• dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources
  contained.contained.empty()
• dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource
  contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
• dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
  contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
• dom-5: If a resource is contained in another resource, it SHALL NOT have a security label
  contained.meta.security.empty()
• dom-6: A resource should have narrative for robust management
  text.`div`.exists()
• lst-1: A list can only have an emptyReason if it is empty
  emptyReason.empty() or entry.empty()
• lst-2: The deleted flag can only be used if the mode of the list is "changes"
  mode = 'changes' or entry.deleted.empty()
• lst-3: An entry date can only be used if the mode of the list is "working"
  mode = 'working' or entry.date.empty()

• rim: Entity. Role, or Act
• rim: Act[classCode<ORG,moodCode=EVN]
• SubmissionSet-Mapping: XDS SubmissionSet

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

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

• rim: n/a

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

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

• rim: n/a

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

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

This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

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

In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

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

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

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

• SubmissionSet-Mapping: SubmissionSet.limitedMetadata

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

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

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

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

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.

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

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

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

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.

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

• rim: Act.text?

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

• rim: N/A

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

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

• rim: N/A

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

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

• rim: N/A
• SubmissionSet-Mapping: SubmissionSet.contentTypeCode

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

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

• rim: N/A
• SubmissionSet-Mapping: SubmissionSet.sourceId

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

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

• rim: N/A
• SubmissionSet-Mapping: SubmissionSet.intendedRecipient

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.

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

• rim: N/A

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

• w5: FiveWs.identifier
• rim: .id
• SubmissionSet-Mapping: SubmissionSet.entryUUID and SubmissionSet.uniqueId

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

• w5: FiveWs.identifier
• rim: .id

• rim: n/a

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

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

• rim: n/a

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

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

official

• v2: N/A
• rim: Role.code or implied by context

Allows users to make use of identifiers when the identifier system is not known.

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

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

• v2: CX.5
• rim: Role.code or implied by context

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Identifier.system is always case sensitive.

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

• v2: CX.4 / EI-2-4
• rim: II.root or Role.id.root
• servd: ./IdentifierType

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

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

• v2: CX.1 / EI.1
• rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
• servd: ./Value

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

• v2: CX.7 + CX.8
• rim: Role.effectiveTime or implied by context
• servd: ./StartDate and ./EndDate

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

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

• v2: CX.4 / (CX.4,CX.9,CX.10)
• rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
• servd: ./IdentifierIssuingAuthority

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

• w5: FiveWs.identifier
• rim: .id
• rim: n/a
• v2: CX / EI (occasionally, more often EI maps to a resource id or a URL)
• rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT]
• servd: Identifier

• rim: n/a

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

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

• rim: n/a

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

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

usual

• v2: N/A
• rim: Role.code or implied by context

Allows users to make use of identifiers when the identifier system is not known.

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

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

• v2: CX.5
• rim: Role.code or implied by context

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Identifier.system is always case sensitive.

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

urn:ietf:rfc:3986

• v2: CX.4 / EI-2-4
• rim: II.root or Role.id.root
• servd: ./IdentifierType

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• mhd-startswithuuid: value must start with urn:uuid:
  value.startsWith('urn:uuid:')

• v2: CX.1 / EI.1
• rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
• servd: ./Value

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

• v2: CX.7 + CX.8
• rim: Role.effectiveTime or implied by context
• servd: ./StartDate and ./EndDate

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

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

• v2: CX.4 / (CX.4,CX.9,CX.10)
• rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
• servd: ./IdentifierIssuingAuthority

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

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

current

• w5: FiveWs.status
• rim: .status[current=active;retired=obsolete;entered-in-error=nullified]
• SubmissionSet-Mapping: SubmissionSet.availabilityStatus

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

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

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

working

• w5: FiveWs.class
• rim: .outBoundRelationship[typeCode=COMP].target[classCode=OBS"].value
• SubmissionSet-Mapping: shall be 'working'

Allows customization beyond just the code identifying the kind of list.

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

• rim: .title
• SubmissionSet-Mapping: SubmissionSet.title

Lists often contain subsets of resources rather than an exhaustive list. The code identifies what type of subset is included.

If there is no code, the purpose of the list is implied where it is used, such as in a document section using Document.section.code.

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

{
  "coding": [
    {
      "system": "https://profiles.ihe.net/ITI/MHD/CodeSystem/MHDlistTypes",
      "code": "submissionset"
    }
  ]
}

• w5: FiveWs.what[x]
• rim: .code
• SubmissionSet-Mapping: shall be 'submissionset'

The primary purpose of listing the subject explicitly is to help with finding the right list.

Some purely arbitrary lists do not have a common subject, so this is optional.

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

• w5: FiveWs.subject[x]
• rim: .participation[typeCode<SUB].role (and sometimes .player)
• w5: FiveWs.subject
• SubmissionSet-Mapping: SubmissionSet.patientId

• rim: n/a

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

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

• rim: n/a

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

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

• rim: N/A

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

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

Patient

• rim: N/A

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

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

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

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

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

• rim: .identifier

• rim: n/a

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

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

• rim: n/a

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

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

• v2: N/A
• rim: Role.code or implied by context

Allows users to make use of identifiers when the identifier system is not known.

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

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

• v2: CX.5
• rim: Role.code or implied by context

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

Identifier.system is always case sensitive.

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

• v2: CX.4 / EI-2-4
• rim: II.root or Role.id.root
• servd: ./IdentifierType

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the Rendered Value extension. Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

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

• v2: CX.1 / EI.1
• rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
• servd: ./Value

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

• v2: CX.7 + CX.8
• rim: Role.effectiveTime or implied by context
• servd: ./StartDate and ./EndDate

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

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

• v2: CX.4 / (CX.4,CX.9,CX.10)
• rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
• servd: ./IdentifierIssuingAuthority

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

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

• rim: N/A

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

• w5: FiveWs.context
• rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
• SubmissionSet-Mapping: n/a

Identifies how current the list is which affects relevance.

The actual important date is the date of currency of the resources that were summarized, but it is usually assumed that these are current when the preparation occurs.

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

• w5: FiveWs.recorded
• rim: .participation[typeCode<AUT].time[type=TS]
• SubmissionSet-Mapping: SubmissionSet.submissionTime

Allows follow-up as well as context.

The primary source is the entity that made the decisions what items are in the list. This may be software or user.

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

• w5: FiveWs.author
• rim: .participation[typeCode<AUT].role[classCode=REL].player[classCode=PSN,determinerCode=INST] or .participation[typeCode<AUT].role[classCode=REL].player[classCode=DEV,determinerCode=INST]
• SubmissionSet-Mapping: SubmissionSet.author

• rim: n/a

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

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

• rim: n/a

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

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

• rim: n/a
• SubmissionSet-Mapping: SubmissionSet.author when the author is an Organization