3.8. Treatment Objective
MzTreatmentObjective (Goal) | C | NlcoreTreatmentObjective | Element idGoalShort description TreatmentObjective / DesiredHealthCondition / FunctionalOrMentalStatus Alternate namesBehandeldoel, GewensteGezondheidstoestand, FunctioneleOfMentaleStatus, nl-core-TreatmentObjective DefinitionDescribes the intended objective(s) for a patient, group or organization care, for example, weight loss, restoring an activity of daily living, obtaining herd immunity via immunization, meeting a process improvement objective, etc. On the zib level, zib TreatmentObjective uses a reference to zib FunctionalOrMentalStatus (in future context). In FHIR the concepts from FunctionalOrMentalStatus are represented directly in the the Goal resource, with the exception of the reference to zib MedicalDevice; this reference is represented by the core extension resource-pertainsToGoal in the nl-core-MedicalDevice profile.
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id | Σ | 0..1 | string | There are no (further) constraints on this element Element idGoal.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 idGoal.metaShort description Metadata about the resource DefinitionThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
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implicitRules | Σ ?! | 0..1 | uri | There are no (further) constraints on this element Element idGoal.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.
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language | 0..1 | codeBinding | There are no (further) constraints on this element Element idGoal.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.
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text | 0..1 | Narrative | There are no (further) constraints on this element Element idGoal.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.
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contained | 0..* | Resource | There are no (further) constraints on this element Element idGoal.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 | 0..* | Extension | There are no (further) constraints on this element Element idGoal.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.
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modifierExtension | ?! C | 0..* | Extension | There are no (further) constraints on this element Element idGoal.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.
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identifier | 0..* | Identifier | There are no (further) constraints on this element Element idGoal.identifierShort description External Ids for this goal DefinitionBusiness identifiers assigned to this goal by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Allows identification of the goal as it is known by various participating systems and in a way that remains consistent across servers. This is a business identifier, not a resource identifier (see discussion). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
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lifecycleStatus | Σ ?! | 1..1 | codeBinding | There are no (further) constraints on this element Element idGoal.lifecycleStatusShort description proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected DefinitionThe state of the goal throughout its lifecycle. Allows knowing whether goal needs to be further tracked. No zib concept can be mapped (implicitly) to this element. Unless Codes that reflect the current state of a goal and whether the goal is still being targeted. GoalLifecycleStatus (required) Constraints
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achievementStatus | Σ | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idGoal.achievementStatusShort description in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable DefinitionDescribes the progression, or lack thereof, towards the goal against the target. Indicates the progression, or lack thereof, towards the goal against the target. GoalAchievementStatus (preferred) Constraints
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category | Σ | 0..* | CodeableConcept | There are no (further) constraints on this element Element idGoal.categoryShort description E.g. Treatment, dietary, behavioral, etc. DefinitionIndicates a category the goal falls within. Allows goals to be filtered and sorted. Codes for grouping and sorting goals.
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priority | Σ | 0..1 | CodeableConceptBinding | Element idGoal.priorityShort description Priority Alternate namesPrioriteit DefinitionThe priority of the treatment objective, e.g. low or high priority. Used for sorting and presenting goals. A short-term and long-term treatment objective correspond with high-priority and low-priority, respectively. The level of importance associated with a goal.
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description | Σ | 1..1 | CodeableConcept | There are no (further) constraints on this element Element idGoal.descriptionShort description Code or text describing goal DefinitionHuman-readable and/or coded description of a specific desired objective of care, such as "control blood pressure" or "negotiate an obstacle course" or "dance with child at wedding". Without a description of what's trying to be achieved, element has no purpose. If no code is available, use CodeableConcept.text. Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used. SNOMEDCTClinicalFindings (example) Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idGoal.description.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 idGoal.description.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 Constraints
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coding | Σ | 0..* | Coding | There are no (further) constraints on this element Element idGoal.description.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.
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text | Σ | 0..1 | string | There are no (further) constraints on this element Element idGoal.description.textShort description DesiredHealthcareResult Alternate namesGewenstZorgresultaat DefinitionThe textual account of the treatment objective. 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. This element is used to represent the zib concept DesiredHealthcareResult (NL-CM:13.5.5) if present. If instead DesiredHealthCondition::FunctionalOrMentalStatus is used (NL-CM:13.5.3), this element should be populated with a textual representation containg at least FunctionalOrMentalStatus.StatusName (NL-CM:4.26.2) and FunctionalOrMentalStatus.StatusValue (NL-CM:4.26.3). Receiving systems that need to map back to the zib could look at
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subject | Σ | 1..1 | Reference(Patient | Group | Organization | NlcorePatient) | Element idGoal.subjectShort description Patient Alternate namesPatient DefinitionIdentifies the patient, group or organization for whom the goal is being established. Subject is optional to support annonymized reporting. Reference(Patient | Group | Organization | NlcorePatient) Constraints
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start[x] | Σ | 0..1 | There are no (further) constraints on this element Element idGoal.start[x]Short description When goal pursuit begins DefinitionThe date or event after which the goal should begin being pursued. Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery. Codes describing events that can trigger the initiation of a goal.
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startDate | date | There are no (further) constraints on this element Data type | ||||
startCodeableConcept | CodeableConcept | There are no (further) constraints on this element Data type | ||||
target | C | 0..* | BackboneElement | There are no (further) constraints on this element Element idGoal.targetShort description Target outcome for the goal DefinitionIndicates what should be done by when. Allows the progress of the goal to be monitored against an observation or due date. Target is 0..* to support Observations with multiple components, such as blood pressure goals with both a systolic and diastolic target. When multiple targets are present for a single goal instance, all targets must be met for the overall goal to be met. The cardinality or value of this element may be affected by these constraints: gol-1 Constraints
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id | 0..1 | string | There are no (further) constraints on this element Element idGoal.target.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 idGoal.target.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.
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modifierExtension | Σ ?! C | 0..* | Extension | There are no (further) constraints on this element Element idGoal.target.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.
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measure | Σ C | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idGoal.target.measureShort description StatusName Alternate namesStatusNaam DefinitionCoded description of the functional or mental status or limitation. Code systems used include:
Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level. StatusNaamCodelijsten (required) ConditionsThe cardinality or value of this element may be affected by these constraints: gol-1 Constraints
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detail[x] | Σ C | 0..1 | There are no (further) constraints on this element Element idGoal.target.detail[x]Short description The target value to be achieved DefinitionThe target value of the focus to be achieved to signify the fulfillment of the goal, e.g. 150 pounds, 7.0%. Either the high or low or both values of the range can be specified. When a low value is missing, it indicates that the goal is achieved at any focus value at or below the high value. Similarly, if the high value is missing, it indicates that the goal is achieved at any focus value at or above the low value. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Goal.target.measure defines a coded value. Unordered, Open, by $this(Type) BindingCodes to identify the target value of the focus to be achieved to signify the fulfillment of the goal. The cardinality or value of this element may be affected by these constraints: gol-1 Constraints
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detailQuantity | Quantity | There are no (further) constraints on this element Data type | ||||
detailRange | Range | There are no (further) constraints on this element Data type | ||||
detailString | string | There are no (further) constraints on this element Data type | ||||
detailBoolean | boolean | There are no (further) constraints on this element Data type | ||||
detailInteger | integer | There are no (further) constraints on this element Data type | ||||
detailRatio | Ratio | There are no (further) constraints on this element Data type | ||||
detailCodeableConcept | Σ C | 0..1 | CodeableConceptBinding | There are no (further) constraints on this element Element idGoal.target.detail[x]:detailCodeableConceptShort description StatusValue Alternate namesStatusWaarde DefinitionThe extent to which the patient is limited by the functional or mental condition. If both the status name and the status value are recorded in code, then both values must come from the same code system. If the patient uses a medical device, the evaluation of the extent of the limitation will take place without this aid. The answer codes must be selected from the subselection of the code system corresponding with the request in accordance with the rules applicable to that system. A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Goal.target.measure defines a coded value. Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal. StatusWaardeCodelijsten (required) ConditionsThe cardinality or value of this element may be affected by these constraints: gol-1 Constraints
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due[x] | Σ | 0..1 | There are no (further) constraints on this element Element idGoal.target.due[x]Short description Reach goal on or before DefinitionIndicates either the date or the duration after start by which the goal should be met. Identifies when the goal should be evaluated. Unordered, Open, by $this(Type) Constraints
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dueDuration | Duration | There are no (further) constraints on this element Data type | ||||
dueDate | Σ | 0..1 | date | There are no (further) constraints on this element Element idGoal.target.due[x]:dueDateShort description StatusDate Alternate namesStatusDatum DefinitionIndicates the date of the DesiredHealthCondition by which the goal should be met. Identifies when the goal should be evaluated. Please note that this definition differs from that of zib FunctionalOrMentalStatus. However, ZIB-1657 clarifies that in the current context, the StatusDate should be interpreted this way.
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statusDate | Σ | 0..1 | date | There are no (further) constraints on this element Element idGoal.statusDateShort description When goal status took effect DefinitionIdentifies when the current status. I.e. When initially created, when achieved, when cancelled, etc. To see the date for past statuses, query history.
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statusReason | 0..1 | string | There are no (further) constraints on this element Element idGoal.statusReasonShort description Reason for current status DefinitionCaptures the reason for the current status. This will typically be captured for statuses such as rejected, on-hold or cancelled, but could be present for others.
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expressedBy | Σ | 0..1 | Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) | There are no (further) constraints on this element Element idGoal.expressedByShort description Who's responsible for creating Goal? DefinitionIndicates whose goal this is - patient goal, practitioner goal, etc. This is the individual responsible for establishing the goal, not necessarily who recorded it. (For that, use the Provenance resource.). Reference(Patient | Practitioner | PractitionerRole | RelatedPerson) Constraints
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addresses | 0..1 | Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment | NlcoreProblem) | There are no (further) constraints on this element Element idGoal.addressesShort description Problem Alternate namesProbleem DefinitionDescription of the problem to which the treatment objective applies. Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable. Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment | NlcoreProblem) Constraints
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note | 0..1 | Annotation | There are no (further) constraints on this element Element idGoal.noteShort description Comments about the goal DefinitionAny comments related to the goal. There's a need to capture information about the goal that doesn't actually describe the goal. May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself.
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id | 0..1 | string | There are no (further) constraints on this element Element idGoal.note.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 idGoal.note.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 Constraints
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author[x] | Σ | 0..1 | There are no (further) constraints on this element Element idGoal.note.author[x]Short description Individual responsible for the annotation DefinitionThe individual responsible for making the annotation. Organization is used when there's no need for specific attribution as to who made the comment.
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authorString | string | There are no (further) constraints on this element Data type | ||||
authorReference | Reference(Practitioner | Patient | RelatedPerson | Organization) | There are no (further) constraints on this element Data typeReference(Practitioner | Patient | RelatedPerson | Organization) | ||||
time | Σ | 0..1 | dateTime | There are no (further) constraints on this element Element idGoal.note.timeShort description When the annotation was made DefinitionIndicates when this particular annotation was made.
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text | Σ | 1..1 | markdown | There are no (further) constraints on this element Element idGoal.note.textShort description Comment Alternate namesToelichting DefinitionExplanatory comments as a description of the functional or mental status.
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outcomeCode | 0..* | CodeableConcept | There are no (further) constraints on this element Element idGoal.outcomeCodeShort description What result was achieved regarding the goal? DefinitionIdentifies the change (or lack of change) at the point when the status of the goal is assessed. Outcome tracking is a key aspect of care planning. Note that this should not duplicate the goal status. The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months". SNOMEDCTClinicalFindings (example) Constraints
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outcomeReference | 0..* | Reference(Observation) | There are no (further) constraints on this element Element idGoal.outcomeReferenceShort description Observation that resulted from goal DefinitionDetails of what's changed (or not changed). Outcome tracking is a key aspect of care planning. The goal outcome is independent of the outcome of the related activities. For example, if the Goal is to achieve a target body weight of 150 lb and a care plan activity is defined to diet, then the care plan’s activity outcome could be calories consumed whereas goal outcome is an observation for the actual body weight measured.
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The mz-TreatmentObjective is a profile on Goal derived from nl-core-TreatmentObjective, where additional constraints and guidance has been added based on the TreatmentObjective building block used in dental care. An extensible binding to the HL7 Goal Priority value set has been added, where short-term objectives align with high priority and long-term objectives with low priority.