DataStandardsWales-PSOM-CarePlan
| Profile | Description | Status | Purpose | URL |
|---|---|---|---|---|
| Data Standards Wales PSOM CarePlan | The clinical circumstance for PROMs collection. The CarePlan is used to group Collection Events and provide context to the pathway. | active | The CarePlan functions as linking pin of all DSCN metadata relevant for a clinical circumstance. | https://fhir.nhs.wales/StructureDefinition/DataStandardsWales-PSOM-CarePlan |
Formal Views of Profile Content
- Snapshot View
- Differential View
- Hybrid View
- Mappings
- Examples
| DataStandardsWalesPSOMCarePlan (CarePlan) | C | CarePlan | Element idCarePlanShort description Clinical Circumstance Alternate namesCare Team DefinitionDescribes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.idShort description Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idCarePlan.metaShort description Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idCarePlan.implicitRulesShort description A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.languageShort description Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idCarePlan.textShort description Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idCarePlan.containedShort description Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources 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. 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.
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| extension | C | 1..* | Extension | There are no (further) constraints on this element Element idCarePlan.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| pathwayLaterality | C | 1..1 | Extension(CodeableConcept) | Element idCarePlan.extension:pathwayLateralityShort description Laterality of the PSOM pathway Alternate namesextensions, user content DefinitionThe laterality is used to capture the anatomical side associated with the healthcare referral / pathway record. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. https://fhir.nhs.wales/StructureDefinition/Extension-DataStandardsWales-PSOM-PathwayLaterality ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.modifierExtensionShort description Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| identifier | Σ | 0..* | Identifier | Element idCarePlan.identifierShort description External Ids for this plan DefinitionBusiness identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. Unordered, Open, by $this(Profile) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| referralIdentifier | Σ | 0..* | DataStandardsWalesPSOMReferralIdentifier | Element idCarePlan.identifier:referralIdentifierShort description An identifier intended for computation DefinitionAn identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. DataStandardsWalesPSOMReferralIdentifier ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) | There are no (further) constraints on this element Element idCarePlan.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element idCarePlan.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| basedOn | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.basedOnShort description Fulfills CarePlan Alternate namesfulfills DefinitionA care plan that is fulfilled in whole or in part by this care plan. Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| replaces | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.replacesShort description CarePlan replaced by this CarePlan Alternate namessupersedes DefinitionCompleted or terminated care plan whose function is taken by this new care plan. Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans. The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| partOf | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.partOfShort description Part of referenced CarePlan DefinitionA larger care plan of which this particular care plan is a component or step. Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | Σ ?! | 1..1 | codeBinding | Element idCarePlan.statusShort description draft | active | on-hold | revoked | completed | entered-in-error | unknown DefinitionIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. Allows clinicians to determine whether the plan is actionable or not. In interactions between the Health Board and the PROMs provider, the CarePlan uses the following statuses:
Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| intent | Σ ?! | 1..1 | codeBinding | Element idCarePlan.intentShort description proposal | plan | order | option DefinitionIndicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain. Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. In interactions between the Health Board and the PROMs provider, the CarePlan intent is fixed as:
Codes indicating the degree of authority/intentionality associated with a care plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| category | Σ | 2..* | CodeableConcept | Element idCarePlan.categoryShort description Type of plan DefinitionIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. Unordered, Open, by $this(Value) BindingIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| treatmentSpecialty | Σ | 1..1 | CodeableConceptBinding | Element idCarePlan.category:treatmentSpecialtyShort description Treatment Specialty Code DefinitionThe code for the pathway specialty at the time the PROMs form is generated. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. Identifies the pathway specialty PracticeSettingCodeValueSet (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| pathwayType | Σ | 1..1 | CodeableConceptBinding | Element idCarePlan.category:pathwayTypeShort description PROMs Pathway Type DefinitionThe type of pathway that the PROM is associated to, e.g. lung cancer, heart failure, cataract, etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. For local pathways use Identifies the type of pathway DataStandardsWalesPSOMPathwayType (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.codingShort description Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | Σ | 0..1 | string | Element idCarePlan.category:pathwayType.textShort description Local PROMs Pathway Type DefinitionA locally-defined code to identify the PROMs pathway. This type is only required for local pathways. 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. For local pathways The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| title | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.titleShort description Human-friendly name for the care plan DefinitionHuman-friendly name for the care plan. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| description | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.descriptionShort description Summary of nature of plan DefinitionA description of the scope and nature of the plan. Provides more detail than conveyed by category. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| subject | Σ C | 1..1 | Reference(DataStandardsWalesPatient) | Element idCarePlan.subjectShort description Who the care plan is for Alternate namespatient DefinitionIdentifies the patient or group whose intended care is described by the plan. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(DataStandardsWalesPatient) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| encounter | Σ C | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idCarePlan.encounterShort description Encounter created as part of DefinitionThe Encounter during which this CarePlan was created or to which the creation of this record is tightly associated. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| period | Σ C | 0..1 | Period | There are no (further) constraints on this element Element idCarePlan.periodShort description Time period plan covers Alternate namestiming DefinitionIndicates when the plan did (or is intended to) come into effect and end. Allows tracking what plan(s) are in effect at a particular time. Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| created | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idCarePlan.createdShort description Date record was first recorded Alternate namesauthoredOn DefinitionRepresents when this particular CarePlan record was created in the system, which is often a system-generated date. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| author | Σ C | 1..1 | Reference(DataStandardsWalesPractitionerRole) | Element idCarePlan.authorShort description Reference to Senior Responsible Professional and Originating Organisation DefinitionReference to Senior Responsible Professional and Originating Organisation Each occurrence of a Senior Responsible Professional is represented by two FHIR resources: a PractitionerRole resource (instance of DataStandardsWales-PractitionerRole) and a Practitioner resource (DataStandardsWales-Practitioner). The Originating Organisation is related to the Senior Responsible Professional and is represented by the Organization resorce (instance of DataStandardsWales-Organization). The Practitioner and Organization resource are both referenced from the PractitionerRole instance through the elements While the Reference(DataStandardsWalesPractitionerRole) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contributor | C | 0..* | Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idCarePlan.contributorShort description Who provided the content of the care plan DefinitionIdentifies the individual(s) or organization who provided the contents of the care plan. Collaborative care plans may have multiple contributors. Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| careTeam | C | 0..* | Reference(CareTeam) | There are no (further) constraints on this element Element idCarePlan.careTeamShort description Who's involved in plan? DefinitionIdentifies all people and organizations who are expected to be involved in the care envisioned by this plan. Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| addresses | Σ C | 0..* | Reference(Condition) | There are no (further) constraints on this element Element idCarePlan.addressesShort description Health issues this plan addresses DefinitionIdentifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns. When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| supportingInfo | C | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idCarePlan.supportingInfoShort description Information considered as part of plan DefinitionIdentifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc. Identifies barriers and other considerations associated with the care plan. Use "concern" to identify specific conditions addressed by the care plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| goal | C | 0..* | Reference(Goal) | There are no (further) constraints on this element Element idCarePlan.goalShort description Desired outcome of plan DefinitionDescribes the intended objective(s) of carrying out the care plan. Provides context for plan. Allows plan effectiveness to be evaluated by clinicians. Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| activity | C | 0..* | BackboneElement | Element idCarePlan.activityShort description Action to occur as part of plan DefinitionIdentifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice. Unordered, Open, by reference.resolve()(Profile) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| (All Slices) | The requirements in this element apply to all slices | |||||
| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeCodeableConcept | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.outcomeCodeableConceptShort description Results of the activity DefinitionIdentifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not). Note that this should not duplicate the activity status (e.g. completed or in progress). Identifies the results of the activity. CarePlanActivityOutcome (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeReference | C | 0..* | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) | Element idCarePlan.activity.outcomeReferenceShort description Appointment, Encounter, Procedure, etc. DefinitionDetails of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource). Links plan to resulting actions. The outcome of activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Encounter and Procedure are added because these resources most likely contain information relevant for PROMs collection. Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| progress | 0..* | Annotation | There are no (further) constraints on this element Element idCarePlan.activity.progressShort description Comments about the activity status/progress DefinitionNotes about the adherence/status/progress of the activity. Can be used to capture information about adherence, progress, concerns, etc. This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reference | C | 0..1 | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) | Element idCarePlan.activity.referenceShort description Activity details defined in specific resource DefinitionThe details of the proposed activity represented in a specific resource. Details in a form consistent with other applications and contexts of use. Proposed activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Appointment and ServiceRequest are added because these resources most likely contain information relevant for PROMs collection. Each reference to an Appointment or a ServiceRequest represents a planned activity that functions as a trigger for the PROMs provider to re-evaluate the PROMs collection schedule and adjust if necessary. Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| detail | C | 0..1 | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity.detailShort description In-line definition of activity DefinitionA simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc. Details in a simple form for generic care plan systems. The cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.detail.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.detail.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.detail.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| kind | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.activity.detail.kindShort description Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription DefinitionA description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest. May determine what types of extensions are permitted. Note that FHIR strings SHALL NOT exceed 1MB in size Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity. CarePlanActivityKind (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesCanonical | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) | There are no (further) constraints on this element Element idCarePlan.activity.detail.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity. Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity. canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesUri | 0..* | uri | There are no (further) constraints on this element Element idCarePlan.activity.detail.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity. Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.codeShort description Detail type of activity DefinitionDetailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter. Allows matching performed to planned as well as validation against protocols. Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead. Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter. ProcedureCodes(SNOMEDCT) (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.reasonCodeShort description Why activity should be done or why activity was prohibited DefinitionProvides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead. Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc. SNOMEDCTClinicalFindings (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonReference | C | 0..* | Reference(Condition | DiagnosticReport | DocumentReference | Observation) | There are no (further) constraints on this element Element idCarePlan.activity.detail.reasonReferenceShort description Why activity is needed DefinitionIndicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan. Conditions can be identified at the activity level that are not identified as reasons for the overall plan. Reference(Condition | DiagnosticReport | DocumentReference | Observation) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| goal | C | 0..* | Reference(Goal) | There are no (further) constraints on this element Element idCarePlan.activity.detail.goalShort description Goals this activity relates to DefinitionInternal reference that identifies the goals that this activity is intended to contribute towards meeting. So that participants know the link explicitly. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.activity.detail.statusShort description not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error DefinitionIdentifies what progress is being made for the specific activity. Indicates progress against the plan, whether the activity is still relevant for the plan. Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated. Codes that reflect the current state of a care plan activity within its overall life cycle. CarePlanActivityStatus (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| statusReason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.statusReasonShort description Reason for current status DefinitionProvides reason why the activity isn't yet started, is on hold, was cancelled, etc. Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| doNotPerform | ?! | 0..1 | boolean | There are no (further) constraints on this element Element idCarePlan.activity.detail.doNotPerformShort description If true, activity is prohibiting action DefinitionIf true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan. Captures intention to not do something that may have been previously typical. This element is labeled as a modifier because it marks an activity as an activity that is not to be performed. If missing indicates that the described activity is one that should be engaged in when following the plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| scheduled[x] | 0..1 | There are no (further) constraints on this element Element idCarePlan.activity.detail.scheduled[x]Short description When activity is to occur DefinitionThe period, timing or frequency upon which the described activity is to occur. Allows prompting for activities and detection of missed planned activities. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| scheduledPeriod | Period | There are no (further) constraints on this element Data type | ||||
| scheduledString | string | There are no (further) constraints on this element Data type | ||||
| scheduledTiming | Timing | There are no (further) constraints on this element Data type | ||||
| location | C | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idCarePlan.activity.detail.locationShort description Where it should happen DefinitionIdentifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc. Helps in planning of activity. May reference a specific clinical location or may identify a type of location. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performer | C | 0..* | Reference(CareTeam | Device | HealthcareService | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idCarePlan.activity.detail.performerShort description Who will be responsible? DefinitionIdentifies who's expected to be involved in the activity. Helps in planning of activity. A performer MAY also be a participant in the care plan. Reference(CareTeam | Device | HealthcareService | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| product[x] | 0..1 | There are no (further) constraints on this element Element idCarePlan.activity.detail.product[x]Short description What is to be administered/supplied DefinitionIdentifies the food, drug or other product to be consumed or supplied in the activity. A product supplied or administered as part of a care plan activity. SNOMEDCTMedicationCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| productCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| productReference | Reference(Medication | Substance) | There are no (further) constraints on this element Data type | ||||
| dailyAmount | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idCarePlan.activity.detail.dailyAmountShort description How to consume/day? Alternate namesdaily dose DefinitionIdentifies the quantity expected to be consumed in a given day. Allows rough dose checking. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| quantity | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idCarePlan.activity.detail.quantityShort description How much to administer/supply/consume DefinitionIdentifies the quantity expected to be supplied, administered or consumed by the subject. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| description | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.detail.descriptionShort description Extra info describing activity to perform DefinitionThis provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| completeQuestionnaire | C | 0..* | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaireShort description Action to occur as part of plan DefinitionIdentifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeCodeableConcept | 0..0 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.outcomeCodeableConceptShort description Results of the activity DefinitionIdentifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not). Note that this should not duplicate the activity status (e.g. completed or in progress). Identifies the results of the activity. CarePlanActivityOutcome (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeReference | C | 0..0 | Reference(Resource) | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) | Element idCarePlan.activity:completeQuestionnaire.outcomeReferenceShort description Appointment, Encounter, Procedure, etc. DefinitionDetails of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource). Links plan to resulting actions. The outcome of activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Encounter and Procedure are added because these resources most likely contain information relevant for PROMs collection. Reference(Resource) | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| progress | 0..0 | Annotation | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.progressShort description Comments about the activity status/progress DefinitionNotes about the adherence/status/progress of the activity. Can be used to capture information about adherence, progress, concerns, etc. This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reference | C | 1..1 | Reference(DataStandardsWalesPSOMTask) | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) | Element idCarePlan.activity:completeQuestionnaire.referenceShort description PSOM Task reference DefinitionEach reference to a Task represents a PROMs Tool within a Collection Event. A Collection Event is a trigger to request a patient to fill in a specific PROMs Tool and to receive the scores and answers filled in by the patient. Details in a form consistent with other applications and contexts of use. Proposed activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Appointment and ServiceRequest are added because these resources most likely contain information relevant for PROMs collection. Each reference to an Appointment or a ServiceRequest represents a planned activity that functions as a trigger for the PROMs provider to re-evaluate the PROMs collection schedule and adjust if necessary. Reference(DataStandardsWalesPSOMTask) | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| detail | C | 0..0 | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.detailShort description In-line definition of activity DefinitionA simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc. Details in a simple form for generic care plan systems. The cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| note | 0..* | Annotation | There are no (further) constraints on this element Element idCarePlan.noteShort description Comments about the plan DefinitionGeneral notes about the care plan not covered elsewhere. Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements. 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). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| DataStandardsWalesPSOMCarePlan (CarePlan) | C | CarePlan | Element idCarePlanShort description Clinical Circumstance Alternate namesCare Team DefinitionDescribes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.idShort description Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idCarePlan.metaShort description Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idCarePlan.implicitRulesShort description A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.languageShort description Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idCarePlan.textShort description Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idCarePlan.containedShort description Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources 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. 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.
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| extension | C | 1..* | Extension | There are no (further) constraints on this element Element idCarePlan.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| pathwayLaterality | C | 1..1 | Extension(CodeableConcept) | Element idCarePlan.extension:pathwayLateralityShort description Laterality of the PSOM pathway Alternate namesextensions, user content DefinitionThe laterality is used to capture the anatomical side associated with the healthcare referral / pathway record. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. https://fhir.nhs.wales/StructureDefinition/Extension-DataStandardsWales-PSOM-PathwayLaterality ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.modifierExtensionShort description Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| identifier | Σ | 0..* | Identifier | Element idCarePlan.identifierShort description External Ids for this plan DefinitionBusiness identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. Unordered, Open, by $this(Profile) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| referralIdentifier | Σ | 0..* | DataStandardsWalesPSOMReferralIdentifier | Element idCarePlan.identifier:referralIdentifierShort description An identifier intended for computation DefinitionAn identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. DataStandardsWalesPSOMReferralIdentifier ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) | There are no (further) constraints on this element Element idCarePlan.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element idCarePlan.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| basedOn | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.basedOnShort description Fulfills CarePlan Alternate namesfulfills DefinitionA care plan that is fulfilled in whole or in part by this care plan. Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| replaces | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.replacesShort description CarePlan replaced by this CarePlan Alternate namessupersedes DefinitionCompleted or terminated care plan whose function is taken by this new care plan. Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans. The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| partOf | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.partOfShort description Part of referenced CarePlan DefinitionA larger care plan of which this particular care plan is a component or step. Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | Σ ?! | 1..1 | codeBinding | Element idCarePlan.statusShort description draft | active | on-hold | revoked | completed | entered-in-error | unknown DefinitionIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. Allows clinicians to determine whether the plan is actionable or not. In interactions between the Health Board and the PROMs provider, the CarePlan uses the following statuses:
Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| intent | Σ ?! | 1..1 | codeBinding | Element idCarePlan.intentShort description proposal | plan | order | option DefinitionIndicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain. Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. In interactions between the Health Board and the PROMs provider, the CarePlan intent is fixed as:
Codes indicating the degree of authority/intentionality associated with a care plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| category | Σ | 2..* | CodeableConcept | Element idCarePlan.categoryShort description Type of plan DefinitionIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. Unordered, Open, by $this(Value) BindingIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| treatmentSpecialty | Σ | 1..1 | CodeableConceptBinding | Element idCarePlan.category:treatmentSpecialtyShort description Treatment Specialty Code DefinitionThe code for the pathway specialty at the time the PROMs form is generated. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. Identifies the pathway specialty PracticeSettingCodeValueSet (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| pathwayType | Σ | 1..1 | CodeableConceptBinding | Element idCarePlan.category:pathwayTypeShort description PROMs Pathway Type DefinitionThe type of pathway that the PROM is associated to, e.g. lung cancer, heart failure, cataract, etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. For local pathways use Identifies the type of pathway DataStandardsWalesPSOMPathwayType (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.codingShort description Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | Σ | 0..1 | string | Element idCarePlan.category:pathwayType.textShort description Local PROMs Pathway Type DefinitionA locally-defined code to identify the PROMs pathway. This type is only required for local pathways. 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. For local pathways The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| title | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.titleShort description Human-friendly name for the care plan DefinitionHuman-friendly name for the care plan. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| description | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.descriptionShort description Summary of nature of plan DefinitionA description of the scope and nature of the plan. Provides more detail than conveyed by category. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| subject | Σ C | 1..1 | Reference(DataStandardsWalesPatient) | Element idCarePlan.subjectShort description Who the care plan is for Alternate namespatient DefinitionIdentifies the patient or group whose intended care is described by the plan. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(DataStandardsWalesPatient) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| encounter | Σ C | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idCarePlan.encounterShort description Encounter created as part of DefinitionThe Encounter during which this CarePlan was created or to which the creation of this record is tightly associated. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| period | Σ C | 0..1 | Period | There are no (further) constraints on this element Element idCarePlan.periodShort description Time period plan covers Alternate namestiming DefinitionIndicates when the plan did (or is intended to) come into effect and end. Allows tracking what plan(s) are in effect at a particular time. Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| created | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idCarePlan.createdShort description Date record was first recorded Alternate namesauthoredOn DefinitionRepresents when this particular CarePlan record was created in the system, which is often a system-generated date. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| author | Σ C | 1..1 | Reference(DataStandardsWalesPractitionerRole) | Element idCarePlan.authorShort description Reference to Senior Responsible Professional and Originating Organisation DefinitionReference to Senior Responsible Professional and Originating Organisation Each occurrence of a Senior Responsible Professional is represented by two FHIR resources: a PractitionerRole resource (instance of DataStandardsWales-PractitionerRole) and a Practitioner resource (DataStandardsWales-Practitioner). The Originating Organisation is related to the Senior Responsible Professional and is represented by the Organization resorce (instance of DataStandardsWales-Organization). The Practitioner and Organization resource are both referenced from the PractitionerRole instance through the elements While the Reference(DataStandardsWalesPractitionerRole) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contributor | C | 0..* | Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idCarePlan.contributorShort description Who provided the content of the care plan DefinitionIdentifies the individual(s) or organization who provided the contents of the care plan. Collaborative care plans may have multiple contributors. Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| careTeam | C | 0..* | Reference(CareTeam) | There are no (further) constraints on this element Element idCarePlan.careTeamShort description Who's involved in plan? DefinitionIdentifies all people and organizations who are expected to be involved in the care envisioned by this plan. Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| addresses | Σ C | 0..* | Reference(Condition) | There are no (further) constraints on this element Element idCarePlan.addressesShort description Health issues this plan addresses DefinitionIdentifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns. When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| supportingInfo | C | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idCarePlan.supportingInfoShort description Information considered as part of plan DefinitionIdentifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc. Identifies barriers and other considerations associated with the care plan. Use "concern" to identify specific conditions addressed by the care plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| goal | C | 0..* | Reference(Goal) | There are no (further) constraints on this element Element idCarePlan.goalShort description Desired outcome of plan DefinitionDescribes the intended objective(s) of carrying out the care plan. Provides context for plan. Allows plan effectiveness to be evaluated by clinicians. Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| activity | C | 0..* | BackboneElement | Element idCarePlan.activityShort description Action to occur as part of plan DefinitionIdentifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice. Unordered, Open, by reference.resolve()(Profile) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| (All Slices) | The requirements in this element apply to all slices | |||||
| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeCodeableConcept | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.outcomeCodeableConceptShort description Results of the activity DefinitionIdentifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not). Note that this should not duplicate the activity status (e.g. completed or in progress). Identifies the results of the activity. CarePlanActivityOutcome (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeReference | C | 0..* | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) | Element idCarePlan.activity.outcomeReferenceShort description Appointment, Encounter, Procedure, etc. DefinitionDetails of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource). Links plan to resulting actions. The outcome of activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Encounter and Procedure are added because these resources most likely contain information relevant for PROMs collection. Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| progress | 0..* | Annotation | There are no (further) constraints on this element Element idCarePlan.activity.progressShort description Comments about the activity status/progress DefinitionNotes about the adherence/status/progress of the activity. Can be used to capture information about adherence, progress, concerns, etc. This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reference | C | 0..1 | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) | Element idCarePlan.activity.referenceShort description Activity details defined in specific resource DefinitionThe details of the proposed activity represented in a specific resource. Details in a form consistent with other applications and contexts of use. Proposed activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Appointment and ServiceRequest are added because these resources most likely contain information relevant for PROMs collection. Each reference to an Appointment or a ServiceRequest represents a planned activity that functions as a trigger for the PROMs provider to re-evaluate the PROMs collection schedule and adjust if necessary. Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| detail | C | 0..1 | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity.detailShort description In-line definition of activity DefinitionA simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc. Details in a simple form for generic care plan systems. The cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.detail.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.detail.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.detail.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| kind | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.activity.detail.kindShort description Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription DefinitionA description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest. May determine what types of extensions are permitted. Note that FHIR strings SHALL NOT exceed 1MB in size Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity. CarePlanActivityKind (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesCanonical | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) | There are no (further) constraints on this element Element idCarePlan.activity.detail.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity. Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity. canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesUri | 0..* | uri | There are no (further) constraints on this element Element idCarePlan.activity.detail.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity. Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.codeShort description Detail type of activity DefinitionDetailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter. Allows matching performed to planned as well as validation against protocols. Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead. Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter. ProcedureCodes(SNOMEDCT) (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.reasonCodeShort description Why activity should be done or why activity was prohibited DefinitionProvides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead. Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc. SNOMEDCTClinicalFindings (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonReference | C | 0..* | Reference(Condition | DiagnosticReport | DocumentReference | Observation) | There are no (further) constraints on this element Element idCarePlan.activity.detail.reasonReferenceShort description Why activity is needed DefinitionIndicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan. Conditions can be identified at the activity level that are not identified as reasons for the overall plan. Reference(Condition | DiagnosticReport | DocumentReference | Observation) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| goal | C | 0..* | Reference(Goal) | There are no (further) constraints on this element Element idCarePlan.activity.detail.goalShort description Goals this activity relates to DefinitionInternal reference that identifies the goals that this activity is intended to contribute towards meeting. So that participants know the link explicitly. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.activity.detail.statusShort description not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error DefinitionIdentifies what progress is being made for the specific activity. Indicates progress against the plan, whether the activity is still relevant for the plan. Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated. Codes that reflect the current state of a care plan activity within its overall life cycle. CarePlanActivityStatus (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| statusReason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.statusReasonShort description Reason for current status DefinitionProvides reason why the activity isn't yet started, is on hold, was cancelled, etc. Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| doNotPerform | ?! | 0..1 | boolean | There are no (further) constraints on this element Element idCarePlan.activity.detail.doNotPerformShort description If true, activity is prohibiting action DefinitionIf true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan. Captures intention to not do something that may have been previously typical. This element is labeled as a modifier because it marks an activity as an activity that is not to be performed. If missing indicates that the described activity is one that should be engaged in when following the plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| scheduled[x] | 0..1 | There are no (further) constraints on this element Element idCarePlan.activity.detail.scheduled[x]Short description When activity is to occur DefinitionThe period, timing or frequency upon which the described activity is to occur. Allows prompting for activities and detection of missed planned activities. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| scheduledPeriod | Period | There are no (further) constraints on this element Data type | ||||
| scheduledString | string | There are no (further) constraints on this element Data type | ||||
| scheduledTiming | Timing | There are no (further) constraints on this element Data type | ||||
| location | C | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idCarePlan.activity.detail.locationShort description Where it should happen DefinitionIdentifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc. Helps in planning of activity. May reference a specific clinical location or may identify a type of location. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performer | C | 0..* | Reference(CareTeam | Device | HealthcareService | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idCarePlan.activity.detail.performerShort description Who will be responsible? DefinitionIdentifies who's expected to be involved in the activity. Helps in planning of activity. A performer MAY also be a participant in the care plan. Reference(CareTeam | Device | HealthcareService | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| product[x] | 0..1 | There are no (further) constraints on this element Element idCarePlan.activity.detail.product[x]Short description What is to be administered/supplied DefinitionIdentifies the food, drug or other product to be consumed or supplied in the activity. A product supplied or administered as part of a care plan activity. SNOMEDCTMedicationCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| productCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| productReference | Reference(Medication | Substance) | There are no (further) constraints on this element Data type | ||||
| dailyAmount | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idCarePlan.activity.detail.dailyAmountShort description How to consume/day? Alternate namesdaily dose DefinitionIdentifies the quantity expected to be consumed in a given day. Allows rough dose checking. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| quantity | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idCarePlan.activity.detail.quantityShort description How much to administer/supply/consume DefinitionIdentifies the quantity expected to be supplied, administered or consumed by the subject. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| description | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.detail.descriptionShort description Extra info describing activity to perform DefinitionThis provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| completeQuestionnaire | C | 0..* | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaireShort description Action to occur as part of plan DefinitionIdentifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeCodeableConcept | 0..0 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.outcomeCodeableConceptShort description Results of the activity DefinitionIdentifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not). Note that this should not duplicate the activity status (e.g. completed or in progress). Identifies the results of the activity. CarePlanActivityOutcome (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeReference | C | 0..0 | Reference(Resource) | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) | Element idCarePlan.activity:completeQuestionnaire.outcomeReferenceShort description Appointment, Encounter, Procedure, etc. DefinitionDetails of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource). Links plan to resulting actions. The outcome of activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Encounter and Procedure are added because these resources most likely contain information relevant for PROMs collection. Reference(Resource) | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| progress | 0..0 | Annotation | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.progressShort description Comments about the activity status/progress DefinitionNotes about the adherence/status/progress of the activity. Can be used to capture information about adherence, progress, concerns, etc. This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reference | C | 1..1 | Reference(DataStandardsWalesPSOMTask) | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) | Element idCarePlan.activity:completeQuestionnaire.referenceShort description PSOM Task reference DefinitionEach reference to a Task represents a PROMs Tool within a Collection Event. A Collection Event is a trigger to request a patient to fill in a specific PROMs Tool and to receive the scores and answers filled in by the patient. Details in a form consistent with other applications and contexts of use. Proposed activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Appointment and ServiceRequest are added because these resources most likely contain information relevant for PROMs collection. Each reference to an Appointment or a ServiceRequest represents a planned activity that functions as a trigger for the PROMs provider to re-evaluate the PROMs collection schedule and adjust if necessary. Reference(DataStandardsWalesPSOMTask) | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| detail | C | 0..0 | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.detailShort description In-line definition of activity DefinitionA simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc. Details in a simple form for generic care plan systems. The cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| note | 0..* | Annotation | There are no (further) constraints on this element Element idCarePlan.noteShort description Comments about the plan DefinitionGeneral notes about the care plan not covered elsewhere. Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements. 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). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| DataStandardsWalesPSOMCarePlan (CarePlan) | C | CarePlan | Element idCarePlanShort description Clinical Circumstance Alternate namesCare Team DefinitionDescribes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.
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| id | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.idShort description Logical id of this artifact DefinitionThe logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation. | ||
| meta | Σ | 0..1 | Meta | There are no (further) constraints on this element Element idCarePlan.metaShort description Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idCarePlan.implicitRulesShort description A set of rules under which this content was created DefinitionA reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| language | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.languageShort description Language of the resource content DefinitionThe base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). A human language.
The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | 0..1 | Narrative | There are no (further) constraints on this element Element idCarePlan.textShort description Text summary of the resource, for human interpretation Alternate namesnarrative, html, xhtml, display DefinitionA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contained | 0..* | Resource | There are no (further) constraints on this element Element idCarePlan.containedShort description Contained, inline Resources Alternate namesinline resources, anonymous resources, contained resources 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. 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.
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| extension | C | 1..* | Extension | There are no (further) constraints on this element Element idCarePlan.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| pathwayLaterality | C | 1..1 | Extension(CodeableConcept) | Element idCarePlan.extension:pathwayLateralityShort description Laterality of the PSOM pathway Alternate namesextensions, user content DefinitionThe laterality is used to capture the anatomical side associated with the healthcare referral / pathway record. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. https://fhir.nhs.wales/StructureDefinition/Extension-DataStandardsWales-PSOM-PathwayLaterality ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.modifierExtensionShort description Extensions that cannot be ignored Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and 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). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| identifier | Σ | 0..* | Identifier | Element idCarePlan.identifierShort description External Ids for this plan DefinitionBusiness identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. Unordered, Open, by $this(Profile) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| referralIdentifier | Σ | 0..* | DataStandardsWalesPSOMReferralIdentifier | Element idCarePlan.identifier:referralIdentifierShort description An identifier intended for computation DefinitionAn identifier - identifies some entity uniquely and unambiguously. Typically this is used for business identifiers. Allows identification of the care plan as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number. DataStandardsWalesPSOMReferralIdentifier ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesCanonical | Σ | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) | There are no (further) constraints on this element Element idCarePlan.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesUri | Σ | 0..* | uri | There are no (further) constraints on this element Element idCarePlan.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| basedOn | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.basedOnShort description Fulfills CarePlan Alternate namesfulfills DefinitionA care plan that is fulfilled in whole or in part by this care plan. Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| replaces | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.replacesShort description CarePlan replaced by this CarePlan Alternate namessupersedes DefinitionCompleted or terminated care plan whose function is taken by this new care plan. Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans. The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| partOf | Σ C | 0..* | Reference(CarePlan) | There are no (further) constraints on this element Element idCarePlan.partOfShort description Part of referenced CarePlan DefinitionA larger care plan of which this particular care plan is a component or step. Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | Σ ?! | 1..1 | codeBinding | Element idCarePlan.statusShort description draft | active | on-hold | revoked | completed | entered-in-error | unknown DefinitionIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. Allows clinicians to determine whether the plan is actionable or not. In interactions between the Health Board and the PROMs provider, the CarePlan uses the following statuses:
Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| intent | Σ ?! | 1..1 | codeBinding | Element idCarePlan.intentShort description proposal | plan | order | option DefinitionIndicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain. Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. In interactions between the Health Board and the PROMs provider, the CarePlan intent is fixed as:
Codes indicating the degree of authority/intentionality associated with a care plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| category | Σ | 2..* | CodeableConcept | Element idCarePlan.categoryShort description Type of plan DefinitionIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. Unordered, Open, by $this(Value) BindingIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| treatmentSpecialty | Σ | 1..1 | CodeableConceptBinding | Element idCarePlan.category:treatmentSpecialtyShort description Treatment Specialty Code DefinitionThe code for the pathway specialty at the time the PROMs form is generated. Used for filtering what plan(s) are retrieved and displayed to different types of users. There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern. Identifies the pathway specialty PracticeSettingCodeValueSet (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| pathwayType | Σ | 1..1 | CodeableConceptBinding | Element idCarePlan.category:pathwayTypeShort description PROMs Pathway Type DefinitionThe type of pathway that the PROM is associated to, e.g. lung cancer, heart failure, cataract, etc. Used for filtering what plan(s) are retrieved and displayed to different types of users. For local pathways use Identifies the type of pathway DataStandardsWalesPSOMPathwayType (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element idCarePlan.category:pathwayType.codingShort description Code defined by a terminology system DefinitionA reference to a code defined by a terminology system. Allows for alternative encodings within a code system, and translations to other code systems. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| text | Σ | 0..1 | string | Element idCarePlan.category:pathwayType.textShort description Local PROMs Pathway Type DefinitionA locally-defined code to identify the PROMs pathway. This type is only required for local pathways. 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. For local pathways The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| title | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.titleShort description Human-friendly name for the care plan DefinitionHuman-friendly name for the care plan. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| description | Σ | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.descriptionShort description Summary of nature of plan DefinitionA description of the scope and nature of the plan. Provides more detail than conveyed by category. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| subject | Σ C | 1..1 | Reference(DataStandardsWalesPatient) | Element idCarePlan.subjectShort description Who the care plan is for Alternate namespatient DefinitionIdentifies the patient or group whose intended care is described by the plan. References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Reference(DataStandardsWalesPatient) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| encounter | Σ C | 0..1 | Reference(Encounter) | There are no (further) constraints on this element Element idCarePlan.encounterShort description Encounter created as part of DefinitionThe Encounter during which this CarePlan was created or to which the creation of this record is tightly associated. This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| period | Σ C | 0..1 | Period | There are no (further) constraints on this element Element idCarePlan.periodShort description Time period plan covers Alternate namestiming DefinitionIndicates when the plan did (or is intended to) come into effect and end. Allows tracking what plan(s) are in effect at a particular time. Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| created | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idCarePlan.createdShort description Date record was first recorded Alternate namesauthoredOn DefinitionRepresents when this particular CarePlan record was created in the system, which is often a system-generated date. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| author | Σ C | 1..1 | Reference(DataStandardsWalesPractitionerRole) | Element idCarePlan.authorShort description Reference to Senior Responsible Professional and Originating Organisation DefinitionReference to Senior Responsible Professional and Originating Organisation Each occurrence of a Senior Responsible Professional is represented by two FHIR resources: a PractitionerRole resource (instance of DataStandardsWales-PractitionerRole) and a Practitioner resource (DataStandardsWales-Practitioner). The Originating Organisation is related to the Senior Responsible Professional and is represented by the Organization resorce (instance of DataStandardsWales-Organization). The Practitioner and Organization resource are both referenced from the PractitionerRole instance through the elements While the Reference(DataStandardsWalesPractitionerRole) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| contributor | C | 0..* | Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idCarePlan.contributorShort description Who provided the content of the care plan DefinitionIdentifies the individual(s) or organization who provided the contents of the care plan. Collaborative care plans may have multiple contributors. Reference(CareTeam | Device | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| careTeam | C | 0..* | Reference(CareTeam) | There are no (further) constraints on this element Element idCarePlan.careTeamShort description Who's involved in plan? DefinitionIdentifies all people and organizations who are expected to be involved in the care envisioned by this plan. Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| addresses | Σ C | 0..* | Reference(Condition) | There are no (further) constraints on this element Element idCarePlan.addressesShort description Health issues this plan addresses DefinitionIdentifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns. When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| supportingInfo | C | 0..* | Reference(Resource) | There are no (further) constraints on this element Element idCarePlan.supportingInfoShort description Information considered as part of plan DefinitionIdentifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc. Identifies barriers and other considerations associated with the care plan. Use "concern" to identify specific conditions addressed by the care plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| goal | C | 0..* | Reference(Goal) | There are no (further) constraints on this element Element idCarePlan.goalShort description Desired outcome of plan DefinitionDescribes the intended objective(s) of carrying out the care plan. Provides context for plan. Allows plan effectiveness to be evaluated by clinicians. Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| activity | C | 0..* | BackboneElement | Element idCarePlan.activityShort description Action to occur as part of plan DefinitionIdentifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice. Unordered, Open, by reference.resolve()(Profile) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| (All Slices) | The requirements in this element apply to all slices | |||||
| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeCodeableConcept | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.outcomeCodeableConceptShort description Results of the activity DefinitionIdentifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not). Note that this should not duplicate the activity status (e.g. completed or in progress). Identifies the results of the activity. CarePlanActivityOutcome (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeReference | C | 0..* | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) | Element idCarePlan.activity.outcomeReferenceShort description Appointment, Encounter, Procedure, etc. DefinitionDetails of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource). Links plan to resulting actions. The outcome of activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Encounter and Procedure are added because these resources most likely contain information relevant for PROMs collection. Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| progress | 0..* | Annotation | There are no (further) constraints on this element Element idCarePlan.activity.progressShort description Comments about the activity status/progress DefinitionNotes about the adherence/status/progress of the activity. Can be used to capture information about adherence, progress, concerns, etc. This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reference | C | 0..1 | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) | Element idCarePlan.activity.referenceShort description Activity details defined in specific resource DefinitionThe details of the proposed activity represented in a specific resource. Details in a form consistent with other applications and contexts of use. Proposed activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Appointment and ServiceRequest are added because these resources most likely contain information relevant for PROMs collection. Each reference to an Appointment or a ServiceRequest represents a planned activity that functions as a trigger for the PROMs provider to re-evaluate the PROMs collection schedule and adjust if necessary. Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| detail | C | 0..1 | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity.detailShort description In-line definition of activity DefinitionA simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc. Details in a simple form for generic care plan systems. The cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.detail.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.detail.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity.detail.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| kind | 0..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.activity.detail.kindShort description Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription DefinitionA description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest. May determine what types of extensions are permitted. Note that FHIR strings SHALL NOT exceed 1MB in size Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity. CarePlanActivityKind (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesCanonical | 0..* | canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) | There are no (further) constraints on this element Element idCarePlan.activity.detail.instantiatesCanonicalShort description Instantiates FHIR protocol or definition DefinitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity. Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity. canonical(ActivityDefinition | Measure | OperationDefinition | PlanDefinition | Questionnaire) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| instantiatesUri | 0..* | uri | There are no (further) constraints on this element Element idCarePlan.activity.detail.instantiatesUriShort description Instantiates external protocol or definition DefinitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity. Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity. This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| code | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.codeShort description Detail type of activity DefinitionDetailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter. Allows matching performed to planned as well as validation against protocols. Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead. Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter. ProcedureCodes(SNOMEDCT) (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.reasonCodeShort description Why activity should be done or why activity was prohibited DefinitionProvides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited. This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead. Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc. SNOMEDCTClinicalFindings (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reasonReference | C | 0..* | Reference(Condition | DiagnosticReport | DocumentReference | Observation) | There are no (further) constraints on this element Element idCarePlan.activity.detail.reasonReferenceShort description Why activity is needed DefinitionIndicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan. Conditions can be identified at the activity level that are not identified as reasons for the overall plan. Reference(Condition | DiagnosticReport | DocumentReference | Observation) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| goal | C | 0..* | Reference(Goal) | There are no (further) constraints on this element Element idCarePlan.activity.detail.goalShort description Goals this activity relates to DefinitionInternal reference that identifies the goals that this activity is intended to contribute towards meeting. So that participants know the link explicitly. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| status | ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idCarePlan.activity.detail.statusShort description not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error DefinitionIdentifies what progress is being made for the specific activity. Indicates progress against the plan, whether the activity is still relevant for the plan. Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated. Codes that reflect the current state of a care plan activity within its overall life cycle. CarePlanActivityStatus (required) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| statusReason | 0..1 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity.detail.statusReasonShort description Reason for current status DefinitionProvides reason why the activity isn't yet started, is on hold, was cancelled, etc. Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| doNotPerform | ?! | 0..1 | boolean | There are no (further) constraints on this element Element idCarePlan.activity.detail.doNotPerformShort description If true, activity is prohibiting action DefinitionIf true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan. Captures intention to not do something that may have been previously typical. This element is labeled as a modifier because it marks an activity as an activity that is not to be performed. If missing indicates that the described activity is one that should be engaged in when following the plan. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| scheduled[x] | 0..1 | There are no (further) constraints on this element Element idCarePlan.activity.detail.scheduled[x]Short description When activity is to occur DefinitionThe period, timing or frequency upon which the described activity is to occur. Allows prompting for activities and detection of missed planned activities. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| scheduledPeriod | Period | There are no (further) constraints on this element Data type | ||||
| scheduledString | string | There are no (further) constraints on this element Data type | ||||
| scheduledTiming | Timing | There are no (further) constraints on this element Data type | ||||
| location | C | 0..1 | Reference(Location) | There are no (further) constraints on this element Element idCarePlan.activity.detail.locationShort description Where it should happen DefinitionIdentifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc. Helps in planning of activity. May reference a specific clinical location or may identify a type of location. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| performer | C | 0..* | Reference(CareTeam | Device | HealthcareService | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idCarePlan.activity.detail.performerShort description Who will be responsible? DefinitionIdentifies who's expected to be involved in the activity. Helps in planning of activity. A performer MAY also be a participant in the care plan. Reference(CareTeam | Device | HealthcareService | Organization | Patient | Practitioner | PractitionerRole | RelatedPerson) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| product[x] | 0..1 | There are no (further) constraints on this element Element idCarePlan.activity.detail.product[x]Short description What is to be administered/supplied DefinitionIdentifies the food, drug or other product to be consumed or supplied in the activity. A product supplied or administered as part of a care plan activity. SNOMEDCTMedicationCodes (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| productCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
| productReference | Reference(Medication | Substance) | There are no (further) constraints on this element Data type | ||||
| dailyAmount | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idCarePlan.activity.detail.dailyAmountShort description How to consume/day? Alternate namesdaily dose DefinitionIdentifies the quantity expected to be consumed in a given day. Allows rough dose checking. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| quantity | C | 0..1 | SimpleQuantity | There are no (further) constraints on this element Element idCarePlan.activity.detail.quantityShort description How much to administer/supply/consume DefinitionIdentifies the quantity expected to be supplied, administered or consumed by the subject. 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. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| description | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity.detail.descriptionShort description Extra info describing activity to perform DefinitionThis provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc. Note that FHIR strings SHALL NOT exceed 1MB in size The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| completeQuestionnaire | C | 0..* | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaireShort description Action to occur as part of plan DefinitionIdentifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc. Allows systems to prompt for performance of planned activities, and validate plans against best practice. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| id | 0..1 | string | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.idShort description Unique id for inter-element referencing DefinitionUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
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| extension | C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.extensionShort description Additional content defined by implementations Alternate namesextensions, user content DefinitionMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Unordered, Open, by url(Value) Extensions are always sliced by (at least) url ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.modifierExtensionShort description Extensions that cannot be ignored even if unrecognized Alternate namesextensions, user content, modifiers DefinitionMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeCodeableConcept | 0..0 | CodeableConcept | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.outcomeCodeableConceptShort description Results of the activity DefinitionIdentifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not). Note that this should not duplicate the activity status (e.g. completed or in progress). Identifies the results of the activity. CarePlanActivityOutcome (example) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| outcomeReference | C | 0..0 | Reference(Resource) | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) | Element idCarePlan.activity:completeQuestionnaire.outcomeReferenceShort description Appointment, Encounter, Procedure, etc. DefinitionDetails of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource). Links plan to resulting actions. The outcome of activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Encounter and Procedure are added because these resources most likely contain information relevant for PROMs collection. Reference(Resource) | Reference(Resource | UKCoreProcedure | DataStandardsWalesEncounter) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| progress | 0..0 | Annotation | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.progressShort description Comments about the activity status/progress DefinitionNotes about the adherence/status/progress of the activity. Can be used to capture information about adherence, progress, concerns, etc. This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description. The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
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| reference | C | 1..1 | Reference(DataStandardsWalesPSOMTask) | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) | Element idCarePlan.activity:completeQuestionnaire.referenceShort description PSOM Task reference DefinitionEach reference to a Task represents a PROMs Tool within a Collection Event. A Collection Event is a trigger to request a patient to fill in a specific PROMs Tool and to receive the scores and answers filled in by the patient. Details in a form consistent with other applications and contexts of use. Proposed activities may trigger or lead to re-evaluation of the PROMs collection schedule. For now references to Appointment and ServiceRequest are added because these resources most likely contain information relevant for PROMs collection. Each reference to an Appointment or a ServiceRequest represents a planned activity that functions as a trigger for the PROMs provider to re-evaluate the PROMs collection schedule and adjust if necessary. Reference(DataStandardsWalesPSOMTask) | Reference(CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | RequestGroup | Task | VisionPrescription | DataStandardsWalesAppointment | DataStandardsWalesServiceRequest) ConditionsThe cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| detail | C | 0..0 | BackboneElement | There are no (further) constraints on this element Element idCarePlan.activity:completeQuestionnaire.detailShort description In-line definition of activity DefinitionA simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc. Details in a simple form for generic care plan systems. The cardinality or value of this element may be affected by these constraints: ele-1, cpl-3 Constraints
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| note | 0..* | Annotation | There are no (further) constraints on this element Element idCarePlan.noteShort description Comments about the plan DefinitionGeneral notes about the care plan not covered elsewhere. Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements. 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). The cardinality or value of this element may be affected by these constraints: ele-1 Constraints
|
| Path | DSCN | ID | Name |
|---|---|---|---|
| CarePlan.category:treatmentSpecialty | PROMs-Metadata-2024004 | MEDPX001X | Treatment Specialty Code |
| CarePlan.category:pathwayType | PROMs-Metadata-2024004 | MPRPX005X | PROMs Pathway Type |
| CarePlan.category:pathwayType.text | PROMs-Metadata-2024004 | MPRPX009X | Local PROMs Pathway Type |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX001X | NHS Number (implicit, main mapping is on Patient.identifier:nhsNumber) |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX001A | NHS Number Status Indicator (implicit, main mapping is on Patient.identifier:nhsNumber.extension:nhsNumberVerificationStatus) |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX002A | Local Person Identifier Origination (implicit, main mapping is on Patient.identifier:[HealthBoard]PasIdentifier.type) |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX002X | Local Person Identifier (implicit, main mapping is on Patient.identifier:[HealthBoard]PasIdentifier.value) |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX003X | Given Name (implicit, main mapping is on Patient.name.given) |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX004X | Family Name (implicit, main mapping is on Patient.name.family) |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX005X | Date of Birth (implicit, main mapping is on Patient.birthDate) |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX006X | Gender Identity (implicit, main mapping is on Patient.gender) |
| CarePlan.subject | PROMs-Metadata-2024004 | MPDPX007X | Postcode (implicit, main mapping is on Patient.address.postalCode) |
| CarePlan.author | PROMs-Metadata-2024004 | MEDPX002A | Senior Responsible Professional Name (implicit, main mapping is on Practitioner.name) |
| CarePlan.author | PROMs-Metadata-2024004 | MEDPX002B | Senior Responsible Professional Identifier Code System (implicit, main mapping is on Practitioner.identifier.system) |
| CarePlan.author | PROMs-Metadata-2024004 | MEDPX002C | Senior Responsible Professional Identifier (implicit, main mapping is on Practitioner.identifier.value) |
| CarePlan.author | PROMs-Metadata-2024004 | MDDPX002X | Originating Organisation Code (implicit, main mapping is on Organization.identifier) |
Search
Below is an overview of recommended Server RESTful FHIR search interactions for this profile. The search syntax used to describe the interactions is described here. The following search parameters are recommended:
identifiercategoryidentifier-assigner*custom defined SearchParameterpatient
Referral Identifier
Retrieves all CarePlan resources that have the specified Referral Identifier:
GET [base]/CarePlan?identifier=urn:oid:2.16.840.1.113883.2.1.8.1.5.140|12345678
Pathway Type
Retrieves all CarePlan resources that have the specified pathway type:
GET [base]/CarePlan?category=https://fhir.nhs.wales/CodeSystem/DataStandardsWales-PSOM-PathwayType|HIA
Treatment Specialty
Retrieves all CarePlan resources that have the specified treatment specialty:
GET [base]/CarePlan?category=http://snomed.info/sct|394593009
Originating Organisation
Retrieves all CarePlan resources that have the specified originating organisation:
GET [base]/CarePlan?identifier-assigner:Organization.identifier=https://fhir.nhs.uk/Id/ods-organization-code|7A4
Patient
Retrieves all CarePlan resources that belong to the specified patient:
GET [base]/CarePlan?patient.identifier=https://fhir.cavuhb.nhs.wales/Id/pas-identifier|A000003