ]
        }
    ],

priority

ServiceRequests marked as urgent (i.e. not routine) SHOULD populate the extension:priorityReason with why an urgent test is being requested. This SHOULD ideally be coded using SNOMED CT concepts. Multiple priorityReason extensions are allowed within a single ServiceRequest in order to aid post-coordination.

"priority": "urgent",
"_priority": {
        "extension" : [ 
            {
                "url" : "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-PriorityReason",
                "valueCodeableConcept" : {
                    "coding": [
                        {
                            "system": "http://snomed.info/sct",
                            "code": "722480002",
                            "display": "Chemotherapy started"
                        }
                    ]
                }
            }
        ]
    }

doNotPerform

For the purposes of Genomic Test Ordering, the doNotPerform field SHALL NOT be used. All ServiceRequests requests received by the system will be assumed to be orders for services/testing.

code

SHALL be provided. Code SHOULD contain the CI or CITT Test Directory code, currently available at https://www.england.nhs.uk/publication/national-genomic-test-directories/. There is currently no CodeSystem or queryable API for retrieving codes but work to address this is underway within the NHS England Genomics Unit.

Codes from the Genomic Test Directory SHOULD also specify the version number of the test directory at the time the test is being ordered, to ensure the test methods used are consistent with that version of the directory.

"code": {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory",
                "code": "R67.2",
                "display": "Monogenic hearing loss",
                "version": "7"
            }
        ]
    },

orderDetail

If multiple codes are being requested within one Test Order, these SHOULD be represented using the 'orderDetail' field, with the main indication captured using the 'code' field above. If completely separate pathways/samples etc. are required for processing against the codes, it is expected these would be requested via multiple ServiceRequests instead of a single ServiceRequest with multiple orderDetail codes. The exact cut-off for when orderDetail vs. multiple ServiceRequest should be used is still being investigated. An appropriate code(Panel codes) SHOULD come from the following NamingSystem: England-GenomicTestPanelCode

"orderDetail": [
    {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory",
                "code": "R67.1",
                "display": "Monogenic hearing loss"
            }
        ]
    }
],

subject

SHALL be provided. Reference to the associated Patient. This MAY be through a resource reference if the ID on the central service is known (or provided within the transaction bundle) or through NHS number where this is known and has been traced through PDS

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

occurrence[x]

If a result is required by a specific date, this MAY be indicated though occurrenceDateTime, though there is no guarantee from the GMS that the ServiceRequest will be processed in the time frame specified.

"occurrenceDateTime": "2023-08-25",

authoredOn

SHALL be populated by the client upon submission, either manually by the user or automatically by the system integrating with the central GMS.

"authoredOn": "2023-08-05",

requester

SHALL be populated on all ServiceRequests submitted to the central GMS. This SHALL reference a PractitionerRole resource also submitted to the system (either within a single transaction or previously POSTed).

"requester": {
        "reference": "PractitionerRole/PractitionerRole-GeneSmithENT-Example"
    },

performer

Allows a requester to assign processing of the ServiceRequest to a particular organization (e.g. a remote GLH). The performer field SHOULD be populated with the ODS code for the managing organization/GLH.

In the future state, ServiceRequests may be kept open, by not specifying a performer, allowing them to be picked up by the local GLH or otherwise routed based on by test routing (TBC).

"performer": [
        {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/ods-organization-code",
                "value": "RGT01"
            }
        }
    ]

reasonCode

reasonCode SHOULD be populated with the type of request being ordered e.g. Diagnostic, Carrier, Predictive, Stored DNA etc. The final list of applicable codes which can be selected is still under review. It is expected that a fixed list of SNOMED CT codes will be permissible, to allow appropriate categorisation by the central service.

This mapping is currently under review as the CI/CITT code is also technically the reason/indication for testing.

"reasonCode":  [
        {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "103693007",
                    "display": "Diagnostic procedure"
                }
            ]
        }
    ],

reasonReference

Reference SHOULD be associated to the primary condition being tested for. i.e,

"reasonReference": {
        "reference": "Condition/Condition-LungTumor-Example"
    },

supportingInfo

Any clinical information provided about the patient for whom the testing is being requested SHALL be referenced though the supportingInfo field, to ensure all the information relevant to the ServiceRequest can be easily retrieved. This includes Observations, Conditions, Procedures, FamilyMemberHistories etc.

This also includes resources related to family members included as part of testing (consultands), e.g. in Duo/Trio scenarios. In this instance, RelatedPerson and Patient resource references for the consultands SHALL be added to the supportingInfo array, as well as any clinical resources related to these individuals. This is to ensure the number of participants for a given test can be calculated correctly, e.g. through counting the number of RelatedPerson resources referenced from ServiceRequest.supportingInfo plus the subject of the ServiceRequest itself (the proband).

For WGS testing, where Records of Discussion are required in order to process the test, Consent resources SHOULD also be added to the supportingInfo array once available.

"supportingInfo":  [
        {
            "reference": "Observation/Observation-DiseaseStatus-Example"
        },
        {
            "reference": "Observation/Observation-GenomicEthnicity-Example"
        },
        {
            "reference": "Observation/Observation-NoPregnancy-Example"
        },
        {
            "reference": "FamilyMemberHistory/FamilyMemberHistory-NonConsanguinousUnion-Example"
        },
        {
            "reference": "Observation/Observation-NoTransplant-Example"
        },
        {
            "reference": "Observation/Observation-NoTransfusion-Example"
        },
        {
            "reference": "Condition/Condition-HearingLoss-Example"
        },
        {
            "reference": "RelatedPerson/RelatedPerson-AliceSmithamProbandMother-Example"
        },
        {
            "reference": "Patient/Patient-PheobeSmithamMother-Example"
        },
    ],

specimen

ServiceRequests where the required samples already exist, e.g. in the case where a specimen already in storage needs to be processed, SHOULD reference these samples through the ServiceRequest.specimen field. Where samples need to be collected to support testing, these SHOULD instead reference the ServiceRequest, through Specimen.request (i.e. the service request has prompted collection of the sample), and SHOULD also be referenced from within ServiceRequest.supportingInfo as per the guidance above (pending review). The referenced Specimen resources SHOULD either be contained within the test order transaction bundle or already exist on the central GMS.

In the case of Reanalysis or Reinterpretation tests, Specimens related to previous ServiceRequest are not required to be added to the new test request. The links from the previous ServiceRequest can be followed to identify the Specimens that resulted in the data being reanalysed, e.g. (reanalysis) ServiceRequest.basedOn -> (prior) ServiceRequest, (prior) ServiceRequest <- (original) Specimen.request

"specimen": [
        {
            "reference": "Specimen/Specimen-BloodSerum-Example"
        }
    ],

note

Any information which cannot be readily be structured SHOULD be entered into the note field, though prolific use of the field to capture clinical information which better fits in level 3/4 FHIR resources is discouraged.

"note":  [
        {
            "text": "No family history of genomic testing"
        }
    ]

Genomics-Specimen

Used to capture information on Samples which will undergo or have undergone processing for genomic testing.

Within FHIR R4, there is no way to capture location against a sample to aid tracking, one of the key requirements of the Genomic Medicine Service. Investigation of a possible solution through backporting the container.location element within R5 is currently being investigated. Until this backport is adopted by UK Core, the location of samples, including interactions to manage and track samples, will be performed through changes to Task resources generated on submission of a ServiceRequest.

A diagram illustrating the links between resources is provided below (Duo Scenario)

Note: links from ServiceRequest.supportingInfo to samples collected after submission are pending further investigation

Profile url FHIR Module Normative Status
https://fhir.hl7.org.uk/StructureDefinition/UKCore-Specimen UKCore trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
sampleCategoryI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
accessionIdentifierΣ0..1Identifier
statusS Σ ?!0..1codeBinding
typeS Σ0..1CodeableConceptBinding
subjectS Σ I0..1Reference(Patient | Group | Device | Substance | Location)
receivedTimeS Σ0..1dateTime
parentI0..*Reference(Specimen)
requestI0..*Reference(ServiceRequest)
id0..1string
specialHandlingI0..*Extension(CodeableConcept)
modifierExtensionΣ ?! I0..*Extension
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Patient | RelatedPerson)
referenceΣ I0..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
collectedDateTimedateTime
collectedPeriodPeriod
durationΣ I0..1Duration
quantityI0..1SimpleQuantity
method0..1CodeableConcept
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(BodyStructure)
codingΣ0..*Coding
textΣ0..1string
fastingStatusCodeableConceptCodeableConcept
fastingStatusDurationDuration
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
description0..1string
procedure0..1CodeableConcept
additiveI0..*Reference(Substance)
timeDateTimedateTime
timePeriodPeriod
id0..1string
deviceR5I0..1Extension(Reference(UKCoreDevice))
locationR5I0..1Extension(Reference(UKCoreLocation))
modifierExtensionΣ ?! I0..*Extension
identifierΣ0..*Identifier
description0..1string
type0..1CodeableConceptBinding
capacityI0..1SimpleQuantity
specimenQuantityI0..1SimpleQuantity
additiveCodeableConceptCodeableConcept
additiveReferenceReference(Substance)
conditionΣ0..*CodeableConceptBinding
note0..*Annotation

Differential from Specimen

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
sampleCategoryI0..1Extension(CodeableConcept)
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
accessionIdentifierΣ0..1Identifier
statusS Σ ?!0..1codeBinding
typeS Σ0..1CodeableConceptBinding
subjectS Σ I0..1Reference(Patient | Group | Device | Substance | Location)
receivedTimeS Σ0..1dateTime
parentI0..*Reference(Specimen)
requestI0..*Reference(ServiceRequest)
id0..1string
specialHandlingI0..*Extension(CodeableConcept)
modifierExtensionΣ ?! I0..*Extension
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(Patient | RelatedPerson)
referenceΣ I0..1string
typeΣ0..1uriBinding
identifierΣ0..1Identifier
displayΣ0..1string
collectedDateTimedateTime
collectedPeriodPeriod
durationΣ I0..1Duration
quantityI0..1SimpleQuantity
method0..1CodeableConcept
id0..1string
id0..1string
extensionI0..*Extension
url1..1uriFixed Value
valueReferenceReference(BodyStructure)
codingΣ0..*Coding
textΣ0..1string
fastingStatusCodeableConceptCodeableConcept
fastingStatusDurationDuration
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
description0..1string
procedure0..1CodeableConcept
additiveI0..*Reference(Substance)
timeDateTimedateTime
timePeriodPeriod
id0..1string
deviceR5I0..1Extension(Reference(UKCoreDevice))
locationR5I0..1Extension(Reference(UKCoreLocation))
modifierExtensionΣ ?! I0..*Extension
identifierΣ0..*Identifier
description0..1string
type0..1CodeableConceptBinding
capacityI0..1SimpleQuantity
specimenQuantityI0..1SimpleQuantity
additiveCodeableConceptCodeableConcept
additiveReferenceReference(Substance)
conditionΣ0..*CodeableConceptBinding
note0..*Annotation

Specimen
DefinitionA sample to be used for analysis.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • ukcore-spec-001: There SHALL be only one reference between `collection.collector` and the extension `collectionCollectorR5`
    collection.collector.reference.empty() or collection.collector.extension('http://hl7.org/fhir/5.0/StructureDefinition/extension-Specimen.collection.collector').empty()
Mappings
  • rim: Entity. Role, or Act
  • rim: Role[classCode=SPEC]
Specimen.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Specimen.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Specimen.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Specimen.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Specimen.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Specimen.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.extension:sampleCategory
DefinitionThis extension allows the recording of the category of a sample for use within Genomics, whether it is a tumour or germline sample.
Cardinality0...1
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.identifier
DefinitionId for specimen.
Cardinality0...*
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: SPM-2
  • rim: .id
Specimen.accessionIdentifier
DefinitionThe identifier assigned by the lab when accessioning specimen(s). This is not necessarily the same as the specimen identifier, depending on local lab procedures.
Cardinality0...1
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • v2: SPM-30 (v2.7+)
  • rim: .participation[typeCode=SBJ].act[classCode=ACSN, moodCode=EVN].id
Specimen.status
DefinitionThe availability of the specimen.
Cardinality0...1
Typecode
Binding

Codes providing the status/availability of a specimen.

SpecimenStatus (required)
Must SupportTrue
ModifierTrue
SummaryTrue
Comments

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • v2: SPM-20
  • rim: status
Specimen.type
DefinitionThe kind of material that forms the specimen.
Cardinality0...1
TypeCodeableConcept
Binding

A code from the SNOMED CT UK Clinical Terminology coding system

UKCoreSpecimenType (preferred)
Must SupportTrue
SummaryTrue
Comments

The type can change the way that a specimen is handled and drives what kind of analyses can properly be performed on the specimen. It is frequently used in diagnostic work flow decision making systems.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • w5: FiveWs.what[x]
  • v2: SPM-4 and possibly SPM-5
  • rim: .code
Specimen.subject
DefinitionWhere the specimen came from. This may be from patient(s), from a location (e.g., the source of an environmental sample), or a sampling of a substance or a device.
Cardinality0...1
TypeReference(Patient | Group | Device | Substance | Location)
Must SupportTrue
SummaryTrue
Requirements

Must know the subject context.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.subject[x]
  • rim: .scoper or .scoper.playsRole
  • w5: FiveWs.subject
Specimen.receivedTime
DefinitionTime when specimen was received for processing or testing.
Cardinality0...1
TypedateTime
Must SupportTrue
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.done[x]
  • v2: SPM-18
  • rim: .participation[typeCode=SBJ].act[code=SPCREC, moodCode=EVN].effectiveTime
Specimen.parent
DefinitionReference to the parent (source) specimen which is used when the specimen was either derived from or a component of another specimen.
Cardinality0...*
TypeReference(Specimen)
Comments

The parent specimen could be the source from which the current specimen is derived by some processing step (e.g. an aliquot or isolate or extracted nucleic acids from clinical samples) or one of many specimens that were combined to create a pooled sample.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .scoper (if parent) .player.scopesRole[classCode=SPEC].player (if child)
Specimen.request
DefinitionDetails concerning a service request that required a specimen to be collected.
Cardinality0...*
TypeReference(ServiceRequest)
Comments

The request may be explicit or implied such with a ServiceRequest that requires a blood draw.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.why[x]
  • v2: ORC? OBR-2/3?
  • rim: outboundRelationship[typeCode=FLFS].target
Specimen.collection
DefinitionDetails concerning the specimen collection.
Cardinality0...1
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: SPM-14
  • rim: .participation[typeCode=SBJ].act[classCode=SPECCOLLECT, moodCode=EVN]
Specimen.collection.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.extension:specialHandling
DefinitionSpecial handling during the collection, transport, or storage of the specimen.
Cardinality0...*
TypeExtension(CodeableConcept)
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector
DefinitionPerson who collected the specimen.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.actor
  • v2: PRT
  • rim: .participation[typeCode=PFM].role
Specimen.collection.collector.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.collector.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.extension:collectionCollectorR5
DefinitionPerson who collected the specimen. This is an R5 backport
Cardinality0...1
TypeExtension(Reference(Patient | RelatedPerson))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.extension:collectionCollectorR5.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.collector.extension:collectionCollectorR5.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.extension:collectionCollectorR5.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

http://hl7.org/fhir/5.0/StructureDefinition/extension-Specimen.collection.collector

Mappings
  • rim: N/A
Specimen.collection.collector.extension:collectionCollectorR5.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
TypeReference(Patient | RelatedPerson)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.reference
DefinitionA reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.
Cardinality0...1
Typestring
SummaryTrue
Comments

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.type
DefinitionThe expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent. The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).
Cardinality0...1
Typeuri
Binding

Aa resource (or, for logical models, the URI of the logical model).

ResourceType (extensible)
SummaryTrue
Comments

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collector.identifier
DefinitionAn identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.
Cardinality0...1
TypeIdentifier
SummaryTrue
Comments

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • rim: .identifier
Specimen.collection.collector.display
DefinitionPlain text narrative that identifies the resource in addition to the resource reference.
Cardinality0...1
Typestring
SummaryTrue
Comments

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.collected[x]
DefinitionTime when specimen was collected from subject - the physiologically relevant time.
Cardinality0...1
TypedateTime
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.init
  • v2: SPM-17
  • rim: .effectiveTime
Specimen.collection.duration
DefinitionThe span of time over which the collection of a specimen occurred.
Cardinality0...1
TypeDuration
SummaryTrue
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • drt-1: There SHALL be a code if there is a value and it SHALL be an expression of time. If system is present, it SHALL be UCUM.
    code.exists() implies ((system = %ucum) and value.exists())
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • rim: PQ, IVL<PQ> depending on the values
  • w5: FiveWs.init
Specimen.collection.quantity
DefinitionThe quantity of specimen collected; for instance the volume of a blood sample, or the physical measurement of an anatomic pathology sample.
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • v2: SPM-12
  • rim: .participation[typeCode=SBJ].role[classCode=SPEC].player.quantity
Specimen.collection.method
DefinitionA coded value specifying the technique that is used to perform the procedure.
Cardinality0...1
TypeCodeableConcept
Binding

The technique that is used to perform the procedure.

FHIRSpecimenCollectionMethod (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM-7
  • rim: .methodCode
Specimen.collection.bodySite
DefinitionAnatomical location from which the specimen was collected (if subject is a patient). This is the target site. This element is not used for environmental specimens.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing anatomical locations. May include laterality.

UKCoreSpecimenBodySite (preferred)
Comments

If the use case requires BodySite to be handled as a separate resource instead of an inline coded element (e.g. to identify and track separately) then use the standard extension bodySite.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM-8 and SPM-9
  • rim: .targetSiteCode
Specimen.collection.bodySite.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.bodySite.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.bodySite.extension:bodySiteReference
DefinitionAn extension to replicate the changes within R5 altering the data type of Specimen.collection.bodySite from CodeableConcept to CodeableReference (bodyStructure).
Cardinality0...1
TypeExtension(Reference(BodyStructure))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.bodySite.extension:bodySiteReference.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.collection.bodySite.extension:bodySiteReference.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.bodySite.extension:bodySiteReference.url
DefinitionSource of the definition for the extension code - a logical name or a URL.
Cardinality1...1
Typeuri
Comments

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

Fixed Value

https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-BodySiteReference

Mappings
  • rim: N/A
Specimen.collection.bodySite.extension:bodySiteReference.value[x]
DefinitionValue of extension - must be one of a constrained set of the data types (see [Extensibility](extensibility.html) for a list).
Cardinality1...1
TypeReference(BodyStructure)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Specimen.collection.bodySite.coding
DefinitionA reference to a code defined by a terminology system.
Cardinality0...*
TypeCoding
SummaryTrue
Requirements

Allows for alternative encodings within a code system, and translations to other code systems.

Comments

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. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
  • rim: CV
  • orim: fhir:Coding rdfs:subClassOf dt:CDCoding
  • v2: C*E.1-8, C*E.10-22
  • rim: union(., ./translation)
  • orim: fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding
Specimen.collection.bodySite.text
DefinitionA human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.
Cardinality0...1
Typestring
SummaryTrue
Requirements

The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

Comments

Very often the text is the same as a displayName of one of the codings.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: C*E.9. But note many systems use C*E.2 for this
  • rim: ./originalText[mediaType/code="text/plain"]/data
  • orim: fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
Specimen.collection.fastingStatus[x]
DefinitionAbstinence or reduction from some or all food, drink, or both, for a period of time prior to sample collection.
Cardinality0...1
TypeCodeableConcept
Binding

Codes describing the fasting status of the patient.

v2.0916 (extensible)
SummaryTrue
Requirements

Many diagnostic tests require fasting to facilitate accurate interpretation.

Comments

Representing fasting status using this element is preferred to representing it with an observation using a 'pre-coordinated code' such as LOINC 2005-7 (Calcium [Moles/​time] in 2 hour Urine --12 hours fasting), or using a component observation such asObservation.component code` = LOINC 49541-6 (Fasting status - Reported).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: OBR-
Specimen.processing
DefinitionDetails concerning processing and processing steps for the specimen.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .participation[typeCode=SBJ].act[code=SPCTRT, moodCode=EVN]
Specimen.processing.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.processing.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.processing.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.processing.description
DefinitionTextual description of procedure.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .text
Specimen.processing.procedure
DefinitionA coded value specifying the procedure used to process the specimen.
Cardinality0...1
TypeCodeableConcept
Binding

Type indicating the technique used to process the specimen.

SpecimenProcessingProcedure (example)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .code
Specimen.processing.additive
DefinitionMaterial used in the processing step.
Cardinality0...*
TypeReference(Substance)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • v2: SPM-6
  • rim: .participation[typeCode=CSM].role[classCode=ADTV].code
Specimen.processing.time[x]
DefinitionA record of the time or period when the specimen processing occurred. For example the time of sample fixation or the period of time the sample was in formalin.
Cardinality0...1
TypedateTime
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .effectiveTime
Specimen.container
DefinitionThe container holding the specimen. The recursive nature of containers; i.e. blood in tube in tray in rack is not addressed here.
Cardinality0...*
TypeBackboneElement
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .player.scopingRole[classCode=CONT].scoper
Specimen.container.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Specimen.container.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.container.extension:deviceR5
DefinitionThe device resource for the the container holding the specimen. If the container is in a holder then the referenced device will point to a parent device.
Cardinality0...1
TypeExtension(Reference(UKCoreDevice))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.container.extension:locationR5
DefinitionThe location of the container holding the specimen.
Cardinality0...1
TypeExtension(Reference(UKCoreLocation))
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.container.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Specimen.container.identifier
DefinitionId for container. There may be multiple; a manufacturer's bar code, lab assigned identifier, etc. The container ID may differ from the specimen id in some circumstances.
Cardinality0...*
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • v2: SAC-3
  • rim: .id
Specimen.container.description
DefinitionTextual description of the container.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .desc
Specimen.container.type
DefinitionThe type of container associated with the specimen (e.g. slide, aliquot, etc.).
Cardinality0...1
TypeCodeableConcept
Binding

Type of specimen container.

SpecimenContainerType (preferred)
Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM-27
  • rim: .code
Specimen.container.capacity
DefinitionThe capacity (volume or other measure) the container may contain.
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • v2: one of: SAC 16, SAC17 and SAC 20, or SAC 21 and SAC 20
  • rim: .quantity
Specimen.container.specimenQuantity
DefinitionThe quantity of specimen in the container; may be volume, dimensions, or other appropriate measurements, depending on the specimen type.
Cardinality0...1
TypeSimpleQuantity
Comments

The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • qty-3: If a code for the unit is present, the system SHALL also be present
    code.empty() or system.exists()
  • sqty-1: The comparator is not used on a SimpleQuantity
    comparator.empty()
Mappings
  • rim: n/a
  • v2: SN (see also Range) or CQ
  • rim: PQ, IVL<PQ>, MO, CO, depending on the values
  • v2: SAC-23 (value) SAC-24 (units
  • rim: .playedRole[classCode=CONT].quantity
Specimen.container.additive[x]
DefinitionIntroduced substance to preserve, maintain or enhance the specimen. Examples: Formalin, Citrate, EDTA.
Cardinality0...1
TypeCodeableConcept
Binding

Substance added to specimen container.

v2.0371 (example)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: SAC-27
  • rim: .scopesRole[classCode=ADTV].player
Specimen.condition
DefinitionA mode or state of being that describes the nature of the specimen.
Cardinality0...*
TypeCodeableConcept
Binding

Codes describing the state of the specimen.

UKCoreBiopsyState (extensible)
SummaryTrue
Requirements

The specimen condition can be used to assess its quality or appropriateness for a specific test.

Comments

Specimen condition is an observation made about the specimen. It's a point-in-time assessment. It can be used to assess its quality or appropriateness for a specific test.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • v2: SPM-24
Specimen.note
DefinitionTo communicate any details or issues about the specimen or during the specimen collection. (for example: broken vial, sent with patient, frozen).
Cardinality0...*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • v2: OBX
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value


FHIRMDSHL7v2
SpecimenSample/Biopsy inc germline, Extracted SpecimenSPM
Specimen.subjectFetus - Is sample for fetal or unregistered neonate, Raw specimen/biopsy - Family member provided byPID segment attached to SPM
Specimen.collection.quantityPLCM activity - Sample volume, Raw specimen/biopsy - VolumeSPM-12
Specimen.typePLCM activity - Sample category codeSPM-4
Specimen.identifier.assignerRaw specimen/biopsy - Id assigning authority ODS code (many), Raw specimen/biopsy - Is assigning authority a histopathology laboratory (many), Extracted specimen - Id assigning authority ODS code (many)SPM-2.1.2
Specimen.identifier.valueRaw specimen/biopsy - Id (many), Extracted specimen - Id (many)SPM-2
Specimen.container.identifierRaw specimen/biopsy - Sample well identifierSAC-3
Specimen.noteRaw specimen/biopsy - Location details (will use backported R5 container.location once released), Extracted specimen - Location details, Raw specimen/biopsy - Sample to follow reason, Raw specimen/biopsy - Additional specimen/biopsy information, Extracted specimen - Additional specimen informationSAC-15, NTE segment attached to ORC, OBX segments attached to SPM
Specimen.extension:sampleCategoryRaw specimen/biopsy - WGS specimen type categorySPM-5
Specimen.typeRaw specimen/biopsy - Type, Raw specimen/biopsy - Blood component, Extracted specimen - TypeSPM-4
Specimen.conditionRaw specimen/biopsy - StateSPM-24
Specimen.processingRaw specimen/biopsy - Sample preparation (submitted to GLH)Combination of SPM-6/SPM-24 or NTE segments if other processing
Specimen.collection.collectedDateTimeRaw specimen/biopsy - Obtained dateSPM-17
Specimen.receivedTimeRaw specimen/biopsy - Received dateSPM-18
Specimen.collection.extension:specimen-specialHandling.valueCoding.codeRaw specimen/biopsy - High risk reason, Raw specimen/biopsy - Option for products of conceptionSPM-16.2, SPM-15
Specimen.collection.bodySiteRaw specimen/biopsy - Biopsy siteSPM-8/SPM-9
Specimen.statusRaw specimen/biopsy - Sample to followN/A implied through absence of SPM segment in test order
Specimen.conditionExtracted specimen - StateSPM-24
Specimen.processing.timeDateTimeExtracted specimen - Extracted dateOBR-7 attached to processing procedure in SAC-30

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Specimen_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Specimen-Genomics

Additional Guidance

extension:sampleCategory

Allows the categorisation of a sample into either tumour or germline. Additional terms may be added upon review though the valueCodeableConcept.text field MAY be used as a free text representation if needed.

"extension": [
        {
            "url": "https://fhir.hl7.org.uk/StructureDefinition/Extension-UKCore-SampleCategory",
            "valueCodeableConcept": {
                "coding": [
                    {
                        "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-SampleCategory",
                        "code": "germline",
                        "display": "Germline"
                    }
                ]
            }
        }
    ]

identifier

Multiple identifiers MAY be assigned to a sample as it travels between labs. Each lab SHOULD append their local identifier to the identifier array if needed, ensuring either the system or assigner, is able to disambiguate any identifiers from possibly overlapping numbers from other organizations. Assigner is preferred in this case (see identifier example on the Genomics-Patient page for further guidance)

Note: accessionIdentifier is unused by the Genomic Medicine Service to facilitate movement of samples across organizational boundaries.

"identifier":  [
        {
            "system": "https://fhir.add.nhs.uk/Id/specimenId",
            "value": "RGT03135"
        }
    ],

status

If a Specimen has not been collected, the status SHOULD be marked as 'unavailable'. If the quality of the Specimen is such that it cannot be processed, the status SHOULD be 'unsatisfactory' (this is equivalent to a QC status of Failed). If the Specimen passes quality control, the status SHOULD be set as 'available

"status": "unsatisfactory",

type

The sample type, SNOMED CT preferred. Used to differentiate between raw and extracted (DNA) samples.

ConceptMaps for the allowed values for primary (raw) and final (extracted DNA) samples upon release of MDSv1.04, to aid identification of whether a sample is primary vs. final

"type": {
        "coding":  [
            {
                "system": "http://snomed.info/sct",
                "code": "445295009",
                "display": "Blood specimen with EDTA"
            }
        ]
    },

subject

SHALL be provided. This SHOULD be a reference to the Patient resource or the identifier, NHS number, for the patient.

Samples collected from a Fetus SHOULD reference a Patient resource for the Fetus. This should then be linked to relevant maternal/paternal resources through the RelatedPerson resource. Further information can be found on the Fetus Management clinical scenario. It is not envisaged that samples would need to be linked to more than one person e.g. both fetus and mother, though this assumption will be tested within the Alpha phase of the Genomic Medicine Service.

"subject": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

receivedTime

SHOULD be updated upon receipt at a destination lab

"receivedTime": "2023-09-18T18:30:00Z"

parent

If a sample has been split into multiple parts, such as DNA being extracted from a primary sample, each SHOULD be represented using an additional Specimen resource, referencing the parent sample through the parent element.

The central Order Management broker will only create Tasks for Specimen resources which do not have a parent element, i.e. primary samples. If required, clients can create Tasks for processing of derivative samples manually.

"parent": [
        {
            "reference": "Specimen/Specimen-BloodEDTA-Example"
        }
    ],

request

SHALL be provided. This SHOULD be a reference to the request which initiated collection of the sample. SHALL NOT be updated if the sample is used for another test e.g. for re-analysis. In the case that a Specimen needs to be processed as part of a new request, e.g. using a sample in storage,the ServiceRequest SHALL reference the pre-existing sample via ServiceRequest.specimen.

"request":  [
        {
            "reference": "ServiceRequest/ServiceRequest-NonWGSTestOrderForm-Example"
        }
    ]

collection

Additional information which can be collected about the circumstances under which as sample was collected, if relevant. This include extensions for specialHandling of the sample, e.g. due to high risk of infection, as well as an extension to bodySite to extend the coding to a BodyStructure reference, for more detailed collection of structural information e.g. where tumour morphology and topography need to be collected.

Where the collector is an Organization, or where the individual is not known, ODS codes MAY be used as identifiers in place of SDS-User-IDs. However, if referencing a resource, the PractitionerRole resource SHOULD still be referenced. In this case the PractitionerRole.identifier and PractitionerRole.practitioner reference would not be filled, leaving only the reference to an Organization from PractitionerRole.organization.

Note on quanitities

The Specimen.collection.quantity is the amount of the sample collected at collection time. This quantity does not change as the sample is processed.

The Specimen.container.specimenQuantity is the amount of sample remaining in a container, this is equivalent to GEL 1001 banked volume. This value should be updated as the specimen is used.

If a specimen is split, additional specimen resources SHOULD be created (referencing the parent specimen), with individual container.specimenQuantity values.

"collection": {
        "collector": {
            "identifier": {
                "system": "https://fhir.nhs.uk/Id/sds-user-id",
                "value": "999999"
            }
        },
        "collectedDateTime": "2022-07-11T09:00:00Z",
        "quantity": {
            "system": "http://unitsofmeasure.org",
            "code": "mL",
            "value": 2.5
        },
        "method": {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "129300006",
                    "display": "Puncture - action"
                }
            ]
        },
        "bodySite": {
            "coding":  [
                {
                    "system": "http://snomed.info/sct",
                    "code": "14975008",
                    "display": "Forearm structure (body structure)"
                }
            ]
        }
    },

processing

SHOULD be updated if processing occurs on the sample which affects later use, e.g. additives added

"processing": [
    {
      "description": "Acidify to pH < 3.0 with 6 N HCl.",
      "procedure": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0373",
            "code": "ACID"
          }
        ]
      },
      "additive": [
        {
          "display": "6 N HCl"
        }
      ],
      "timeDateTime": "2015-08-18T08:10:00Z"
    }
  ],

container

The UK Core STU3 version of Specimen backports the R5 changes to the container BackboneElement to support capturing of storage location for a sample (through container.location) and recursive capture of device identifiers (e.g. tube, well, rack, freezer through container.device).

Additional examples/guidance will be provided within this IG once use of the fields has been appropriately tested.

Sample tracking information SHOULD be added to Tasks acting on Specimen resources, e.g. Tasks marked SamplePreparation or SampleProcessing, on either the output or input elements. This information MAY include consignment number, destination, date sent etc.

"container":  [
        {
            "extension":  [
                {
                    "url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Specimen.container.location",
                    "valueReference": {
                            "reference": "Location/Location-NTGLHFridge-Example"
                    }
                }
            ]
        }
    ]

condition

Used to record the condition of a specimen. Within Genomics, SHOULD be used to record the fixed/frozen state, using the UK Core bound ValueSet.

"condition":  [
        {
            "coding":  [
                {
                    "system": "https://fhir.hl7.org.uk/CodeSystem/UKCore-BiopsyState",
                    "code": "fresh-frozen",
                    "display": "Fresh Frozen"
                }
            ]
        }
    ]

Genomics-Subscription

The Genomics Subscription is currently pending Clinical and Technical Assurance of the base UKCore resource. Once this profile becomes active in UKCore its suitability for use and need for profiling within Genomics will be assessed.

The profile for the NHSDigital/England Subscription is provided below for completeness.

In the Alpha build of the Genomic Medicine Service, MESH/email will be used as the primary notification procedure though a FHIR native solution is being investigated.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/Subscription HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
statusΣ ?!1..1codeBinding
contactΣ I0..*ContactPoint
endΣ0..1instant
reasonΣ1..1string
criteriaΣ1..1string
errorΣ0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
typeΣ1..1codeBinding
endpointΣ0..1url
payloadΣ0..1codeBinding
headerΣ0..*string

Differential from Subscription

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
statusΣ ?!1..1codeBinding
contactΣ I0..*ContactPoint
endΣ0..1instant
reasonΣ1..1string
criteriaΣ1..1string
errorΣ0..1string
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
typeΣ1..1codeBinding
endpointΣ0..1url
payloadΣ0..1codeBinding
headerΣ0..*string

Subscription
DefinitionThe subscription resource is used to define a push-based subscription from a server to another system. Once a subscription is registered with the server, the server checks every resource that is created or updated, and if the resource matches the given criteria, it sends a message on the defined "channel" so that another system can take an appropriate action.
Cardinality0...*
AliasWebHook, Hook, Routing Rule
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Subscription.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Subscription.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Subscription.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Subscription.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Subscription.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Subscription.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Subscription.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Subscription.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Subscription.status
DefinitionThe status of the subscription, which marks the server state for managing the subscription.
Cardinality1...1
Typecode
Binding

The status of a subscription.

SubscriptionStatus (required)
ModifierTrue
SummaryTrue
Comments

A client can only submit subscription resources in the requested or off state. Only the server can move a subscription from requested to active, and then to error. Either the server or the client can turn a subscription off.

This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
Subscription.contact
DefinitionContact details for a human to contact about the subscription. The primary use of this for system administrator troubleshooting.
Cardinality0...*
TypeContactPoint
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • cpt-2: A system is required if a value is provided.
    value.empty() or system.exists()
Mappings
  • rim: n/a
  • v2: XTN
  • rim: TEL
  • servd: ContactPoint
  • w5: FiveWs.subject[x]
  • w5: FiveWs.subject
Subscription.end
DefinitionThe time for the server to turn the subscription off.
Cardinality0...1
Typeinstant
SummaryTrue
Comments

The server is permitted to deviate from this time but should observe it.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.done[x]
Subscription.reason
DefinitionA description of why this subscription is defined.
Cardinality1...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.why[x]
Subscription.criteria
DefinitionThe rules that the server should use to determine when to generate notifications for this subscription.
Cardinality1...1
Typestring
SummaryTrue
Comments

The rules are search criteria (without the [base] part). Like Bundle.entry.request.url, it has no leading "/".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Subscription.error
DefinitionA record of the last error that occurred when the server processed a notification.
Cardinality0...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Subscription.channel
DefinitionDetails where to send notifications when resources are received that meet the criteria.
Cardinality1...1
TypeBackboneElement
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Subscription.channel.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Subscription.channel.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Subscription.channel.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Subscription.channel.type
DefinitionThe type of channel to send notifications on.
Cardinality1...1
Typecode
Binding

The type of method used to execute a subscription.

SubscriptionChannelType (required)
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Subscription.channel.endpoint
DefinitionThe url that describes the actual end-point to send messages to.
Cardinality0...1
Typeurl
SummaryTrue
Comments

For rest-hook, and websocket, the end-point must be an http: or https: URL; for email, a mailto: url, for sms, a tel: url, and for message the endpoint can be in any form of url the server understands (usually, http: or mllp:). The URI is allowed to be relative; in which case, it is relative to the server end-point (since there may be more than one, clients should avoid using relative URIs).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Subscription.channel.payload
DefinitionThe mime type to send the payload in - either application/fhir+xml, or application/fhir+json. If the payload is not present, then there is no payload in the notification, just a notification. The mime type "text/plain" may also be used for Email and SMS subscriptions.
Cardinality0...1
Typecode
Binding

The mime type of an attachment. Any valid mime type is allowed.

Mime Types (required)
SummaryTrue
Comments

Sending the payload has obvious security implications. The server is responsible for ensuring that the content is appropriately secured.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Subscription.channel.header
DefinitionAdditional headers / information to send as part of the notification.
Cardinality0...*
Typestring
SummaryTrue
Comments

Exactly what these mean depend on the channel type. They can convey additional information to the recipient and/or meet security requirements; for example, support of multiple headers in the outgoing notifications for rest-hook type subscriptions.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a


FHIRMDSHL7v2

Genomics-ResearchSubject

The need for a Genomics ResearchSubject is currently under review.

The profile for the international FHIR ResearchSubject is provided below for completeness.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/ResearchSubject HL7 International trial-use

The CareConnect profile will be uplifted to the R4 UKCore in a future release

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
statusΣ ?!1..1codeBinding
periodΣ I0..1Period
studyΣ I1..1Reference(ResearchStudy)
individualΣ I1..1Reference(Patient)
assignedArm0..1string
actualArm0..1string
consentI0..1Reference(Consent)

Differential from ResearchSubject

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifierΣ0..*Identifier
statusΣ ?!1..1codeBinding
periodΣ I0..1Period
studyΣ I1..1Reference(ResearchStudy)
individualΣ I1..1Reference(Patient)
assignedArm0..1string
actualArm0..1string
consentI0..1Reference(Consent)

ResearchSubject
DefinitionA physical entity which is the primary unit of operational and/or administrative interest in a study.
Cardinality0...*
AliasStudy Subject
Comments

Need to make sure we encompass public health studies.

Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
Mappings
  • rim: Entity. Role, or Act
  • BRIDG5.1: StudySubject
  • v2: OBX
  • rim: Observation[classCode=CLNTRL, moodCode=EVN]
ResearchSubject.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

ResearchSubject.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
ResearchSubject.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
ResearchSubject.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
ResearchSubject.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
ResearchSubject.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
ResearchSubject.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ResearchSubject.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
ResearchSubject.identifier
DefinitionIdentifiers assigned to this research subject for a study.
Cardinality0...*
TypeIdentifier
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • w5: FiveWs.identifier
  • BRIDG5.1: StudySubject > Subject.identifier
  • rim: .identifier
ResearchSubject.status
DefinitionThe current state of the subject.
Cardinality1...1
Typecode
Binding

Indicates the progression of a study subject through a study.

ResearchSubjectStatus (required)
ModifierTrue
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • w5: FiveWs.status
  • BRIDG5.1: StudySubject.statusCode
  • rim: .status
ResearchSubject.period
DefinitionThe dates the subject began and ended their participation in the study.
Cardinality0...1
TypePeriod
SummaryTrue
Aliastiming
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • w5: FiveWs.planned
  • BRIDG5.1: PerformedStudySubjectMilestone.studyReferenceDateRange
ResearchSubject.study
DefinitionReference to the study the subject is participating in.
Cardinality1...1
TypeReference(ResearchStudy)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • BRIDG5.1: StudySubjectProtocolVersionRelationship
ResearchSubject.individual
DefinitionThe record of the person or animal who is involved in the study.
Cardinality1...1
TypeReference(Patient)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • BRIDG5.1: StudySubject
ResearchSubject.assignedArm
DefinitionThe name of the arm in the study the subject is expected to follow as part of this study.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • BRIDG5.1: Arm > ExperimentalUnit > BiologicEntity > Subject > StudySubject
ResearchSubject.actualArm
DefinitionThe name of the arm in the study the subject actually followed as part of this study.
Cardinality0...1
Typestring
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • BRIDG5.1: Arm > ExperimentalUnit > BiologicEntity > Subject > StudySubject
ResearchSubject.consent
DefinitionA record of the patient's informed agreement to participate in the study.
Cardinality0...1
TypeReference(Consent)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • BRIDG5.1: ResearchStudy.consent is related to PerformedStudySubjectMilestone.informedConsentIndicator in that the informedConsentIndicator can be derived from the data in the Consent resource.



FHIRMDSHL7v2

Genomics-Task

The core workflow resource for managing processing of a ServiceRequest from order through to delivery of a DiagnosticReport and completion is Task. Task tracking is a core requirement of the central Genomic Medicine Service.

Each ServiceRequest submitted will instantiate a series of High Level Tasks, which MAY be assigned to different organizations for managing the test request e.g. Sample Processing, Interpretation, Reporting etc. The full list of possible Task types/codes, their associated business statuses, and status reasons is pending internal review.

Tasks will be automatically created by the central broker but updates to statuses and attachment of input/output resources is the responsibility of the assigned organizations.

An illustrative diagram of the links between ServiceRequests and Tasks are provided below (for the initial sample processing). Note: not all resource links are represented, to increase legibility of the diagram. In most cases, the full library of 10 tasks, as defined within Genomic-Task-Code, will be 'spun-up', on submission of a Test order. Tasks related to Samples may be duplicated per Sample to allow tracking of work related to individual Samples as part of the same test request, or equally, may be omitted as in the case of Re-Analysis or Re-Interpretation where data from an existing sample is used, eliminating the need for additional wet-work. For the full cardinality breakdown see further guidance for the Task.code element.

Profile url FHIR Module Normative Status
http://hl7.org/fhir/StructureDefinition/Task HL7 International trial-use



idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifier0..*Identifier
instantiatesCanonicalΣ0..1canonical(ActivityDefinition)
instantiatesUriΣ0..1uri
basedOnΣ I0..*Reference(Resource)
groupIdentifierΣ0..1Identifier
partOfΣ I0..*Reference(Task)
statusΣ ?!1..1codeBinding
statusReasonΣ0..1CodeableConcept
businessStatusΣ0..1CodeableConcept
intentΣ1..1codeBinding
priority0..1codeBinding
codeΣ0..1CodeableConcept
descriptionΣ0..1string
focusΣ I0..1Reference(Resource)
forΣ I0..1Reference(Resource)
encounterΣ I0..1Reference(Encounter)
executionPeriodΣ I0..1Period
authoredOnI0..1dateTime
lastModifiedΣ I0..1dateTime
requesterΣ I0..1Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
performerType0..*CodeableConceptBinding
ownerΣ I0..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)
locationΣ I0..1Reference(Location)
reasonCode0..1CodeableConcept
reasonReferenceI0..1Reference(Resource)
insuranceI0..*Reference(Coverage | ClaimResponse)
note0..*Annotation
relevantHistoryI0..*Reference(Provenance)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
repetitions0..1positiveInt
periodI0..1Period
recipientI0..*Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Group | Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
type1..1CodeableConcept
valueBase64Binarybase64Binary
valueBooleanboolean
valueCanonicalcanonical()
valueCodecode
valueDatedate
valueDateTimedateTime
valueDecimaldecimal
valueIdid
valueInstantinstant
valueIntegerinteger
valueMarkdownmarkdown
valueOidoid
valuePositiveIntpositiveInt
valueStringstring
valueTimetime
valueUnsignedIntunsignedInt
valueUriuri
valueUrlurl
valueUuiduuid
valueAddressAddress
valueAgeAge
valueAnnotationAnnotation
valueAttachmentAttachment
valueCodeableConceptCodeableConcept
valueCodingCoding
valueContactPointContactPoint
valueCountCount
valueDistanceDistance
valueDurationDuration
valueHumanNameHumanName
valueIdentifierIdentifier
valueMoneyMoney
valuePeriodPeriod
valueQuantityQuantity
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueSignatureSignature
valueTimingTiming
valueContactDetailContactDetail
valueContributorContributor
valueDataRequirementDataRequirement
valueExpressionExpression
valueParameterDefinitionParameterDefinition
valueRelatedArtifactRelatedArtifact
valueTriggerDefinitionTriggerDefinition
valueUsageContextUsageContext
valueDosageDosage
valueMetaMeta
valueReferenceReference()
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
type1..1CodeableConcept
valueBase64Binarybase64Binary
valueBooleanboolean
valueCanonicalcanonical()
valueCodecode
valueDatedate
valueDateTimedateTime
valueDecimaldecimal
valueIdid
valueInstantinstant
valueIntegerinteger
valueMarkdownmarkdown
valueOidoid
valuePositiveIntpositiveInt
valueStringstring
valueTimetime
valueUnsignedIntunsignedInt
valueUriuri
valueUrlurl
valueUuiduuid
valueAddressAddress
valueAgeAge
valueAnnotationAnnotation
valueAttachmentAttachment
valueCodeableConceptCodeableConcept
valueCodingCoding
valueContactPointContactPoint
valueCountCount
valueDistanceDistance
valueDurationDuration
valueHumanNameHumanName
valueIdentifierIdentifier
valueMoneyMoney
valuePeriodPeriod
valueQuantityQuantity
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueSignatureSignature
valueTimingTiming
valueContactDetailContactDetail
valueContributorContributor
valueDataRequirementDataRequirement
valueExpressionExpression
valueParameterDefinitionParameterDefinition
valueRelatedArtifactRelatedArtifact
valueTriggerDefinitionTriggerDefinition
valueUsageContextUsageContext
valueDosageDosage
valueMetaMeta
valueReferenceReference()

Differential from Task

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifier0..*Identifier
instantiatesCanonicalΣ0..1canonical(ActivityDefinition)
instantiatesUriΣ0..1uri
basedOnΣ I0..*Reference(Resource)
groupIdentifierΣ0..1Identifier
partOfΣ I0..*Reference(Task)
statusΣ ?!1..1codeBinding
statusReasonΣ0..1CodeableConcept
businessStatusΣ0..1CodeableConcept
intentΣ1..1codeBinding
priority0..1codeBinding
codeΣ0..1CodeableConcept
descriptionΣ0..1string
focusΣ I0..1Reference(Resource)
forΣ I0..1Reference(Resource)
encounterΣ I0..1Reference(Encounter)
executionPeriodΣ I0..1Period
authoredOnI0..1dateTime
lastModifiedΣ I0..1dateTime
requesterΣ I0..1Reference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
performerType0..*CodeableConceptBinding
ownerΣ I0..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)
locationΣ I0..1Reference(Location)
reasonCode0..1CodeableConcept
reasonReferenceI0..1Reference(Resource)
insuranceI0..*Reference(Coverage | ClaimResponse)
note0..*Annotation
relevantHistoryI0..*Reference(Provenance)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
repetitions0..1positiveInt
periodI0..1Period
recipientI0..*Reference(Patient | Practitioner | PractitionerRole | RelatedPerson | Group | Organization)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
type1..1CodeableConcept
valueBase64Binarybase64Binary
valueBooleanboolean
valueCanonicalcanonical()
valueCodecode
valueDatedate
valueDateTimedateTime
valueDecimaldecimal
valueIdid
valueInstantinstant
valueIntegerinteger
valueMarkdownmarkdown
valueOidoid
valuePositiveIntpositiveInt
valueStringstring
valueTimetime
valueUnsignedIntunsignedInt
valueUriuri
valueUrlurl
valueUuiduuid
valueAddressAddress
valueAgeAge
valueAnnotationAnnotation
valueAttachmentAttachment
valueCodeableConceptCodeableConcept
valueCodingCoding
valueContactPointContactPoint
valueCountCount
valueDistanceDistance
valueDurationDuration
valueHumanNameHumanName
valueIdentifierIdentifier
valueMoneyMoney
valuePeriodPeriod
valueQuantityQuantity
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueSignatureSignature
valueTimingTiming
valueContactDetailContactDetail
valueContributorContributor
valueDataRequirementDataRequirement
valueExpressionExpression
valueParameterDefinitionParameterDefinition
valueRelatedArtifactRelatedArtifact
valueTriggerDefinitionTriggerDefinition
valueUsageContextUsageContext
valueDosageDosage
valueMetaMeta
valueReferenceReference()
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
type1..1CodeableConcept
valueBase64Binarybase64Binary
valueBooleanboolean
valueCanonicalcanonical()
valueCodecode
valueDatedate
valueDateTimedateTime
valueDecimaldecimal
valueIdid
valueInstantinstant
valueIntegerinteger
valueMarkdownmarkdown
valueOidoid
valuePositiveIntpositiveInt
valueStringstring
valueTimetime
valueUnsignedIntunsignedInt
valueUriuri
valueUrlurl
valueUuiduuid
valueAddressAddress
valueAgeAge
valueAnnotationAnnotation
valueAttachmentAttachment
valueCodeableConceptCodeableConcept
valueCodingCoding
valueContactPointContactPoint
valueCountCount
valueDistanceDistance
valueDurationDuration
valueHumanNameHumanName
valueIdentifierIdentifier
valueMoneyMoney
valuePeriodPeriod
valueQuantityQuantity
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueSignatureSignature
valueTimingTiming
valueContactDetailContactDetail
valueContributorContributor
valueDataRequirementDataRequirement
valueExpressionExpression
valueParameterDefinitionParameterDefinition
valueRelatedArtifactRelatedArtifact
valueTriggerDefinitionTriggerDefinition
valueUsageContextUsageContext
valueDosageDosage
valueMetaMeta
valueReferenceReference()

Task
DefinitionA task to be performed.
Cardinality0...*
Invariants
  • dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
    contained.contained.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 or SHALL refer to the containing resource
    contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
  • dom-6: A resource should have narrative for robust management
    text.`div`.exists()
  • dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
    contained.meta.security.empty()
  • inv-1: Last modified date must be greater than or equal to authored-on date.
    lastModified.exists().not() or authoredOn.exists().not() or lastModified >= authoredOn
Mappings
  • rim: Entity. Role, or Act
  • workflow: Request, Event
  • rim: ControlAct[moodCode=INT]
Task.id
DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality0...1
Typestring
SummaryTrue
Comments

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

Task.meta
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.
Cardinality0...1
TypeMeta
SummaryTrue
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
Task.implicitRules
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.
Cardinality0...1
Typeuri
ModifierTrue
SummaryTrue
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Task.language
DefinitionThe base language in which the resource is written.
Cardinality0...1
Typecode
Binding

A human language.

CommonLanguages (preferred)
Comments

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
Task.text
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.
Cardinality0...1
TypeNarrative
Aliasnarrative, html, xhtml, display
Comments

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

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: N/A
  • rim: Act.text?
Task.contained
DefinitionThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality0...*
TypeResource
Aliasinline resources, anonymous resources, contained resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.

Mappings
  • rim: Entity. Role, or Act
  • rim: N/A
Task.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Task.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
Aliasextensions, user content
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Task.identifier
DefinitionThe business identifier for this task.
Cardinality0...*
TypeIdentifier
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.identifier, Event.identifier
  • w5: FiveWs.identifier
  • rim: .id
Task.instantiatesCanonical
DefinitionThe URL pointing to a *FHIR*-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Task.
Cardinality0...1
Typecanonical(ActivityDefinition)
SummaryTrue
Requirements

Enables a formal definition of how he task is to be performed, enabling automation.

Comments

see Canonical References

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.instantiatesCanonical, Event.instantiatesCanonical
  • rim: .outboundRelationship[typeCode=DEFN].target
Task.instantiatesUri
DefinitionThe URL pointing to an *externally* maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Task.
Cardinality0...1
Typeuri
SummaryTrue
Requirements

Enables a formal definition of how he task is to be performed (e.g. using BPMN, BPEL, XPDL or other formal notation to be associated with a task), enabling automation.

Comments

see http://en.wikipedia.org/wiki/Uniform_resource_identifier

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Event.instantiatesUrl
  • rim: .outboundRelationship[typeCode=DEFN].target
Task.basedOn
DefinitionBasedOn refers to a higher-level authorization that triggered the creation of the task. It references a "request" resource such as a ServiceRequest, MedicationRequest, ServiceRequest, CarePlan, etc. which is distinct from the "request" resource the task is seeking to fulfill. This latter resource is referenced by FocusOn. For example, based on a ServiceRequest (= BasedOn), a task is created to fulfill a procedureRequest ( = FocusOn ) to collect a specimen from a patient.
Cardinality0...*
TypeReference(Resource)
SummaryTrue
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.basedOn, Event.basedOn
  • rim: .outboundRelationship[typeCode=FLFS].target[moodCode=INT]
Task.groupIdentifier
DefinitionAn identifier that links together multiple tasks and other requests that were created in the same context.
Cardinality0...1
TypeIdentifier
SummaryTrue
Requirements

Billing and/or reporting can be linked to whether multiple requests were created as a single unit.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
  • rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
  • servd: Identifier
  • workflow: Request.groupIdentifier
  • rim: .inboundRelationship[typeCode=COMP].source[moodCode=INT].id
Task.partOf
DefinitionTask that this particular task is part of.
Cardinality0...*
TypeReference(Task)
SummaryTrue
Requirements

Allows tasks to be broken down into sub-steps (and this division can occur independent of the original task).

Comments

This should usually be 0..1.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.partOf
  • rim: .inboundRelationship[typeCode=COMP].source[moodCode=INT]
Task.status
DefinitionThe current status of the task.
Cardinality1...1
Typecode
Binding

The current status of the task.

TaskStatus (required)
ModifierTrue
SummaryTrue
Requirements

These states enable coordination of task status with off-the-shelf workflow solutions that support automation of tasks.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.status, Event.status
  • w5: FiveWs.status
  • rim: .statusCode
Task.statusReason
DefinitionAn explanation as to why this task is held, failed, was refused, etc.
Cardinality0...1
TypeCodeableConcept
Binding

Codes to identify the reason for current status. These will typically be specific to a particular workflow.

(unbound) (example)
SummaryTrue
Comments

This applies to the current status. Look at the history of the task to see reasons for past statuses.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=CACT, moodCode=EVN, code="status change"].reasonCode
Task.businessStatus
DefinitionContains business-specific nuances of the business state.
Cardinality0...1
TypeCodeableConcept
Binding

The domain-specific business-contextual sub-state of the task. For example: "Blood drawn", "IV inserted", "Awaiting physician signature", etc.

(unbound) (example)
SummaryTrue
Requirements

There's often a need to track substates of a task - this is often variable by specific workflow implementation.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="business status"]
Task.intent
DefinitionIndicates the "level" of actionability associated with the Task, i.e. i+R[9]Cs this a proposed task, a planned task, an actionable task, etc.
Cardinality1...1
Typecode
Binding

Distinguishes whether the task is a proposal, plan or full order.

TaskIntent (required)
SummaryTrue
Comments

This element is immutable. Proposed tasks, planned tasks, etc. must be distinct instances.

In most cases, Tasks will have an intent of "order".

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.intent
  • w5: FiveWs.class
  • rim: .moodCode
Task.priority
DefinitionIndicates how quickly the Task should be addressed with respect to other requests.
Cardinality0...1
Typecode
Binding

The task's priority.

RequestPriority (required)
Requirements

Used to identify the service level expected while performing a task.

Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.priority
  • w5: FiveWs.grade
  • rim: .priorityCode
Task.code
DefinitionA name or code (or both) briefly describing what the task involves.
Cardinality0...1
TypeCodeableConcept
Binding

Codes to identify what the task involves. These will typically be specific to a particular workflow.

TaskCode (example)
SummaryTrue
Comments

The title (eg "My Tasks", "Outstanding Tasks for Patient X") should go into the code.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Request.code, Event.code
  • w5: FiveWs.what[x]
  • rim: .code
Task.description
DefinitionA free-text description of what is to be performed.
Cardinality0...1
Typestring
SummaryTrue
Comments

Note that FHIR strings SHALL NOT exceed 1MB in size

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .text
Task.focus
DefinitionThe request being actioned or the resource being manipulated by this task.
Cardinality0...1
TypeReference(Resource)
SummaryTrue
Requirements

Used to identify the thing to be done.

Comments

If multiple resources need to be manipulated, use sub-tasks. (This ensures that status can be tracked independently for each referenced resource.).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • w5: FiveWs.what[x]
  • rim: .outboundRelationship[typeCode=SUBJ].target
Task.for
DefinitionThe entity who benefits from the performance of the service specified in the task (e.g., the patient).
Cardinality0...1
TypeReference(Resource)
SummaryTrue
AliasPatient
Requirements

Used to track tasks outstanding for a beneficiary. Do not use to track the task owner or creator (see owner and creator respectively). This can also affect access control.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.subject, Event.subject
  • w5: FiveWs.subject[x]
  • rim: .participation[typeCode=RCT].role
  • w5: FiveWs.subject
Task.encounter
DefinitionThe healthcare event (e.g. a patient and healthcare provider interaction) during which this task was created.
Cardinality0...1
TypeReference(Encounter)
SummaryTrue
Requirements

For some tasks it may be important to know the link between the encounter the task originated within.

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.context, Event.context
  • w5: FiveWs.context
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=PCPR, moodCode=EVN]
Task.executionPeriod
DefinitionIdentifies the time action was first taken against the task (start) and/or the time final action was taken against the task prior to marking it as completed (end).
Cardinality0...1
TypePeriod
SummaryTrue
Comments

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • workflow: Event.occurrence[x]
  • w5: FiveWs.done[x]
  • rim: .effectiveTime
Task.authoredOn
DefinitionThe date and time this task was created.
Cardinality0...1
TypedateTime
AliasCreated Date
Requirements

Most often used along with lastUpdated to track duration of task to supporting monitoring and management.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • workflow: Request.authoredOn
  • w5: FiveWs.recorded
  • rim: .participation[typeCode=AUT].time
Task.lastModified
DefinitionThe date and time of last modification to this task.
Cardinality0...1
TypedateTime
SummaryTrue
AliasUpdate Date
Requirements

Used along with history to track task activity and time in a particular task state. This enables monitoring and management.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .inboundRelationship[typeCode=SUBJ, ].source[classCode=CACT, moodCode=EVN].effectiveTime
Task.requester
DefinitionThe creator of the task.
Cardinality0...1
TypeReference(Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson)
SummaryTrue
Requirements

Identifies who created this task. May be used by access control mechanisms (e.g., to ensure that only the creator can cancel a task).

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.requester
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
Task.performerType
DefinitionThe kind of participant that should perform the task.
Cardinality0...*
TypeCodeableConcept
Binding

The type(s) of task performers allowed.

ProcedurePerformerRoleCodes (preferred)
Requirements

Use to distinguish tasks on different activity queues.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.performer.role, Request.performerType
  • w5: FiveWs.actor
  • rim: .participation[typeCode=PRF].role.code
Task.owner
DefinitionIndividual organization or Device currently responsible for task execution.
Cardinality0...1
TypeReference(Practitioner | PractitionerRole | Organization | CareTeam | HealthcareService | Patient | Device | RelatedPerson)
SummaryTrue
AliasPerformer, Executer
Requirements

Identifies who is expected to perform this task.

Comments

Tasks may be created with an owner not yet identified.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Event.performer.actor, Request.performer
  • w5: FiveWs.actor
  • rim: .participation[typeCode=PRF].role
Task.location
DefinitionPrincipal physical location where the this task is performed.
Cardinality0...1
TypeReference(Location)
SummaryTrue
Requirements

Ties the event to where the records are likely kept and provides context around the event occurrence (e.g. if it occurred inside or outside a dedicated healthcare setting).

Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.reasonCode, Event.reasonCode
  • w5: FiveWs.where[x]
  • rim: .participation[typeCode=LOC].role
Task.reasonCode
DefinitionA description or code indicating why this task needs to be performed.
Cardinality0...1
TypeCodeableConcept
Binding

Indicates why the task is needed. E.g. Suspended because patient admitted to hospital.

(unbound) (example)
Comments

This should only be included if there is no focus or if it differs from the reason indicated on the focus.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • workflow: Event.location
  • w5: FiveWs.why[x]
  • v2: EVN.7
  • rim: .reasonCode
Task.reasonReference
DefinitionA resource reference indicating why this task needs to be performed.
Cardinality0...1
TypeReference(Resource)
Comments

Tasks might be justified based on an Observation, a Condition, a past or planned procedure, etc. This should only be included if there is no focus or if it differs from the reason indicated on the focus. Use the CodeableConcept text element in Task.reasonCode if the data is free (uncoded) text.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.reasonReference, Event.reasonReference
  • w5: FiveWs.why[x]
  • rim: .outboundRelationship[typeCode=RSON].target
Task.insurance
DefinitionInsurance plans, coverage extensions, pre-authorizations and/or pre-determinations that may be relevant to the Task.
Cardinality0...*
TypeReference(Coverage | ClaimResponse)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.insurance
  • v2: IN1/IN2
  • rim: .outboundRelationship[typeCode=COVBY].target
Task.note
DefinitionFree-text information captured about the task as it progresses.
Cardinality0...*
TypeAnnotation
Comments

For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible).

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: N/A
  • rim: Act
  • workflow: Request.note, Event.note
  • rim: .inboundRelationship[typeCode=SUBJ, ].source[classCode=OBS, moodCode=EVN, code="annotation"].value(string)
Task.relevantHistory
DefinitionLinks to Provenance records for past versions of this Task that identify key state transitions or updates that are likely to be relevant to a user looking at the current version of the task.
Cardinality0...*
TypeReference(Provenance)
AliasStatus History
Comments

This element does not point to the Provenance associated with the current version of the resource - as it would be created after this version existed. The Provenance for the current version can be retrieved with a _revinclude.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • workflow: Request.relevantHistory
  • rim: .inboundRelationship(typeCode=SUBJ].source[classCode=CACT, moodCode=EVN]
Task.restriction
DefinitionIf the Task.focus is a request resource and the task is seeking fulfillment (i.e. is asking for the request to be actioned), this element identifies any limitations on what parts of the referenced request should be actioned.
Cardinality0...1
TypeBackboneElement
Requirements

Sometimes when fulfillment is sought, you don't want full fulfillment.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: Instead of pointing to request, would point to component of request, having these characteristics
Task.restriction.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Task.restriction.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Task.restriction.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Task.restriction.repetitions
DefinitionIndicates the number of times the requested action should occur.
Cardinality0...1
TypepositiveInt
Requirements

E.g. order that requests monthly lab tests, fulfillment is sought for 1.

Comments

32 bit number; for values larger than this, use decimal

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: .repeatNumber
Task.restriction.period
DefinitionOver what time-period is fulfillment sought.
Cardinality0...1
TypePeriod
Requirements

E.g. order that authorizes 1 year's services. Fulfillment is sought for next 3 months.

Comments

Note that period.high is the due date representing the time by which the task should be completed.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • per-1: If present, start SHALL have a lower value than end
    start.hasValue().not() or end.hasValue().not() or (start <= end)
Mappings
  • rim: n/a
  • v2: DR
  • rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
  • rim: .effectiveTime(IVL<TS>)
Task.restriction.recipient
DefinitionFor requests that are targeted to more than on potential recipient/target, for whom is fulfillment sought?
Cardinality0...*
TypeReference(Patient | Practitioner | PractitionerRole | RelatedPerson | Group | Organization)
Comments

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ref-1: SHALL have a contained resource if a local reference is provided
    reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))
Mappings
  • rim: n/a
  • rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
  • rim: .participation[typeCode=SBJ].role
Task.input
DefinitionAdditional information that may be needed in the execution of the task.
Cardinality0...*
TypeBackboneElement
AliasSupporting Information
Requirements

Resources and data used to perform the task. This data is used in the business logic of task execution, and is stored separately because it varies between workflows.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ???
Task.input.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Task.input.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Task.input.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Task.input.type
DefinitionA code or description indicating how the input is intended to be used as part of the task execution.
Cardinality1...1
TypeCodeableConcept
Binding

Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Comparison source", "Applicable consent", "Concomitent Medications", etc.

(unbound) (example)
AliasName
Requirements

Inputs are named to enable task automation to bind data and pass it from one task to the next.

Comments

If referencing a BPMN workflow or Protocol, the "system" is the URL for the workflow definition and the code is the "name" of the required input.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: ???
Task.input.value[x]
DefinitionThe value of the input parameter as a basic type.
Cardinality1...1
Typebase64Binary
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ???
Task.output
DefinitionOutputs produced by the Task.
Cardinality0...*
TypeBackboneElement
Requirements

Resources and data produced during the execution the task. This data is generated by the business logic of task execution, and is stored separately because it varies between workflows.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ???
Task.output.id
DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality0...1
Typestring
Mappings
  • rim: n/a
Task.output.extension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality0...*
TypeExtension
Aliasextensions, user content
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

SlicingUnordered, Open, by url(Value)
Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Task.output.modifierExtension
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 manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality0...*
TypeExtension
ModifierTrue
SummaryTrue
Aliasextensions, user content, modifiers
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
  • rim: N/A
Task.output.type
DefinitionThe name of the Output parameter.
Cardinality1...1
TypeCodeableConcept
Binding

Codes to identify types of input parameters. These will typically be specific to a particular workflow. E.g. "Identified issues", "Preliminary results", "Filler order", "Final results", etc.

(unbound) (example)
AliasName
Requirements

Outputs are named to enable task automation to bind data and pass it from one task to the next.

Comments

Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
  • rim: ???
Task.output.value[x]
DefinitionThe value of the Output parameter as a basic type.
Cardinality1...1
Typebase64Binary
Requirements

Task outputs can take any form.

Invariants
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: n/a
  • rim: ???

Task-NonWGSRareDiseaseTestOrder-Cancellation-Example
Task-NonWGSRareDiseaseTestOrder-Example
Task-NonWGSRareDiseaseTestOrderAccepted-Example
Task-NonWGSRareDiseaseTestOrderAccepted-FetalScenario-Example
Task-NonWGSRareDiseaseTestOrderAccepted-FollowupTest-Example
Task-NonWGSRareDiseaseTestOrderAccepted-HaemOncology-Example
Task-NonWGSRareDiseaseTestOrderAccepted-Reanalysis-Example
Task-NonWGSRareDiseaseTestOrderAccepted-SufficientSample-Example
Task-NonWGSRareDiseaseTestOrderCancelled-FollowupTest-Example
Task-NonWGSRareDiseaseTestOrderCompleted-CascadeTesting-Example
Task-NonWGSRareDiseaseTestOrderCompleted-FollowupTest-Example
Task-NonWGSRareDiseaseTestOrderForwarded-OutOfCountry-Example
Task-NonWGSRareDiseaseTestOrderForwarded-SolidTumor-Example
Task-NonWGSRareDiseaseTestOrderRejected-Example
Task-NonWGSRareDiseaseTestOrderHold-Example
Task-NonWGSRareDiseaseTestOrderRejected-CancerSolidTumor-Example
Task-NonWGSRareDiseaseTestOrderRejected-FetalScenario-Example
Task-NonWGSRareDiseaseTestOrder-InsufficientSample-Example
Task-NonWGSTestOrderAccepted-VariantReinterpretation-Example
Task-NonWGSTestOrderFormAccepted-UsingStoredSample-Example
Task-TestOrderFormAccepted-StorageOfMaterial-Example
Task-WGSRareDiseaseTestOrder-Example
Task-WGSRareDiseaseTestOrderAccepted-Example
Task-WGSRareDiseaseTestOrderAccepted-DirectToLab-Example
Task-WGSRareDiseaseTestOrderAccepted-TrioTestingProband-Example
Task-WGSRareDiseaseTestOrderCompleted-DirectToLab-Example
Task-WGSRareDiseaseTestOrderCompleted-TrioTestingProband-Example
Task-WGSRareDiseaseTestOrderForwarded-Example
Task-WGSRareDiseaseTestOrderHold-DirectToLab-Example
Task-WGSRareDiseaseTestOrderHold-TrioTestingProband-Example
Task-WGSRareDiseaseTestOrderRequested-DirectToLab-Example
Task-NonWGSTestOrderFormRequested-UsingStoredSample-Example
Task-WGSRareDiseaseTestOrderAccepted-TrioTestingFather-Example
Task-WGSRareDiseaseTestOrderAccepted-TrioTestingMother-Example


FHIRMDSHL7v2
Task.executionPeriod.startPLCM activity - Activity start date and timeDerived from TQ1-7 in the ORL response message for the activity based on the OML request
Task.executionPeriod.endPLCM activity - Activity end date and timeDerived from TQ1-8 in the ORL response message for the activity based on the OML request
Task.ownerPLCM activity - ODS code of organisation submitting to PLCM, PLCM activity - ODS code of organisation delivering requested test, PLCM activity - ODS code of the laboratory site delivering requested testOBR-32.7 if sourced from principle results interpreter, OBX-32.10, AFF-2.10 associated with performing organization
Task.statusPLCM activity - Sample plating quality controlImplied through status recorded in ORC-25 indicating plating quality control had passed
Task.statusReasonPLCM activity - Sample plating quality control fail codeORC-25
Task.outputExtracted specimen - Location detailsSAC-15

Constraint Profiles

Profiles indicating preferred element cardinality for use in Genomics, not to be used for validation

nameprofile
NHSDigital_Task_Genomicshttps://fhir.nhs.uk/StructureDefinition/NHSDigital-Task-Genomics

Additional Guidance

basedOn

This element will not be used within the Genomic Medicine Service. The ServiceRequest a Task is seeking to fulfill SHALL be referenced through the focus element. Specimen resources being acted upon by tasks related to specimen prep/processing SHOULD be referenced through the Task.input element.

status

Initially, automatically populated by the central service upon instantiation. Tasks will be first marked as 'draft' until their prerequisites have been satisfied, after which they will be marked as 'requested' until accepted/claimed by an organization. Upon acceptance, the owning organization is responsible for updating the status up until completion (or if the owning organization is not integrated into the GMS, the organization who has referred the task to the unintegrated org).

If a ServiceRequest is cancelled, any Tasks which have not already moved into in-progress SHALL be moved into the cancelled state, any in-progress Tasks will require lab processes to manage closure of the Task and appropriate reimbursement.

For the full list of expected Task statuses in use by the GMS, please refer to the table below. For the allowed Task status transitions, please see the FHIR R4 Task state machine model.

Status Description Genomic workflow usage
Draft The task is not yet ready to be acted upon. Initial state for Tasks. Used for tasks which require prerequisite tasks to be completed first.
Requested The task is ready to be acted upon and action is sought. Status indicating a task can be worked on/claimed, all prerequisites have been satisfied.
Received A potential performer has claimed ownership of the task and is evaluating whether to perform it. NOT USED within Genomics as Tasks will be polled for rather than being sent out to assigned organizations. Most likely not used unless tasks are automatically assigned and organizations are notified by the central service, e.g. to GLH.
Accepted The potential performer has agreed to execute the task but has not yet started work. Used when an assigned owner has accepted the task after being assigned.
Rejected The potential performer who claimed ownership of the task has decided not to execute it prior to performing any action. Used if an organization was assigned to a task but is unable to perform work against it. It is expected if an alternative organization can be assigned, this is done as an owner update rather than marking the task as rejected. If subsequent work does occur, a duplicate task will need to be created as the 'rejected' state is a terminal one.
Ready The task is ready to be performed, but no action has yet been taken. Used in place of requested/received/accepted/rejected when request assignment and acceptance is a given. NOT USED within Genomics as it is not assumed that Tasks will be automatically accepted when prerequisites are satisfied.
Cancelled The task was not completed. Used when a task has been created but later identified as unneeded, e.g. due to modifications to test order such as the ServiceRequest being cancelled. Automatically set by the central broker.
In Progress The task has been started but is not yet complete. When work has commenced.
On Hold The task has been started but work has been paused. A holding state where work is expected to continue but is being blocked through some external issue. Suppliers will need to state reason why work is on hold through the statusReason field e.g. Awaiting Sample.
Failed The task was attempted but could not be completed due to some error. Indicates the task cannot continue and is unrcoverable without external intervention. If modifications to the test order allow the task to be resumed, a new task should be created e.g. a new sample is provided to replace a previous sample which has failed quality control. If the Task results in an unrecoverable error, the ServiceRequest may need to be revoked.
Completed The task has been completed. Marked once all actions against a task are complete, and follow on Tasks can commence.
Entered in Error The task should never have existed and is retained only because of the possibility it may have used. May be used if user created Tasks are created in error, e.g. duplicate Tasks, or Tasks have been created by the central broker and the ServiceRequest has subsequently been marked as entered-in-error.
"status": "rejected",

statusReason

Reasons why a Task has been marked as on-hold, cancelled etc. SHOULD use the Genomic-Task-StatusReason CodeSystem. NOTE: The list of appropriate statusReasons is pending finalization.

"statusReason": {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/task-status-reason-genomics",
                "code": "further-information-needed",
                "display": "Further Information Needed"
            }
        ]
    },

businessStatus

Genomic specific business statuses for capturing more granular information as part of processing the task. SHOULD use the Genomic-Business-Status CodeSystem. NOTE: The list of appropriate buinessStatuses is pending finalization. Mapping business statuses to the high level container Tasks and statuses is still ongoing.

"businessStatus": {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/business-status-genomics",
                "code": "sample-sent",
                "display": "Sample Sent"
            }
        ]
    },

code

High level coding for the Task, matches the NGTP stages for genomic test processing. Clients SHOULD use the Genomic-Task-Code CodeSystem. NOTE: The list of appropriate codes is pending finalization.

The currently allowed code list and their definition is provided in the table below. The table also provides the cardinality of each Task per ServiceRequest or Sample attached to the request as generated by the central broker on submission of a test request. Note: the cardinalities listed reflect the number of concurrent active tasks per service request at any one time, there may be cases where additional Tasks need to be spun up manually, e.g. on failure such as when a new sample needs to be processed after a previous sample fails Quality Control, or when further preparation is required. This cardinality supports the use cases for both requests with multiple participants, e.g. Duo/Trio, and multiple samples per participant e.g. Cancer testing.

Task.code display Definition of work within Task Cardinality (general case) Cardinality (Reanalysis/Reinterpretation) Cardinality (DNA Storage)
Process Genomic Test Request Test code requested is ratified by the lab against provided patient information (checking eligibility) 1..1 (per ServiceRequest) 1..1 1..1
Request & Sample Alignment The lab confirms/validates the data and sample(s) required for given test type are present 1..* (1 per Specimen referenced from or referencing the ServiceRequest) 1..1 (At least 1 will always be required, e.g. for validation of data in the No Sample scenario) 1..* (per Sample)
Sample Preparation Sample is prepared, as appropriate for the selected test type, and DNA extracted. May have multiples if further preparation is required 1..* (1 per Sample) 0..0 (Not required for Reanalysis/Reinterpretation requests where a sample does not need to be prepared) 1..* (1 per Sample)
Sample Processing DNA sample(s) are sequenced, generating read/sequence data to feed into analysis 1..* (1 per Sample or extracted DNA sample) 0..0 (Not required for Reanalysis/Reinterpretation requests where a sample does not need to be sequenced) 0..0 (Not required for DNA storage where a sample does not need to be sequenced)
Genetic/Genomic Data Processing Sequence data is passed through a bio-pipeline, generates variant priorities lists for analysis 1..* (1 per Sample or read data) 0..* (For Reanalysis, should match the number of Samples for the parent request. Not required for Reinterpretation requests) 0..0 (Not required for DNA storage requests)
Interpretation Results analysis is organised and interpreted by a Clincial Scientist 1..* (1 per Sample or variant priorities list) 1..* (For Reanalysis/Reinterpretation, should match the number of Samples for the parent request 0..0 (Not required for DNA storage requests)
Produce Interim Report A report is created and deemed interim pending MDT, if necessary 1..* (1 per Sample. TBC whether one interim report would be generated per sample/set of genetic data or 1 per request) 1..* (For Reanalysis/Reinterpretation, should match the number of Samples for the parent request 0..0 (Not required for DNA storage requests)
Genomic MDT Multi-Diciplinary-Team consults on the interim report 1..1 (max 1 per ServiceRequest, for the purposes of the Alpha an MDT task will always be created, even if not needed) 1..1 0..0 (Not required for DNA storage requests)
Produce Final Report Interim report is deemed final or is updated following MDT 1..1 (per ServiceRequest) 1..1 1..1
Distribute Report Final report is distributed or marked as distributable/available 1..1 (per ServiceRequest or Final Report) 1..1 1..1

Rendered within a diagram, the Task cardinalities and their inputs are illustrated in the diagram below:

GenomicOrderManagementTaskModel

"code": {
        "coding":  [
            {
                "system": "https://fhir.nhs.uk/CodeSystem/task-code-genomics",
                "code": "sample-processing",
                "display": "Sample Processing"
            }
        ]
    },

focus

The ServiceRequest the Task is fulfilling. Autopopulated by the central service.

"focus": {
        "reference": "ServiceRequest/ServiceRequest-SavedTestOrder-Example"
    },

for

A reference to the Patient resource or the identifier, NHS number, for the patient for whom the Task is for. Autopopulated by the central service.

"for": {
        "reference": "Patient/Patient-MeirLieberman-Example",
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/nhs-number",
            "value": "9449307873"
        }
    },

executionPeriod

MAY be used to capture start and end DateTimes associated with execution of a Task. It is expected the start time will be populated as a Task is moved to in-progress and the end time will be populated as a Task is marked as completed. Usage of this field will be investigated during the Alpha phase of the Genomic Order Management project as timelines for task execution can also be derived from the AuditEvents recorded as Tasks are updated.

"executionPeriod": {
        "start": "2023-10-31T10:25:05+00:00",
        "end": "2023-11-15T16:45:05+00:00"
    },

authoredOn

Autopopulated by the central service on creation of the Task.

"authoredOn": "2023-09-18T18:30:00Z"

lastModified

Time at which a change to the task was made, e.g. status updated. SHALL be updated on change.

"lastModified": "2023-09-18T19:11:00Z"

requester

The original requester of the ServiceRequest the Task is fulfilling. Autopopulated by the central service.

"requester": {
        "reference": "PractitionerRole/PractitionerRole-GeneSmithENT-Example"
    },

owner

Autopopulated by the central service if a performer is assigned at Test submission. By default, this will the Home GLH for the submitting organization, unless an alternative is specified. The Home GLH/original performer (managing entity) SHOULD remain the owner for the Process Genomic Test Task, throughout the test order-fulfillment process.

This field can be updated by the organization claiming the task (though this could also be autopopulated if automated per test routing tables are integrated into the central service functionality). Owner SHOULD be populated using organization ODS code references.

The responsibility for routing/reassigning ownership of Tasks lies with the current owner following the transfers of responsibility as per the National Genomic Testing Process (NGTP). The different scenarios for how follow-on routing may be achieved is summarised in the points below:

  • In most cases, by default the test will be routed to the home GLH (or other lab/GLH as dictated by the initial routing table).
  • This would mean all Tasks by default would have this organization, e.g. home GLH, as the initial owner, it would then be the responsibility of the GLH to reassign tasks to other organizations, where they 'send away' or commission work.
  • Once that work is complete, the send-away organization can choose to reassign the current Task (where another organization needs to conduct work against the same Task before it can be marked as complete)/or assign the follow-on Task (where the current task can be marked as complete) to the next organization, if this is known.
  • If the next organization to send work to is unknown, responsibility should lie with the original/previous owner e.g. Home GLH to reassign the task to the next organization that needs to complete work. This should be captured by having the current owner reassign the task back to the GLH (or organization which assigned the task to them) if further work needs to occur within the current task; or the next task in the NGTP moves from the draft state into the requested state (indicating all its prerequisites have been satisfied). The owner of that task, e.g home GLH, then either starts work or assigns this to the relevant organization.
  • In further phases, a routing advice service may be provided by NHS England to aid organizations in identifying which organization should be assigned, after completing their work.

Tasks assigned to a particular organization SHOULD be searched for using the owner search parameter with the :identifier modifier i.e. [base]/Task?owner:identifier=8J834 or [base]/Task?owner:identifier=https://fhir.nhs.uk/Id/ods-organization-code|8J834

"owner": {
        "identifier": {
            "system": "https://fhir.nhs.uk/Id/ods-organization-code",
            "value": "69010"
        },
        "display": "Pathology Lab - ADDENBROOKE'S HOSPITAL LABORATORY"
    },

note

Used for messaging between owner and other orgnizations e.g. during handover of task or requesting information from requesting clinician

"note":  [
        {
            "text": "Sample has not been received within 4 week window. Task will be closed unless further communication is received"
        }
    ]

input

Used to attach inputs to a Task, if relevant. e.g. references to Specimen's which a Sample Processing task is acting on. No CodeSystem exists for this field as of publication but this will be investigated as future work.

Specimen references SHOULD be added to Tasks acting on Specimen resources, e.g. Tasks marked SamplePreparation or SampleProcessing. This is to clearly disambiguate which specimen a task is acting on, where multiple specimens are necessary for processing the test request.

The table below provides possible inputs that could be provided for certain Tasks as part of fulfillment of a test order. A finalised list is pending business analysis work to identify the operational data generated as fulfilment against a test order progresses and the need for this data to pass between organizations.

Task.code display Possible Task.input
Process Genomic Test Request N/A, all information required should be part of or refernced from the ServiceRequest
Request & Sample Alignment Specimen resource to be aligned and potentially Consent resources where these are captured post submission of a test request
Sample Preparation Specimen resource to be prepared as part of this Task
Sample Processing DNA Specimen resource to be sequenced as part of this Task as well as Consignment, Rack and Well identifiers to allow for specimen tracking
Genetic/Genomic Data Processing Sequence data generated from the previous Task, potentially referenced using DocumentReference resources, these SHOULD reference the Specimen from which the data originated
Interpretation Variant Priorities lists generated from the previous Task, the representation of these lists is still under investigation
Produce Interim Report Guidance/Recommendations generated though data interpretation, the representation of these items is still under investigation
Genomic MDT Interim reports, references to Diagnostic report resources containing either structured Genomic reports or binary representations of the reports
Produce Final Report Interim reports and potentially recommendations from the MDT, whether these are represented within the DiagnosticReport itself or contained as other resource types is still under investigation
Distribute Report The final report to be distributed
"input":  [
    {
            "type": {
                "coding":  [
                    {
                        "system": "https://fhir.nhs.uk/CodeSystem/AdditionalInfoTypeGenomics",
                        "code": "Specimen",
                        "display": "Specimen"
                    }
                ]
            },
            "valueReference": {
                "reference": "Specimen/Specimen-CancerSolidTumor-Example"
            }
        }
    ]

output

Used to attach outputs from a Task, if relevant. e.g. VUS files during processing or a DiagnosticReport upon completion of reporting stage. No CodeSystem exists for this field as of publication but this will be investigated as future work.

Sample tracking information SHOULD be added to Tasks acting on Specimen resources, e.g. Tasks marked SamplePreparation or SampleProcessing, on either the output or input elements. This information MAY include consignment number, destination, date sent etc. Further modelling of the types/format expected are pending clinical scenarios.

The table below provides possible outputs that could be generated by certain Tasks as part of fulfillment of a test order. A finalised list is pending business analysis work to identify the operational data generated as fulfilment against a test order progresses and the need for this data to pass between organizations.

Task.code display Possible Task.output
Process Genomic Test Request N/A, may result in updates to the ServiceRequest if codes or supporting information needs to change
Request & Sample Alignment Aligned Specimen resource for request (except for Reanalysis/Reinterpretation)
Sample Preparation DNA Specimen resource as well as Consignment, Rack and Well identifiers to allow for specimen tracking
Sample Processing Sequence/Read data
Genetic/Genomic Data Processing Variant information
Interpretation Potentially structured guidance/recommendations
Produce Interim Report Interim reports
Genomic MDT Potentially ammended Interim/combined report or recommendations from MDT
Produce Final Report Final Report
Distribute Report N/A, final report will be included as input to Task
"output":  [
       {
          "type": {
            "coding": [
              {
                "system": "https://fhir.nhs.uk/CodeSystem/AdditionalInfoTypeGenomics",
                "code": "DiagnosticReport",
                "display": "DiagnosticReport"
              }
            ]
          },
          "valueReference": {
            "reference": "DiagnosticReport/DiagnosticReport-PhoebeSmithGeneticReport-Example"
          }
        }
    ]