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Pan-Canadian Patient Summary (PS-CA) v2.1.0 DFT

2.1.0-DFT   Canada flag
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    1. Index
    2. FHIR Artifacts
    3. Condition (PS-CA)

DFT - For a full list of available versions, see the Directory of published versions

Condition (PS-CA)

Links

Profile

condition-ca-ps

Derived from

http://hl7.org/fhir/StructureDefinition/Condition

Examples

heart-condition-example

Description

This profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the Condition IPS-UV profile and the Canadian Baseline Profile to allow for cross-border and cross-jurisdiction sharing of a record of a problem represented in the patient summary as an instance of the Condition resource constrained by this profile.

References to this resource

CompositionPSCA

Resource Content

  • Tree view
  • Overview
  • XML
  • JSON
ConditionPSCA (Condition)CCondition
There are no (further) constraints on this element
Element id
Condition
Short description

Detailed information about conditions, problems or diagnoses

Definition

A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

Data type

Condition

Constraints
  • con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item
    clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
  • con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
    abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
  • con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
    verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
  • 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()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • sct-concept: < 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)
  • v2: PPR message
  • rim: Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
idΣ0..1string
There are no (further) constraints on this element
Element id
Condition.id
Short description

Logical id of this artifact

Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Comments

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

Data type

string

metaΣ0..1Meta
There are no (further) constraints on this element
Element id
Condition.meta
Short description

Metadata about the resource

Definition

The 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.

Data type

Meta

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
implicitRulesΣ ?!0..1uri
There are no (further) constraints on this element
Element id
Condition.implicitRules
Short description

A set of rules under which this content was created

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Comments

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

Data type

uri

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
language0..1codeBinding
There are no (further) constraints on this element
Element id
Condition.language
Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

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

Data type

code

Binding

A human language.

CommonLanguages (preferred)

Binding extensions
maxValueSetAllLanguages
Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
text0..1Narrative
There are no (further) constraints on this element
Element id
Condition.text
Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

A human-readable narrative that contains a summary of the resource and 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.

Comments

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

Data type

Narrative

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: Act.text?
contained0..*Resource
There are no (further) constraints on this element
Element id
Condition.contained
Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Comments

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

Data type

Resource

Mappings
  • rim: N/A
extensionC0..*Extension
There are no (further) constraints on this element
Element id
Condition.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource. 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.

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: N/A
modifierExtension?! C0..*Extension
There are no (further) constraints on this element
Element id
Condition.modifierExtension
Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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).

Requirements

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

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: N/A
identifierΣ0..*Identifier
There are no (further) constraints on this element
Element id
Condition.identifier
Short description

External Ids for this condition

Definition

Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

Requirements

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

Comments

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

Data type

Identifier

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • rim: .id
clinicalStatusS Σ ?! C0..1CodeableConceptBindingElement id
Condition.clinicalStatus
Short description

active | recurrence | relapse | inactive | remission | resolved

Definition

The clinical status of the condition.

Comments

While the IPS-UV specification considers this a Must Support element, some systems will not have a field directly representing clinicalStatus, but have other means of differentiating between current and historical conditions. Implementers are expected to be able to differentiate between active and inactive conditions. However, the valueSet that is required in the base specification does not provide an 'unknown' concept to support legacy data without a clinicalStatus. This has resulted in additional burdens that some participating systems could not meet with their legacy data.

The requirement from the base FHIR specification to provide a system and value from the bound value set means the PS-CA CodeableConcept data type profile does not need to be applied on this particular element.

In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed.

Data type

CodeableConcept

Binding

The clinical status of the condition or diagnosis.

ConditionClinicalStatusCodes (required)

Conditions

The cardinality or value of this element may be affected by these constraints: con-3, con-4, con-5

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.status
  • w5: FiveWs.status
  • sct-concept: < 303105007 |Disease phases|
  • v2: PRB-14
  • rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
verificationStatusΣ ?! C0..1CodeableConceptBindingElement id
Condition.verificationStatus
Short description

unconfirmed | provisional | differential | confirmed | refuted | entered-in-error

Definition

The verification status to support the clinical status of the condition.

Comments

IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.

FHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.

IPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed.

Data type

CodeableConcept

Binding

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

ConditionVerificationStatus (required)

Conditions

The cardinality or value of this element may be affected by these constraints: con-3, con-5

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.status
  • w5: FiveWs.status
  • sct-concept: < 410514004 |Finding context value|
  • v2: PRB-13
  • rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
  • sct-attr: 408729009
category0..*CodeableConceptBindingElement id
Condition.category
Short description

problem-list-item | encounter-diagnosis

Definition

A category assigned to the condition. In this profile, a health problem of the patient, therefore a 'problem-list-item'.

Comments

IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.

Implementers should be aware that IPS encourages the use of 'problem-list-item'. This is identified through the additionalBinding extension as a component value set (which provides a subset of values from the base valueSet and context around their use).

IPS also provides an additionalBinding to the LOINC value of 75326-9 for backwards compatibility. While not preferred for continued use this is also identified as a additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach).

Data type

CodeableConcept

Binding

A category assigned to the condition.

ConditionCategoryCodes (extensible)

Additional bindings
  • ProblemTypeUvIps (component)

    Component of extensible valueSet put forth in IPS to encourage the use condition records with the category code of 'problem-list-item' for use in the Problems Section and History of Past Illness Section.

  • ProblemTypeLoinc (candidate)

    Codes put forth in IPS to supply an additional binding to the LOINC "Problem" code - retained for backward compatibility. While not preferred for continued use this is also identified as an additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach).

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.class
  • sct-concept: < 404684003 |Clinical finding|
  • v2: 'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message
  • rim: .code
severity0..1CodeableConceptBindingElement id
Condition.severity
Short description

Subjective severity of condition

Definition

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

Comments

IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.

Data type

CodeableConcept

Binding

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

SeverityCode (preferred)

Additional bindings
  • Condition/DiagnosisSeverity (candidate)

    Codes representing the severity of a problem using the preferred value set from base FHIR.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.grade
  • sct-concept: < 272141005 |Severities|
  • v2: PRB-26 / ABS-3
  • rim: Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value
  • sct-attr: 246112005
codeS Σ1..1CodeableConceptPSCABindingElement id
Condition.code
Short description

Concept - reference to a terminology or just text

Alternate names

type

Definition

Identification of the condition, problem or diagnosis or recording of "problem absent" or of "problems unknown".

Requirements

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

Comments

Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The Condition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA ClinicalFindingCode ValueSet that is preferred for this element.

Future releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.

Data type

CodeableConceptPSCA

Binding

Identification of the condition or diagnosis.

HealthConditionCode (preferred)

Additional bindings
  • ICD9CMAllCode (candidate)

    Any code from ICD-9 CM. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology.

  • ICD10CAAllCode (candidate)

    Any Code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology.

  • http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-problems-uv-ips (candidate)

    Absent problem or unknown problem.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.code
  • w5: FiveWs.what[x]
  • sct-concept: code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 413350009 |Finding with explicit context| OR < 272379006 |Event|
  • v2: PRB-3
  • rim: .value
  • sct-attr: 246090004
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
bodySiteΣ0..*CodeableConceptBindingElement id
Condition.bodySite
Short description

Anatomical location, if relevant

Definition

The anatomical location where this condition manifests itself.

Comments

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

Data type

CodeableConcept

Binding

Codes describing anatomical locations. May include laterality.

AnatomicalOrAcquiredBodyStructureCode (preferred)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • sct-concept: < 442083009 |Anatomical or acquired body structure|
  • rim: .targetBodySiteCode
  • sct-attr: 363698007
subjectS Σ1..1Reference(PatientPSCA)Element id
Condition.subject
Short description

Who has the condition?

Alternate names

patient

Definition

Indicates the patient or group who the condition record is associated with.

Requirements

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

Data type

Reference(PatientPSCA)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • v2: PID-3
  • rim: .participation[typeCode=SBJ].role[classCode=PAT]
  • w5: FiveWs.subject
id0..1string
There are no (further) constraints on this element
Element id
Condition.subject.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
Condition.subject.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the 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.

Comments

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

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
referenceS Σ C1..1string
There are no (further) constraints on this element
Element id
Condition.subject.reference
Short description

Literal reference, Relative, internal or absolute URL

Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Comments

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

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: N/A
typeΣ0..1uriBinding
There are no (further) constraints on this element
Element id
Condition.subject.type
Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Comments

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

Data type

uri

Binding

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

ResourceType (extensible)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: N/A
identifierΣ0..1Identifier
There are no (further) constraints on this element
Element id
Condition.subject.identifier
Short description

Logical reference, when literal reference is not known

Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

Comments

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

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

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

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

Data type

Identifier

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .identifier
displayΣ0..1string
There are no (further) constraints on this element
Element id
Condition.subject.display
Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

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

Data type

string

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: N/A
encounterΣ0..1Reference(Encounter)
There are no (further) constraints on this element
Element id
Condition.encounter
Short description

Encounter created as part of

Definition

The Encounter during which this Condition was created or to which the creation of this record is tightly associated.

Comments

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

Data type

Reference(Encounter)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.context
  • w5: FiveWs.context
  • v2: PV1-19 (+PV1-54)
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
onset[x]S Σ0..1Element id
Condition.onset[x]
Short description

Estimated or actual date, date-time, or age

Definition

Estimated or actual date or date-time the condition began, in the opinion of the clinician.

Comments

IPS-UV constrains the condition onset element to only DateTime and Period data types. Both IPS-UV and PS-CA prefer the use of onsetDateTime

Slicing

Unordered, Open, by $this(Type)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.occurrence[x]
  • w5: FiveWs.init
  • v2: PRB-16
  • rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
onsetAgeAge
There are no (further) constraints on this element
Data type

Age

onsetPeriodPeriod
There are no (further) constraints on this element
Data type

Period

onsetRangeRange
There are no (further) constraints on this element
Data type

Range

onsetStringstring
There are no (further) constraints on this element
Data type

string

onsetDateTimeS Σ0..1dateTimeElement id
Condition.onset[x]:onsetDateTime
Short description

Estimated or actual date, date-time, or age

Definition

Estimated or actual date or date-time the condition began, in the opinion of the clinician.

Comments

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

Data type

dateTime

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.occurrence[x]
  • w5: FiveWs.init
  • v2: PRB-16
  • rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
abatement[x]C0..1
There are no (further) constraints on this element
Element id
Condition.abatement[x]
Short description

When in resolution/remission

Definition

The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

Comments

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

Conditions

The cardinality or value of this element may be affected by these constraints: con-4

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.done[x]
  • rim: .effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
abatementDateTimedateTime
There are no (further) constraints on this element
Data type

dateTime

abatementAgeAge
There are no (further) constraints on this element
Data type

Age

abatementPeriodPeriod
There are no (further) constraints on this element
Data type

Period

abatementRangeRange
There are no (further) constraints on this element
Data type

Range

abatementStringstring
There are no (further) constraints on this element
Data type

string

recordedDateΣ0..1dateTime
There are no (further) constraints on this element
Element id
Condition.recordedDate
Short description

Date record was first recorded

Definition

The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.

Data type

dateTime

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.recorded
  • v2: REL-11
  • rim: .participation[typeCode=AUT].time
recorderΣ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
There are no (further) constraints on this element
Element id
Condition.recorder
Short description

Who recorded the condition

Definition

Individual who recorded the record and takes responsibility for its content.

Data type

Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
asserterΣ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
There are no (further) constraints on this element
Element id
Condition.asserter
Short description

Person who asserts this condition

Definition

Individual who is making the condition statement.

Data type

Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.source
  • v2: REL-7.1 identifier + REL-7.12 type code
  • rim: .participation[typeCode=INF].role
stageC0..*BackboneElement
There are no (further) constraints on this element
Element id
Condition.stage
Short description

Stage/grade, usually assessed formally

Definition

Clinical stage or grade of a condition. May include formal severity assessments.

Data type

BackboneElement

Constraints
  • con-1: Stage SHALL have summary or assessment
    summary.exists() or assessment.exists()
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage/grade"]
id0..1string
There are no (further) constraints on this element
Element id
Condition.stage.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
Condition.stage.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the 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.

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
Condition.stage.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).

Requirements

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

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: N/A
summaryC0..1CodeableConcept
There are no (further) constraints on this element
Element id
Condition.stage.summary
Short description

Simple summary (disease specific)

Definition

A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.

Data type

CodeableConcept

Binding

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

ConditionStage (example)

Conditions

The cardinality or value of this element may be affected by these constraints: con-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • sct-concept: < 254291000 |Staging and scales|
  • v2: PRB-14
  • rim: .value
assessmentC0..*Reference(ClinicalImpression | DiagnosticReport | Observation)
There are no (further) constraints on this element
Element id
Condition.stage.assessment
Short description

Formal record of assessment

Definition

Reference to a formal record of the evidence on which the staging assessment is based.

Data type

Reference(ClinicalImpression | DiagnosticReport | Observation)

Conditions

The cardinality or value of this element may be affected by these constraints: con-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .self
type0..1CodeableConcept
There are no (further) constraints on this element
Element id
Condition.stage.type
Short description

Kind of staging

Definition

The kind of staging, such as pathological or clinical staging.

Data type

CodeableConcept

Binding

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

ConditionStageType (example)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage type"]
evidenceC0..*BackboneElement
There are no (further) constraints on this element
Element id
Condition.evidence
Short description

Supporting evidence

Definition

Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

Comments

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

Data type

BackboneElement

Constraints
  • con-2: evidence SHALL have code or details
    code.exists() or detail.exists()
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]
id0..1string
There are no (further) constraints on this element
Element id
Condition.evidence.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
Condition.evidence.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the 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.

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
Condition.evidence.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).

Requirements

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

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: N/A
codeΣ C0..*CodeableConcept
There are no (further) constraints on this element
Element id
Condition.evidence.code
Short description

Manifestation/symptom

Definition

A manifestation or symptom that led to the recording of this condition.

Data type

CodeableConcept

Binding

Codes that describe the manifestation or symptoms of a condition.

ManifestationAndSymptomCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: con-2

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.reasonCode
  • w5: FiveWs.why[x]
  • sct-concept: < 404684003 |Clinical finding|
  • rim: [code="diagnosis"].value
detailΣ C0..*Reference(Resource)
There are no (further) constraints on this element
Element id
Condition.evidence.detail
Short description

Supporting information found elsewhere

Definition

Links to other relevant information, including pathology reports.

Data type

Reference(Resource)

Conditions

The cardinality or value of this element may be affected by these constraints: con-2

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.why[x]
  • rim: .self
note0..*Annotation
There are no (further) constraints on this element
Element id
Condition.note
Short description

Additional information about the Condition

Definition

Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.

Data type

Annotation

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.note
  • v2: NTE child of PRB
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
ConditionPSCA (Condition)CCondition
There are no (further) constraints on this element
Element id
Condition
Short description

Detailed information about conditions, problems or diagnoses

Definition

A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

Data type

Condition

Constraints
  • con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item
    clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()
  • con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission
    abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()
  • con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error
    verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()
  • 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()
Mappings
  • rim: Entity. Role, or Act
  • workflow: Event
  • sct-concept: < 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)
  • v2: PPR message
  • rim: Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]
idΣ0..1string
There are no (further) constraints on this element
Element id
Condition.id
Short description

Logical id of this artifact

Definition

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Comments

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

Data type

string

metaΣ0..1Meta
There are no (further) constraints on this element
Element id
Condition.meta
Short description

Metadata about the resource

Definition

The 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.

Data type

Meta

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
implicitRulesΣ ?!0..1uri
There are no (further) constraints on this element
Element id
Condition.implicitRules
Short description

A set of rules under which this content was created

Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Comments

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

Data type

uri

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
language0..1codeBinding
There are no (further) constraints on this element
Element id
Condition.language
Short description

Language of the resource content

Definition

The base language in which the resource is written.

Comments

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

Data type

code

Binding

A human language.

CommonLanguages (preferred)

Binding extensions
maxValueSetAllLanguages
Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
text0..1Narrative
There are no (further) constraints on this element
Element id
Condition.text
Short description

Text summary of the resource, for human interpretation

Alternate names

narrative, html, xhtml, display

Definition

A human-readable narrative that contains a summary of the resource and 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.

Comments

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

Data type

Narrative

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: Act.text?
contained0..*Resource
There are no (further) constraints on this element
Element id
Condition.contained
Short description

Contained, inline Resources

Alternate names

inline resources, anonymous resources, contained resources

Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.

Comments

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

Data type

Resource

Mappings
  • rim: N/A
extensionC0..*Extension
There are no (further) constraints on this element
Element id
Condition.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource. 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.

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: N/A
modifierExtension?! C0..*Extension
There are no (further) constraints on this element
Element id
Condition.modifierExtension
Short description

Extensions that cannot be ignored

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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).

Requirements

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

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: N/A
identifierΣ0..*Identifier
There are no (further) constraints on this element
Element id
Condition.identifier
Short description

External Ids for this condition

Definition

Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.

Requirements

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

Comments

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

Data type

Identifier

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.identifier
  • w5: FiveWs.identifier
  • rim: .id
clinicalStatusS Σ ?! C0..1CodeableConceptBinding
There are no (further) constraints on this element
Element id
Condition.clinicalStatus
Short description

active | recurrence | relapse | inactive | remission | resolved

Definition

The clinical status of the condition.

Comments

While the IPS-UV specification considers this a Must Support element, some systems will not have a field directly representing clinicalStatus, but have other means of differentiating between current and historical conditions. Implementers are expected to be able to differentiate between active and inactive conditions. However, the valueSet that is required in the base specification does not provide an 'unknown' concept to support legacy data without a clinicalStatus. This has resulted in additional burdens that some participating systems could not meet with their legacy data.

The requirement from the base FHIR specification to provide a system and value from the bound value set means the PS-CA CodeableConcept data type profile does not need to be applied on this particular element.

In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed.

Data type

CodeableConcept

Binding

The clinical status of the condition or diagnosis.

ConditionClinicalStatusCodes (required)

Conditions

The cardinality or value of this element may be affected by these constraints: con-3, con-4, con-5

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.status
  • w5: FiveWs.status
  • sct-concept: < 303105007 |Disease phases|
  • v2: PRB-14
  • rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value
verificationStatusΣ ?! C0..1CodeableConceptBinding
There are no (further) constraints on this element
Element id
Condition.verificationStatus
Short description

unconfirmed | provisional | differential | confirmed | refuted | entered-in-error

Definition

The verification status to support the clinical status of the condition.

Comments

IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.

FHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.

IPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed.

Data type

CodeableConcept

Binding

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

ConditionVerificationStatus (required)

Conditions

The cardinality or value of this element may be affected by these constraints: con-3, con-5

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.status
  • w5: FiveWs.status
  • sct-concept: < 410514004 |Finding context value|
  • v2: PRB-13
  • rim: Observation ACT .inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value
  • sct-attr: 408729009
category0..*CodeableConceptBinding
There are no (further) constraints on this element
Element id
Condition.category
Short description

problem-list-item | encounter-diagnosis

Definition

A category assigned to the condition. In this profile, a health problem of the patient, therefore a 'problem-list-item'.

Comments

IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.

Implementers should be aware that IPS encourages the use of 'problem-list-item'. This is identified through the additionalBinding extension as a component value set (which provides a subset of values from the base valueSet and context around their use).

IPS also provides an additionalBinding to the LOINC value of 75326-9 for backwards compatibility. While not preferred for continued use this is also identified as a additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach).

Data type

CodeableConcept

Binding

A category assigned to the condition.

ConditionCategoryCodes (extensible)

Additional bindings
  • ProblemTypeUvIps (component)

    Component of extensible valueSet put forth in IPS to encourage the use condition records with the category code of 'problem-list-item' for use in the Problems Section and History of Past Illness Section.

  • ProblemTypeLoinc (candidate)

    Codes put forth in IPS to supply an additional binding to the LOINC "Problem" code - retained for backward compatibility. While not preferred for continued use this is also identified as an additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach).

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.class
  • sct-concept: < 404684003 |Clinical finding|
  • v2: 'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message
  • rim: .code
severity0..1CodeableConceptBinding
There are no (further) constraints on this element
Element id
Condition.severity
Short description

Subjective severity of condition

Definition

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

Comments

IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.

Data type

CodeableConcept

Binding

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

SeverityCode (preferred)

Additional bindings
  • Condition/DiagnosisSeverity (candidate)

    Codes representing the severity of a problem using the preferred value set from base FHIR.

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.grade
  • sct-concept: < 272141005 |Severities|
  • v2: PRB-26 / ABS-3
  • rim: Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value
  • sct-attr: 246112005
codeS Σ1..1CodeableConceptPSCABinding
There are no (further) constraints on this element
Element id
Condition.code
Short description

Concept - reference to a terminology or just text

Alternate names

type

Definition

Identification of the condition, problem or diagnosis or recording of "problem absent" or of "problems unknown".

Requirements

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

Comments

Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The Condition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA ClinicalFindingCode ValueSet that is preferred for this element.

Future releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.

Data type

CodeableConceptPSCA

Binding

Identification of the condition or diagnosis.

HealthConditionCode (preferred)

Additional bindings
  • ICD9CMAllCode (candidate)

    Any code from ICD-9 CM. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology.

  • ICD10CAAllCode (candidate)

    Any Code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology.

  • http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-problems-uv-ips (candidate)

    Absent problem or unknown problem.

Conditions

The cardinality or value of this element may be affected by these constraints: ele-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.code
  • w5: FiveWs.what[x]
  • sct-concept: code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS << 420134006 |Propensity to adverse reactions| MINUS << 473010000 |Hypersensitivity condition| MINUS << 79899007 |Drug interaction| MINUS << 69449002 |Drug action| MINUS << 441742003 |Evaluation finding| MINUS << 307824009 |Administrative status| MINUS << 385356007 |Tumor stage finding|) OR < 413350009 |Finding with explicit context| OR < 272379006 |Event|
  • v2: PRB-3
  • rim: .value
  • sct-attr: 246090004
  • rim: n/a
  • v2: CE/CNE/CWE
  • rim: CD
  • orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
bodySiteΣ0..*CodeableConceptBinding
There are no (further) constraints on this element
Element id
Condition.bodySite
Short description

Anatomical location, if relevant

Definition

The anatomical location where this condition manifests itself.

Comments

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

Data type

CodeableConcept

Binding

Codes describing anatomical locations. May include laterality.

AnatomicalOrAcquiredBodyStructureCode (preferred)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • sct-concept: < 442083009 |Anatomical or acquired body structure|
  • rim: .targetBodySiteCode
  • sct-attr: 363698007
subjectS Σ1..1Reference(PatientPSCA)
There are no (further) constraints on this element
Element id
Condition.subject
Short description

Who has the condition?

Alternate names

patient

Definition

Indicates the patient or group who the condition record is associated with.

Requirements

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

Data type

Reference(PatientPSCA)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.subject
  • w5: FiveWs.subject[x]
  • v2: PID-3
  • rim: .participation[typeCode=SBJ].role[classCode=PAT]
  • w5: FiveWs.subject
id0..1string
There are no (further) constraints on this element
Element id
Condition.subject.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
Condition.subject.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the 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.

Comments

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

Data type

Extension

Slicing

Unordered, Open, by url(Value)

Extensions are always sliced by (at least) url

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
referenceS Σ C1..1string
There are no (further) constraints on this element
Element id
Condition.subject.reference
Short description

Literal reference, Relative, internal or absolute URL

Definition

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Comments

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

Data type

string

Conditions

The cardinality or value of this element may be affected by these constraints: ref-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: N/A
typeΣ0..1uriBinding
There are no (further) constraints on this element
Element id
Condition.subject.type
Short description

Type the reference refers to (e.g. "Patient")

Definition

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

Comments

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

Data type

uri

Binding

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

ResourceType (extensible)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: N/A
identifierΣ0..1Identifier
There are no (further) constraints on this element
Element id
Condition.subject.identifier
Short description

Logical reference, when literal reference is not known

Definition

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

Comments

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

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

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

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

Data type

Identifier

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .identifier
displayΣ0..1string
There are no (further) constraints on this element
Element id
Condition.subject.display
Short description

Text alternative for the resource

Definition

Plain text narrative that identifies the resource in addition to the resource reference.

Comments

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

Data type

string

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: N/A
encounterΣ0..1Reference(Encounter)
There are no (further) constraints on this element
Element id
Condition.encounter
Short description

Encounter created as part of

Definition

The Encounter during which this Condition was created or to which the creation of this record is tightly associated.

Comments

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

Data type

Reference(Encounter)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.context
  • w5: FiveWs.context
  • v2: PV1-19 (+PV1-54)
  • rim: .inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
onset[x]S Σ0..1
There are no (further) constraints on this element
Element id
Condition.onset[x]
Short description

Estimated or actual date, date-time, or age

Definition

Estimated or actual date or date-time the condition began, in the opinion of the clinician.

Comments

IPS-UV constrains the condition onset element to only DateTime and Period data types. Both IPS-UV and PS-CA prefer the use of onsetDateTime

Slicing

Unordered, Open, by $this(Type)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.occurrence[x]
  • w5: FiveWs.init
  • v2: PRB-16
  • rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
onsetAgeAge
There are no (further) constraints on this element
Data type

Age

onsetPeriodPeriod
There are no (further) constraints on this element
Data type

Period

onsetRangeRange
There are no (further) constraints on this element
Data type

Range

onsetStringstring
There are no (further) constraints on this element
Data type

string

onsetDateTimeS Σ0..1dateTime
There are no (further) constraints on this element
Element id
Condition.onset[x]:onsetDateTime
Short description

Estimated or actual date, date-time, or age

Definition

Estimated or actual date or date-time the condition began, in the opinion of the clinician.

Comments

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

Data type

dateTime

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.occurrence[x]
  • w5: FiveWs.init
  • v2: PRB-16
  • rim: .effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value
abatement[x]C0..1
There are no (further) constraints on this element
Element id
Condition.abatement[x]
Short description

When in resolution/remission

Definition

The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

Comments

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

Conditions

The cardinality or value of this element may be affected by these constraints: con-4

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.done[x]
  • rim: .effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed
abatementDateTimedateTime
There are no (further) constraints on this element
Data type

dateTime

abatementAgeAge
There are no (further) constraints on this element
Data type

Age

abatementPeriodPeriod
There are no (further) constraints on this element
Data type

Period

abatementRangeRange
There are no (further) constraints on this element
Data type

Range

abatementStringstring
There are no (further) constraints on this element
Data type

string

recordedDateΣ0..1dateTime
There are no (further) constraints on this element
Element id
Condition.recordedDate
Short description

Date record was first recorded

Definition

The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.

Data type

dateTime

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.recorded
  • v2: REL-11
  • rim: .participation[typeCode=AUT].time
recorderΣ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
There are no (further) constraints on this element
Element id
Condition.recorder
Short description

Who recorded the condition

Definition

Individual who recorded the record and takes responsibility for its content.

Data type

Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.author
  • rim: .participation[typeCode=AUT].role
asserterΣ0..1Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)
There are no (further) constraints on this element
Element id
Condition.asserter
Short description

Person who asserts this condition

Definition

Individual who is making the condition statement.

Data type

Reference(Practitioner | PractitionerRole | Patient | RelatedPerson)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.source
  • v2: REL-7.1 identifier + REL-7.12 type code
  • rim: .participation[typeCode=INF].role
stageC0..*BackboneElement
There are no (further) constraints on this element
Element id
Condition.stage
Short description

Stage/grade, usually assessed formally

Definition

Clinical stage or grade of a condition. May include formal severity assessments.

Data type

BackboneElement

Constraints
  • con-1: Stage SHALL have summary or assessment
    summary.exists() or assessment.exists()
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage/grade"]
id0..1string
There are no (further) constraints on this element
Element id
Condition.stage.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
Condition.stage.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the 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.

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
Condition.stage.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).

Requirements

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

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: N/A
summaryC0..1CodeableConcept
There are no (further) constraints on this element
Element id
Condition.stage.summary
Short description

Simple summary (disease specific)

Definition

A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific.

Data type

CodeableConcept

Binding

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

ConditionStage (example)

Conditions

The cardinality or value of this element may be affected by these constraints: con-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • sct-concept: < 254291000 |Staging and scales|
  • v2: PRB-14
  • rim: .value
assessmentC0..*Reference(ClinicalImpression | DiagnosticReport | Observation)
There are no (further) constraints on this element
Element id
Condition.stage.assessment
Short description

Formal record of assessment

Definition

Reference to a formal record of the evidence on which the staging assessment is based.

Data type

Reference(ClinicalImpression | DiagnosticReport | Observation)

Conditions

The cardinality or value of this element may be affected by these constraints: con-1

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .self
type0..1CodeableConcept
There are no (further) constraints on this element
Element id
Condition.stage.type
Short description

Kind of staging

Definition

The kind of staging, such as pathological or clinical staging.

Data type

CodeableConcept

Binding

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

ConditionStageType (example)

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage type"]
evidenceC0..*BackboneElement
There are no (further) constraints on this element
Element id
Condition.evidence
Short description

Supporting evidence

Definition

Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

Comments

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

Data type

BackboneElement

Constraints
  • con-2: evidence SHALL have code or details
    code.exists() or detail.exists()
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • rim: .outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]
id0..1string
There are no (further) constraints on this element
Element id
Condition.evidence.id
Short description

Unique id for inter-element referencing

Definition

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

Data type

string

Mappings
  • rim: n/a
extensionC0..*Extension
There are no (further) constraints on this element
Element id
Condition.evidence.extension
Short description

Additional content defined by implementations

Alternate names

extensions, user content

Definition

May be used to represent additional information that is not part of the basic definition of the 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.

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: n/a
modifierExtensionΣ ?! C0..*Extension
There are no (further) constraints on this element
Element id
Condition.evidence.modifierExtension
Short description

Extensions that cannot be ignored even if unrecognized

Alternate names

extensions, user content, modifiers

Definition

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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).

Requirements

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

Comments

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

Data type

Extension

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
  • ext-1: Must have either extensions or value[x], not both
    extension.exists() != value.exists()
Mappings
  • rim: N/A
codeΣ C0..*CodeableConcept
There are no (further) constraints on this element
Element id
Condition.evidence.code
Short description

Manifestation/symptom

Definition

A manifestation or symptom that led to the recording of this condition.

Data type

CodeableConcept

Binding

Codes that describe the manifestation or symptoms of a condition.

ManifestationAndSymptomCodes (example)

Conditions

The cardinality or value of this element may be affected by these constraints: con-2

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.reasonCode
  • w5: FiveWs.why[x]
  • sct-concept: < 404684003 |Clinical finding|
  • rim: [code="diagnosis"].value
detailΣ C0..*Reference(Resource)
There are no (further) constraints on this element
Element id
Condition.evidence.detail
Short description

Supporting information found elsewhere

Definition

Links to other relevant information, including pathology reports.

Data type

Reference(Resource)

Conditions

The cardinality or value of this element may be affected by these constraints: con-2

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • w5: FiveWs.why[x]
  • rim: .self
note0..*Annotation
There are no (further) constraints on this element
Element id
Condition.note
Short description

Additional information about the Condition

Definition

Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.

Data type

Annotation

Constraints
  • ele-1: All FHIR elements must have a @value or children
    hasValue() or (children().count() > id.count())
Mappings
  • workflow: Event.note
  • v2: NTE child of PRB
  • rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
<StructureDefinition xmlns="http://hl7.org/fhir">
<id value="condition-ca-ps" />
<url value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/condition-ca-ps" />
<name value="ConditionPSCA" />
<title value="Condition (PS-CA)" />
<status value="draft" />
<experimental value="false" />
<date value="2024-04-09T00:00:00-08:00" />
<description value="This profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the [Condition IPS-UV profile](http://hl7.org/fhir/uv/ips/StructureDefinition-Condition-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-condition.html) to allow for cross-border and cross-jurisdiction sharing of a record of a problem represented in the patient summary as an instance of the Condition resource constrained by this profile." />
<copyright value="Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." />
<fhirVersion value="4.0.1" />
<kind value="resource" />
<abstract value="false" />
<type value="Condition" />
<baseDefinition value="http://hl7.org/fhir/StructureDefinition/Condition" />
<derivation value="constraint" />
<snapshot>
<element id="Condition">
<path value="Condition" />
<short value="Detailed information about conditions, problems or diagnoses" />
<definition value="A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition" />
<min value="0" />
<max value="*" />
</base>
<constraint>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
<valueBoolean value="true" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="Most systems will expect a clinicalStatus to be valued for problem-list-items that are managed over time, but might not need a clinicalStatus for point in time encounter-diagnosis." />
</extension>
<key value="con-3" />
<severity value="warning" />
<human value="Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item" />
<expression value="clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()" />
<xpath value="exists(f:clinicalStatus) or exists(f:verificationStatus/f:coding/f:code/@value='entered-in-error') or not(exists(category[@value='problem-list-item']))" />
</constraint>
<constraint>
<key value="con-4" />
<severity value="error" />
<human value="If condition is abated, then clinicalStatus must be either inactive, resolved, or remission" />
<expression value="abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()" />
<xpath value="not(exists(*[starts-with(local-name(.), 'abatement')])) or exists(f:clinicalStatus/f:coding[f:system/@value='http://terminology.hl7.org/CodeSystem/condition-clinical' and f:code/@value=('resolved', 'remission', 'inactive')])" />
</constraint>
<constraint>
<key value="con-5" />
<severity value="error" />
<human value="Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error" />
<expression value="verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()" />
<xpath value="not(exists(f:verificationStatus/f:coding[f:system/@value='http://terminology.hl7.org/CodeSystem/condition-ver-status' and f:code/@value='entered-in-error'])) or not(exists(f:clinicalStatus))" />
</constraint>
<constraint>
<key value="dom-2" />
<severity value="error" />
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
<expression value="contained.contained.empty()" />
<xpath value="not(parent::f:contained and f:contained)" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-3" />
<severity value="error" />
<human value="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" />
<expression value="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()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-4" />
<severity value="error" />
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<expression value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<key value="dom-5" />
<severity value="error" />
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
<expression value="contained.meta.security.empty()" />
<xpath value="not(exists(f:contained/*/f:meta/f:security))" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<constraint>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
<valueBoolean value="true" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
<key value="dom-6" />
<severity value="warning" />
<human value="A resource should have narrative for robust management" />
<expression value="text.`div`.exists()" />
<xpath value="exists(f:text/h:div)" />
<source value="http://hl7.org/fhir/StructureDefinition/DomainResource" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="Entity. Role, or Act" />
</mapping>
<mapping>
<identity value="workflow" />
<map value="Event" />
</mapping>
<mapping>
<identity value="sct-concept" />
<map value="< 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PPR message" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]" />
</mapping>
</element>
<element id="Condition.id">
<path value="Condition.id" />
<short value="Logical id of this artifact" />
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isModifier value="false" />
<isSummary value="true" />
</element>
<element id="Condition.meta">
<path value="Condition.meta" />
<short value="Metadata about the resource" />
<definition value="The 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." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.meta" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Meta" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
</element>
<element id="Condition.implicitRules">
<path value="Condition.implicitRules" />
<short value="A set of rules under which this content was created" />
<definition value="A 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." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.implicitRules" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="uri" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
<isSummary value="true" />
</element>
<element id="Condition.language">
<path value="Condition.language" />
<short value="Language of the resource content" />
<definition value="The base language in which the resource is written." />
<comment value="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)." />
<min value="0" />
<max value="1" />
<base>
<path value="Resource.language" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="code" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="Language" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding">
<valueBoolean value="true" />
</extension>
<strength value="preferred" />
<description value="A human language." />
<valueSet value="http://hl7.org/fhir/ValueSet/languages" />
</binding>
</element>
<element id="Condition.text">
<path value="Condition.text" />
<short value="Text summary of the resource, for human interpretation" />
<definition value="A 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." />
<comment value="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." />
<alias value="narrative" />
<alias value="html" />
<alias value="xhtml" />
<alias value="display" />
<min value="0" />
<max value="1" />
<base>
<path value="DomainResource.text" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Narrative" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="Act.text?" />
</mapping>
</element>
<element id="Condition.contained">
<path value="Condition.contained" />
<short value="Contained, inline Resources" />
<definition value="These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope." />
<comment value="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." />
<alias value="inline resources" />
<alias value="anonymous resources" />
<alias value="contained resources" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.contained" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Resource" />
</type>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Condition.extension">
<path value="Condition.extension" />
<short value="Additional content defined by implementations" />
<definition value="May 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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Condition.modifierExtension">
<path value="Condition.modifierExtension" />
<short value="Extensions that cannot be ignored" />
<definition value="May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="DomainResource.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Condition.identifier">
<path value="Condition.identifier" />
<short value="External Ids for this condition" />
<definition value="Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server." />
<comment value="This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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." />
<requirements value="Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.identifier" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Identifier" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="workflow" />
<map value="Event.identifier" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.identifier" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".id" />
</mapping>
</element>
<element id="Condition.clinicalStatus">
<path value="Condition.clinicalStatus" />
<short value="active | recurrence | relapse | inactive | remission | resolved" />
<definition value="The clinical status of the condition." />
<comment value="While the IPS-UV specification considers this a Must Support element, some systems will not have a field directly representing clinicalStatus, but have other means of differentiating between current and historical conditions. Implementers are expected to be able to differentiate between active and inactive conditions. However, the valueSet that is required in the base specification does not provide an 'unknown' concept to support legacy data without a clinicalStatus. This has resulted in additional burdens that some participating systems could not meet with their legacy data.\n\n The requirement from the base FHIR specification to provide a system and value from the bound value set means the PS-CA CodeableConcept data type profile does not need to be applied on this particular element.\n\nIn the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.clinicalStatus" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="con-3" />
<condition value="con-4" />
<condition value="con-5" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because the status contains codes that mark the condition as no longer active." />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ConditionClinicalStatus" />
</extension>
<strength value="required" />
<description value="The clinical status of the condition or diagnosis." />
<valueSet value="http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1" />
</binding>
<mapping>
<identity value="workflow" />
<map value="Event.status" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.status" />
</mapping>
<mapping>
<identity value="sct-concept" />
<map value="< 303105007 |Disease phases|" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PRB-14" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Observation ACT\n.inboundRelationship[typeCode=COMP].source[classCode=OBS, code="clinicalStatus", moodCode=EVN].value" />
</mapping>
</element>
<element id="Condition.verificationStatus">
<path value="Condition.verificationStatus" />
<short value="unconfirmed | provisional | differential | confirmed | refuted | entered-in-error" />
<definition value="The verification status to support the clinical status of the condition." />
<comment value="IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.\n\nFHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.\n\nIPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.verificationStatus" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="con-3" />
<condition value="con-5" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="true" />
<isModifierReason value="This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid." />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ConditionVerificationStatus" />
</extension>
<strength value="required" />
<description value="The verification status to support or decline the clinical status of the condition or diagnosis." />
<valueSet value="http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1" />
</binding>
<mapping>
<identity value="workflow" />
<map value="Event.status" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.status" />
</mapping>
<mapping>
<identity value="sct-concept" />
<map value="< 410514004 |Finding context value|" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PRB-13" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Observation ACT\n.inboundRelationship[typeCode=COMP].source[classCode=OBS, code="verificationStatus", moodCode=EVN].value" />
</mapping>
<mapping>
<identity value="sct-attr" />
<map value="408729009" />
</mapping>
</element>
<element id="Condition.category">
<path value="Condition.category" />
<short value="problem-list-item | encounter-diagnosis" />
<definition value="A category assigned to the condition. In this profile, a health problem of the patient, therefore a 'problem-list-item'." />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. \n\n Implementers should be aware that IPS encourages the use of 'problem-list-item'. This is identified through the additionalBinding extension as a component value set (which provides a subset of values from the base valueSet and context around their use). \n\n IPS also provides an additionalBinding to the LOINC value of 75326-9 for backwards compatibility. While not preferred for continued use this is also identified as a additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.category" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ConditionCategory" />
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="component" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/problem-type-uv-ips" />
</extension>
<extension url="documentation">
<valueMarkdown value="Component of extensible valueSet put forth in IPS to encourage the use condition records with the category code of 'problem-list-item' for use in the Problems Section and History of Past Illness Section." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/problem-type-loinc" />
</extension>
<extension url="documentation">
<valueMarkdown value="Codes put forth in IPS to supply an additional binding to the LOINC "Problem" code - retained for backward compatibility. While not preferred for continued use this is also identified as an additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)." />
</extension>
</extension>
<strength value="extensible" />
<description value="A category assigned to the condition." />
<valueSet value="http://hl7.org/fhir/ValueSet/condition-category" />
</binding>
<mapping>
<identity value="w5" />
<map value="FiveWs.class" />
</mapping>
<mapping>
<identity value="sct-concept" />
<map value="< 404684003 |Clinical finding|" />
</mapping>
<mapping>
<identity value="v2" />
<map value="'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".code" />
</mapping>
</element>
<element id="Condition.severity">
<path value="Condition.severity" />
<short value="Subjective severity of condition" />
<definition value="A subjective assessment of the severity of the condition as evaluated by the clinician." />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.severity" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ConditionSeverity" />
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/condition-severity" />
</extension>
<extension url="documentation">
<valueMarkdown value="Codes representing the severity of a problem using the preferred value set from base FHIR." />
</extension>
</extension>
<strength value="preferred" />
<description value="A subjective assessment of the severity of the condition as evaluated by the clinician." />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/severitycode" />
</binding>
<mapping>
<identity value="w5" />
<map value="FiveWs.grade" />
</mapping>
<mapping>
<identity value="sct-concept" />
<map value="< 272141005 |Severities|" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PRB-26 / ABS-3" />
</mapping>
<mapping>
<identity value="rim" />
<map value="Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="severity"].value" />
</mapping>
<mapping>
<identity value="sct-attr" />
<map value="246112005" />
</mapping>
</element>
<element id="Condition.code">
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="normative" />
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version">
<valueCode value="4.0.0" />
</extension>
<path value="Condition.code" />
<short value="Concept - reference to a terminology or just text" />
<definition value="Identification of the condition, problem or diagnosis or recording of "problem absent" or of "problems unknown"." />
<comment value="Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The Condition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA ClinicalFindingCode ValueSet that is preferred for this element.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content." />
<requirements value="0..1 to account for primarily narrative only resources." />
<alias value="type" />
<min value="1" />
<max value="1" />
<base>
<path value="Condition.code" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
<condition value="ele-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isModifier value="false" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ConditionKind" />
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD9CM" />
</extension>
<extension url="documentation">
<valueMarkdown value="Any code from ICD-9 CM. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD10CA" />
</extension>
<extension url="documentation">
<valueMarkdown value="Any Code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-problems-uv-ips" />
</extension>
<extension url="documentation">
<valueMarkdown value="Absent problem or unknown problem." />
</extension>
</extension>
<strength value="preferred" />
<description value="Identification of the condition or diagnosis." />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/healthconditioncode" />
</binding>
<mapping>
<identity value="workflow" />
<map value="Event.code" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.what[x]" />
</mapping>
<mapping>
<identity value="sct-concept" />
<map value="code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS\n<< 420134006 |Propensity to adverse reactions| MINUS \n<< 473010000 |Hypersensitivity condition| MINUS \n<< 79899007 |Drug interaction| MINUS\n<< 69449002 |Drug action| MINUS \n<< 441742003 |Evaluation finding| MINUS \n<< 307824009 |Administrative status| MINUS \n<< 385356007 |Tumor stage finding|) \nOR < 413350009 |Finding with explicit context|\nOR < 272379006 |Event|" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PRB-3" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".value" />
</mapping>
<mapping>
<identity value="sct-attr" />
<map value="246090004" />
</mapping>
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
<mapping>
<identity value="v2" />
<map value="CE/CNE/CWE" />
</mapping>
<mapping>
<identity value="rim" />
<map value="CD" />
</mapping>
<mapping>
<identity value="orim" />
<map value="fhir:CodeableConcept rdfs:subClassOf dt:CD" />
</mapping>
</element>
<element id="Condition.bodySite">
<path value="Condition.bodySite" />
<short value="Anatomical location, if relevant" />
<definition value="The anatomical location where this condition manifests itself." />
<comment value="Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.bodySite" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="BodySite" />
</extension>
<strength value="preferred" />
<description value="Codes describing anatomical locations. May include laterality." />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/anatomicaloracquiredbodystructurecode" />
</binding>
<mapping>
<identity value="sct-concept" />
<map value="< 442083009 |Anatomical or acquired body structure|" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".targetBodySiteCode" />
</mapping>
<mapping>
<identity value="sct-attr" />
<map value="363698007" />
</mapping>
</element>
<element id="Condition.subject">
<path value="Condition.subject" />
<short value="Who has the condition?" />
<definition value="Indicates the patient or group who the condition record is associated with." />
<requirements value="Group is typically used for veterinary or public health use cases." />
<alias value="patient" />
<min value="1" />
<max value="1" />
<base>
<path value="Condition.subject" />
<min value="1" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="workflow" />
<map value="Event.subject" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.subject[x]" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PID-3" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=SBJ].role[classCode=PAT]" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.subject" />
</mapping>
</element>
<element id="Condition.subject.id">
<path value="Condition.subject.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Condition.subject.extension">
<path value="Condition.subject.extension" />
<slicing>
<discriminator>
<type value="value" />
<path value="url" />
</discriminator>
<description value="Extensions are always sliced by (at least) url" />
<rules value="open" />
</slicing>
<short value="Additional content defined by implementations" />
<definition value="May 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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Condition.subject.reference">
<path value="Condition.subject.reference" />
<short value="Literal reference, Relative, internal or absolute URL" />
<definition value="A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources." />
<comment value="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." />
<min value="1" />
<max value="1" />
<base>
<path value="Reference.reference" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="string" />
</type>
<condition value="ref-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Condition.subject.type">
<path value="Condition.subject.type" />
<short value="Type the reference refers to (e.g. "Patient")" />
<definition value="The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources)." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Reference.type" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="uri" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="FHIRResourceTypeExt" />
</extension>
<strength value="extensible" />
<description value="Aa resource (or, for logical models, the URI of the logical model)." />
<valueSet value="http://hl7.org/fhir/ValueSet/resource-types" />
</binding>
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Condition.subject.identifier">
<path value="Condition.subject.identifier" />
<short value="Logical reference, when literal reference is not known" />
<definition value="An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference." />
<comment value="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. \n\nWhen 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\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference 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)." />
<min value="0" />
<max value="1" />
<base>
<path value="Reference.identifier" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Identifier" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value=".identifier" />
</mapping>
</element>
<element id="Condition.subject.display">
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
<valueBoolean value="true" />
</extension>
<path value="Condition.subject.display" />
<short value="Text alternative for the resource" />
<definition value="Plain text narrative that identifies the resource in addition to the resource reference." />
<comment value="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." />
<min value="0" />
<max value="1" />
<base>
<path value="Reference.display" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="string" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Condition.encounter">
<path value="Condition.encounter" />
<short value="Encounter created as part of" />
<definition value="The Encounter during which this Condition was created or to which the creation of this record is tightly associated." />
<comment value="This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known"." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.encounter" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="workflow" />
<map value="Event.context" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.context" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PV1-19 (+PV1-54)" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]" />
</mapping>
</element>
<element id="Condition.onset[x]">
<path value="Condition.onset[x]" />
<slicing>
<discriminator>
<type value="type" />
<path value="$this" />
</discriminator>
<rules value="open" />
</slicing>
<short value="Estimated or actual date, date-time, or age" />
<definition value="Estimated or actual date or date-time the condition began, in the opinion of the clinician." />
<comment value="IPS-UV constrains the condition onset element to only DateTime and Period data types. Both IPS-UV and PS-CA prefer the use of onsetDateTime" />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.onset[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="dateTime" />
</type>
<type>
<code value="Age" />
</type>
<type>
<code value="Period" />
</type>
<type>
<code value="Range" />
</type>
<type>
<code value="string" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="workflow" />
<map value="Event.occurrence[x]" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.init" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PRB-16" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value" />
</mapping>
</element>
<element id="Condition.onset[x]:onsetDateTime">
<path value="Condition.onset[x]" />
<sliceName value="onsetDateTime" />
<short value="Estimated or actual date, date-time, or age" />
<definition value="Estimated or actual date or date-time the condition began, in the opinion of the clinician." />
<comment value="Age is generally used when the patient reports an age at which the Condition began to occur." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.onset[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="dateTime" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<mustSupport value="true" />
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="workflow" />
<map value="Event.occurrence[x]" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.init" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PRB-16" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at onset"].value" />
</mapping>
</element>
<element id="Condition.abatement[x]">
<path value="Condition.abatement[x]" />
<short value="When in resolution/remission" />
<definition value="The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate." />
<comment value="There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.abatement[x]" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="dateTime" />
</type>
<type>
<code value="Age" />
</type>
<type>
<code value="Period" />
</type>
<type>
<code value="Range" />
</type>
<type>
<code value="string" />
</type>
<condition value="con-4" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="w5" />
<map value="FiveWs.done[x]" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="age at remission"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed" />
</mapping>
</element>
<element id="Condition.recordedDate">
<path value="Condition.recordedDate" />
<short value="Date record was first recorded" />
<definition value="The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.recordedDate" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="dateTime" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="w5" />
<map value="FiveWs.recorded" />
</mapping>
<mapping>
<identity value="v2" />
<map value="REL-11" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=AUT].time" />
</mapping>
</element>
<element id="Condition.recorder">
<path value="Condition.recorder" />
<short value="Who recorded the condition" />
<definition value="Individual who recorded the record and takes responsibility for its content." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.recorder" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="w5" />
<map value="FiveWs.author" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=AUT].role" />
</mapping>
</element>
<element id="Condition.asserter">
<path value="Condition.asserter" />
<short value="Person who asserts this condition" />
<definition value="Individual who is making the condition statement." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.asserter" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="w5" />
<map value="FiveWs.source" />
</mapping>
<mapping>
<identity value="v2" />
<map value="REL-7.1 identifier + REL-7.12 type code" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".participation[typeCode=INF].role" />
</mapping>
</element>
<element id="Condition.stage">
<path value="Condition.stage" />
<short value="Stage/grade, usually assessed formally" />
<definition value="Clinical stage or grade of a condition. May include formal severity assessments." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.stage" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="BackboneElement" />
</type>
<constraint>
<key value="con-1" />
<severity value="error" />
<human value="Stage SHALL have summary or assessment" />
<expression value="summary.exists() or assessment.exists()" />
<xpath value="exists(f:summary) or exists(f:assessment)" />
</constraint>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage/grade"]" />
</mapping>
</element>
<element id="Condition.stage.id">
<path value="Condition.stage.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Condition.stage.extension">
<path value="Condition.stage.extension" />
<short value="Additional content defined by implementations" />
<definition value="May 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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Condition.stage.modifierExtension">
<path value="Condition.stage.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Condition.stage.summary">
<path value="Condition.stage.summary" />
<short value="Simple summary (disease specific)" />
<definition value="A simple summary of the stage such as "Stage 3". The determination of the stage is disease-specific." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.stage.summary" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="con-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ConditionStage" />
</extension>
<strength value="example" />
<description value="Codes describing condition stages (e.g. Cancer stages)." />
<valueSet value="http://hl7.org/fhir/ValueSet/condition-stage" />
</binding>
<mapping>
<identity value="sct-concept" />
<map value="< 254291000 |Staging and scales|" />
</mapping>
<mapping>
<identity value="v2" />
<map value="PRB-14" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".value" />
</mapping>
</element>
<element id="Condition.stage.assessment">
<path value="Condition.stage.assessment" />
<short value="Formal record of assessment" />
<definition value="Reference to a formal record of the evidence on which the staging assessment is based." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.stage.assessment" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/ClinicalImpression" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Observation" />
</type>
<condition value="con-1" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value=".self" />
</mapping>
</element>
<element id="Condition.stage.type">
<path value="Condition.stage.type" />
<short value="Kind of staging" />
<definition value="The kind of staging, such as pathological or clinical staging." />
<min value="0" />
<max value="1" />
<base>
<path value="Condition.stage.type" />
<min value="0" />
<max value="1" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ConditionStageType" />
</extension>
<strength value="example" />
<description value="Codes describing the kind of condition staging (e.g. clinical or pathological)." />
<valueSet value="http://hl7.org/fhir/ValueSet/condition-stage-type" />
</binding>
<mapping>
<identity value="rim" />
<map value="./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="stage type"]" />
</mapping>
</element>
<element id="Condition.evidence">
<path value="Condition.evidence" />
<short value="Supporting evidence" />
<definition value="Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition." />
<comment value="The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.evidence" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="BackboneElement" />
</type>
<constraint>
<key value="con-2" />
<severity value="error" />
<human value="evidence SHALL have code or details" />
<expression value="code.exists() or detail.exists()" />
<xpath value="exists(f:code) or exists(f:detail)" />
</constraint>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value=".outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]" />
</mapping>
</element>
<element id="Condition.evidence.id">
<path value="Condition.evidence.id" />
<representation value="xmlAttr" />
<short value="Unique id for inter-element referencing" />
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
<min value="0" />
<max value="1" />
<base>
<path value="Element.id" />
<min value="0" />
<max value="1" />
</base>
<type>
<extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
<valueUrl value="string" />
</extension>
<code value="http://hl7.org/fhirpath/System.String" />
</type>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Condition.evidence.extension">
<path value="Condition.evidence.extension" />
<short value="Additional content defined by implementations" />
<definition value="May 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." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<alias value="extensions" />
<alias value="user content" />
<min value="0" />
<max value="*" />
<base>
<path value="Element.extension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="rim" />
<map value="n/a" />
</mapping>
</element>
<element id="Condition.evidence.modifierExtension">
<path value="Condition.evidence.modifierExtension" />
<short value="Extensions that cannot be ignored even if unrecognized" />
<definition value="May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone." />
<requirements value="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](extensibility.html#modifierExtension)." />
<alias value="extensions" />
<alias value="user content" />
<alias value="modifiers" />
<min value="0" />
<max value="*" />
<base>
<path value="BackboneElement.modifierExtension" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Extension" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<constraint>
<key value="ext-1" />
<severity value="error" />
<human value="Must have either extensions or value[x], not both" />
<expression value="extension.exists() != value.exists()" />
<xpath value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])" />
<source value="http://hl7.org/fhir/StructureDefinition/Extension" />
</constraint>
<isModifier value="true" />
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
<isSummary value="true" />
<mapping>
<identity value="rim" />
<map value="N/A" />
</mapping>
</element>
<element id="Condition.evidence.code">
<path value="Condition.evidence.code" />
<short value="Manifestation/symptom" />
<definition value="A manifestation or symptom that led to the recording of this condition." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.evidence.code" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="CodeableConcept" />
</type>
<condition value="con-2" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<binding>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
<valueString value="ManifestationOrSymptom" />
</extension>
<strength value="example" />
<description value="Codes that describe the manifestation or symptoms of a condition." />
<valueSet value="http://hl7.org/fhir/ValueSet/manifestation-or-symptom" />
</binding>
<mapping>
<identity value="workflow" />
<map value="Event.reasonCode" />
</mapping>
<mapping>
<identity value="w5" />
<map value="FiveWs.why[x]" />
</mapping>
<mapping>
<identity value="sct-concept" />
<map value="< 404684003 |Clinical finding|" />
</mapping>
<mapping>
<identity value="rim" />
<map value="[code="diagnosis"].value" />
</mapping>
</element>
<element id="Condition.evidence.detail">
<path value="Condition.evidence.detail" />
<short value="Supporting information found elsewhere" />
<definition value="Links to other relevant information, including pathology reports." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.evidence.detail" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Reference" />
<targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource" />
</type>
<condition value="con-2" />
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="true" />
<mapping>
<identity value="w5" />
<map value="FiveWs.why[x]" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".self" />
</mapping>
</element>
<element id="Condition.note">
<path value="Condition.note" />
<short value="Additional information about the Condition" />
<definition value="Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis." />
<min value="0" />
<max value="*" />
<base>
<path value="Condition.note" />
<min value="0" />
<max value="*" />
</base>
<type>
<code value="Annotation" />
</type>
<constraint>
<key value="ele-1" />
<severity value="error" />
<human value="All FHIR elements must have a @value or children" />
<expression value="hasValue() or (children().count() > id.count())" />
<xpath value="@value|f:*|h:div" />
<source value="http://hl7.org/fhir/StructureDefinition/Element" />
</constraint>
<isModifier value="false" />
<isSummary value="false" />
<mapping>
<identity value="workflow" />
<map value="Event.note" />
</mapping>
<mapping>
<identity value="v2" />
<map value="NTE child of PRB" />
</mapping>
<mapping>
<identity value="rim" />
<map value=".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value" />
</mapping>
</element>
</snapshot>
<differential>
<element id="Condition.clinicalStatus">
<path value="Condition.clinicalStatus" />
<comment value="While the IPS-UV specification considers this a Must Support element, some systems will not have a field directly representing clinicalStatus, but have other means of differentiating between current and historical conditions. Implementers are expected to be able to differentiate between active and inactive conditions. However, the valueSet that is required in the base specification does not provide an 'unknown' concept to support legacy data without a clinicalStatus. This has resulted in additional burdens that some participating systems could not meet with their legacy data.\n\n The requirement from the base FHIR specification to provide a system and value from the bound value set means the PS-CA CodeableConcept data type profile does not need to be applied on this particular element.\n\nIn the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed." />
<mustSupport value="true" />
</element>
<element id="Condition.verificationStatus">
<path value="Condition.verificationStatus" />
<comment value="IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.\n\nFHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.\n\nIPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed." />
</element>
<element id="Condition.category">
<path value="Condition.category" />
<definition value="A category assigned to the condition. In this profile, a health problem of the patient, therefore a 'problem-list-item'." />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. \n\n Implementers should be aware that IPS encourages the use of 'problem-list-item'. This is identified through the additionalBinding extension as a component value set (which provides a subset of values from the base valueSet and context around their use). \n\n IPS also provides an additionalBinding to the LOINC value of 75326-9 for backwards compatibility. While not preferred for continued use this is also identified as a additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)." />
<binding>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="component" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/problem-type-uv-ips" />
</extension>
<extension url="documentation">
<valueMarkdown value="Component of extensible valueSet put forth in IPS to encourage the use condition records with the category code of 'problem-list-item' for use in the Problems Section and History of Past Illness Section." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/problem-type-loinc" />
</extension>
<extension url="documentation">
<valueMarkdown value="Codes put forth in IPS to supply an additional binding to the LOINC "Problem" code - retained for backward compatibility. While not preferred for continued use this is also identified as an additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)." />
</extension>
</extension>
<strength value="extensible" />
<valueSet value="http://hl7.org/fhir/ValueSet/condition-category" />
</binding>
</element>
<element id="Condition.severity">
<path value="Condition.severity" />
<comment value="IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received." />
<binding>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/ValueSet/condition-severity" />
</extension>
<extension url="documentation">
<valueMarkdown value="Codes representing the severity of a problem using the preferred value set from base FHIR." />
</extension>
</extension>
<strength value="preferred" />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/severitycode" />
</binding>
</element>
<element id="Condition.code">
<path value="Condition.code" />
<definition value="Identification of the condition, problem or diagnosis or recording of "problem absent" or of "problems unknown"." />
<comment value="Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The Condition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA ClinicalFindingCode ValueSet that is preferred for this element.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content." />
<min value="1" />
<type>
<code value="CodeableConcept" />
<profile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps" />
</type>
<mustSupport value="true" />
<binding>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD9CM" />
</extension>
<extension url="documentation">
<valueMarkdown value="Any code from ICD-9 CM. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD10CA" />
</extension>
<extension url="documentation">
<valueMarkdown value="Any Code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology." />
</extension>
</extension>
<extension url="http://hl7.org/fhir/tools/StructureDefinition/additional-binding">
<extension url="purpose">
<valueCode value="candidate" />
</extension>
<extension url="valueSet">
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-problems-uv-ips" />
</extension>
<extension url="documentation">
<valueMarkdown value="Absent problem or unknown problem." />
</extension>
</extension>
<strength value="preferred" />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/healthconditioncode" />
</binding>
</element>
<element id="Condition.bodySite">
<path value="Condition.bodySite" />
<binding>
<strength value="preferred" />
<valueSet value="https://fhir.infoway-inforoute.ca/ValueSet/anatomicaloracquiredbodystructurecode" />
</binding>
</element>
<element id="Condition.subject">
<path value="Condition.subject" />
<type>
<code value="Reference" />
<targetProfile value="http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps" />
</type>
<mustSupport value="true" />
</element>
<element id="Condition.subject.reference">
<path value="Condition.subject.reference" />
<min value="1" />
<mustSupport value="true" />
</element>
<element id="Condition.onset[x]">
<path value="Condition.onset[x]" />
<slicing>
<discriminator>
<type value="type" />
<path value="$this" />
</discriminator>
<rules value="open" />
</slicing>
<comment value="IPS-UV constrains the condition onset element to only DateTime and Period data types. Both IPS-UV and PS-CA prefer the use of onsetDateTime" />
<mustSupport value="true" />
</element>
<element id="Condition.onset[x]:onsetDateTime">
<path value="Condition.onset[x]" />
<sliceName value="onsetDateTime" />
<type>
<code value="dateTime" />
</type>
<mustSupport value="true" />
</element>
</differential>
</StructureDefinition>
{
"resourceType": "StructureDefinition",
"id": "condition-ca-ps",
"url": "http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/condition-ca-ps",
"name": "ConditionPSCA",
"title": "Condition (PS-CA)",
"status": "draft",
"experimental": false,
"date": "2024-04-09T00:00:00-08:00",
"description": "This profile represents the constraints applied to the Condition resource by the PS-CA project, which is informed by the constraints of the [Condition IPS-UV profile](http://hl7.org/fhir/uv/ips/StructureDefinition-Condition-uv-ips.html) and the [Canadian Baseline Profile](http://build.fhir.org/ig/HL7-Canada/ca-baseline/branches/master/StructureDefinition-profile-condition.html) to allow for cross-border and cross-jurisdiction sharing of a record of a problem represented in the patient summary as an instance of the Condition resource constrained by this profile.",
"copyright": "Copyright © 2024+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
"fhirVersion": "4.0.1",
"kind": "resource",
"abstract": false,
"type": "Condition",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Condition",
"derivation": "constraint",
"snapshot": {
"element": [
{
"id": "Condition",
"path": "Condition",
"short": "Detailed information about conditions, problems or diagnoses",
"definition": "A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.",
"min": 0,
"max": "*",
"base": {
"path": "Condition",
"min": 0,
"max": "*"
},
"constraint": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean": true
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown": "Most systems will expect a clinicalStatus to be valued for problem-list-items that are managed over time, but might not need a clinicalStatus for point in time encounter-diagnosis."
}
],
"key": "con-3",
"severity": "warning",
"human": "Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item",
"expression": "clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty()",
"xpath": "exists(f:clinicalStatus) or exists(f:verificationStatus/f:coding/f:code/@value='entered-in-error') or not(exists(category[@value='problem-list-item']))"
},
{
"key": "con-4",
"severity": "error",
"human": "If condition is abated, then clinicalStatus must be either inactive, resolved, or remission",
"expression": "abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists()",
"xpath": "not(exists(*[starts-with(local-name(.), 'abatement')])) or exists(f:clinicalStatus/f:coding[f:system/@value='http://terminology.hl7.org/CodeSystem/condition-clinical' and f:code/@value=('resolved', 'remission', 'inactive')])"
},
{
"key": "con-5",
"severity": "error",
"human": "Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error",
"expression": "verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty()",
"xpath": "not(exists(f:verificationStatus/f:coding[f:system/@value='http://terminology.hl7.org/CodeSystem/condition-ver-status' and f:code/@value='entered-in-error'])) or not(exists(f:clinicalStatus))"
},
{
"key": "dom-2",
"severity": "error",
"human": "If the resource is contained in another resource, it SHALL NOT contain nested Resources",
"expression": "contained.contained.empty()",
"xpath": "not(parent::f:contained and f:contained)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-3",
"severity": "error",
"human": "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",
"expression": "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()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-4",
"severity": "error",
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"expression": "contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"key": "dom-5",
"severity": "error",
"human": "If a resource is contained in another resource, it SHALL NOT have a security label",
"expression": "contained.meta.security.empty()",
"xpath": "not(exists(f:contained/*/f:meta/f:security))",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice",
"valueBoolean": true
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation",
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
"key": "dom-6",
"severity": "warning",
"human": "A resource should have narrative for robust management",
"expression": "text.`div`.exists()",
"xpath": "exists(f:text/h:div)",
"source": "http://hl7.org/fhir/StructureDefinition/DomainResource"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Entity. Role, or Act"
},
{
"identity": "workflow",
"map": "Event"
},
{
"identity": "sct-concept",
"map": "< 243796009 |Situation with explicit context| : 246090004 |Associated finding| = ( ( < 404684003 |Clinical finding| MINUS ( << 420134006 |Propensity to adverse reactions| OR << 473010000 |Hypersensitivity condition| OR << 79899007 |Drug interaction| OR << 69449002 |Drug action| OR << 441742003 |Evaluation finding| OR << 307824009 |Administrative status| OR << 385356007 |Tumor stage finding|)) OR < 272379006 |Event|)"
},
{
"identity": "v2",
"map": "PPR message"
},
{
"identity": "rim",
"map": "Observation[classCode=OBS, moodCode=EVN, code=ASSERTION, value<Diagnosis]"
}
]
},
{
"id": "Condition.id",
"path": "Condition.id",
"short": "Logical id of this artifact",
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isModifier": false,
"isSummary": true
},
{
"id": "Condition.meta",
"path": "Condition.meta",
"short": "Metadata about the resource",
"definition": "The 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.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.meta",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Meta"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true
},
{
"id": "Condition.implicitRules",
"path": "Condition.implicitRules",
"short": "A set of rules under which this content was created",
"definition": "A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Resource.implicitRules",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
"isSummary": true
},
{
"id": "Condition.language",
"path": "Condition.language",
"short": "Language of the resource content",
"definition": "The base language in which the resource is written.",
"comment": "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).",
"min": 0,
"max": "1",
"base": {
"path": "Resource.language",
"min": 0,
"max": "1"
},
"type": [
{
"code": "code"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/all-languages"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "Language"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-isCommonBinding",
"valueBoolean": true
}
],
"strength": "preferred",
"description": "A human language.",
"valueSet": "http://hl7.org/fhir/ValueSet/languages"
}
},
{
"id": "Condition.text",
"path": "Condition.text",
"short": "Text summary of the resource, for human interpretation",
"definition": "A 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.",
"comment": "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.",
"alias": [
"narrative",
"html",
"xhtml",
"display"
],
"min": 0,
"max": "1",
"base": {
"path": "DomainResource.text",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Narrative"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "Act.text?"
}
]
},
{
"id": "Condition.contained",
"path": "Condition.contained",
"short": "Contained, inline Resources",
"definition": "These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.",
"comment": "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.",
"alias": [
"inline resources",
"anonymous resources",
"contained resources"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.contained",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Resource"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Condition.extension",
"path": "Condition.extension",
"short": "Additional content defined by implementations",
"definition": "May 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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Condition.modifierExtension",
"path": "Condition.modifierExtension",
"short": "Extensions that cannot be ignored",
"definition": "May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "DomainResource.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Condition.identifier",
"path": "Condition.identifier",
"short": "External Ids for this condition",
"definition": "Business identifiers assigned to this condition by the performer or other systems which remain constant as the resource is updated and propagates from server to server.",
"comment": "This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). 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.",
"requirements": "Allows identification of the condition as it is known by various participating systems and in a way that remains consistent across servers.",
"min": 0,
"max": "*",
"base": {
"path": "Condition.identifier",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Identifier"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.identifier"
},
{
"identity": "w5",
"map": "FiveWs.identifier"
},
{
"identity": "rim",
"map": ".id"
}
]
},
{
"id": "Condition.clinicalStatus",
"path": "Condition.clinicalStatus",
"short": "active | recurrence | relapse | inactive | remission | resolved",
"definition": "The clinical status of the condition.",
"comment": "While the IPS-UV specification considers this a Must Support element, some systems will not have a field directly representing clinicalStatus, but have other means of differentiating between current and historical conditions. Implementers are expected to be able to differentiate between active and inactive conditions. However, the valueSet that is required in the base specification does not provide an 'unknown' concept to support legacy data without a clinicalStatus. This has resulted in additional burdens that some participating systems could not meet with their legacy data.\n\n The requirement from the base FHIR specification to provide a system and value from the bound value set means the PS-CA CodeableConcept data type profile does not need to be applied on this particular element.\n\nIn the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.clinicalStatus",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"con-3",
"con-4",
"con-5"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ConditionClinicalStatus"
}
],
"strength": "required",
"description": "The clinical status of the condition or diagnosis.",
"valueSet": "http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "FiveWs.status"
},
{
"identity": "sct-concept",
"map": "< 303105007 |Disease phases|"
},
{
"identity": "v2",
"map": "PRB-14"
},
{
"identity": "rim",
"map": "Observation ACT\n.inboundRelationship[typeCode=COMP].source[classCode=OBS, code=\"clinicalStatus\", moodCode=EVN].value"
}
]
},
{
"id": "Condition.verificationStatus",
"path": "Condition.verificationStatus",
"short": "unconfirmed | provisional | differential | confirmed | refuted | entered-in-error",
"definition": "The verification status to support the clinical status of the condition.",
"comment": "IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.\n\nFHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.\n\nIPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.verificationStatus",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"con-3",
"con-5"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": true,
"isModifierReason": "This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.",
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ConditionVerificationStatus"
}
],
"strength": "required",
"description": "The verification status to support or decline the clinical status of the condition or diagnosis.",
"valueSet": "http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.status"
},
{
"identity": "w5",
"map": "FiveWs.status"
},
{
"identity": "sct-concept",
"map": "< 410514004 |Finding context value|"
},
{
"identity": "v2",
"map": "PRB-13"
},
{
"identity": "rim",
"map": "Observation ACT\n.inboundRelationship[typeCode=COMP].source[classCode=OBS, code=\"verificationStatus\", moodCode=EVN].value"
},
{
"identity": "sct-attr",
"map": "408729009"
}
]
},
{
"id": "Condition.category",
"path": "Condition.category",
"short": "problem-list-item | encounter-diagnosis",
"definition": "A category assigned to the condition. In this profile, a health problem of the patient, therefore a 'problem-list-item'.",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. \n\n Implementers should be aware that IPS encourages the use of 'problem-list-item'. This is identified through the additionalBinding extension as a component value set (which provides a subset of values from the base valueSet and context around their use). \n\n IPS also provides an additionalBinding to the LOINC value of 75326-9 for backwards compatibility. While not preferred for continued use this is also identified as a additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach).",
"min": 0,
"max": "*",
"base": {
"path": "Condition.category",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ConditionCategory"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "component"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/problem-type-uv-ips"
},
{
"url": "documentation",
"valueMarkdown": "Component of extensible valueSet put forth in IPS to encourage the use condition records with the category code of 'problem-list-item' for use in the Problems Section and History of Past Illness Section."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/problem-type-loinc"
},
{
"url": "documentation",
"valueMarkdown": "Codes put forth in IPS to supply an additional binding to the LOINC \"Problem\" code - retained for backward compatibility. While not preferred for continued use this is also identified as an additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "extensible",
"description": "A category assigned to the condition.",
"valueSet": "http://hl7.org/fhir/ValueSet/condition-category"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.class"
},
{
"identity": "sct-concept",
"map": "< 404684003 |Clinical finding|"
},
{
"identity": "v2",
"map": "'problem' if from PRB-3. 'diagnosis' if from DG1 segment in PV1 message"
},
{
"identity": "rim",
"map": ".code"
}
]
},
{
"id": "Condition.severity",
"path": "Condition.severity",
"short": "Subjective severity of condition",
"definition": "A subjective assessment of the severity of the condition as evaluated by the clinician.",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.severity",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ConditionSeverity"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/condition-severity"
},
{
"url": "documentation",
"valueMarkdown": "Codes representing the severity of a problem using the preferred value set from base FHIR."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"description": "A subjective assessment of the severity of the condition as evaluated by the clinician.",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/severitycode"
},
"mapping": [
{
"identity": "w5",
"map": "FiveWs.grade"
},
{
"identity": "sct-concept",
"map": "< 272141005 |Severities|"
},
{
"identity": "v2",
"map": "PRB-26 / ABS-3"
},
{
"identity": "rim",
"map": "Can be pre/post-coordinated into value. Or ./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"severity\"].value"
},
{
"identity": "sct-attr",
"map": "246112005"
}
]
},
{
"id": "Condition.code",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "normative"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-normative-version",
"valueCode": "4.0.0"
}
],
"path": "Condition.code",
"short": "Concept - reference to a terminology or just text",
"definition": "Identification of the condition, problem or diagnosis or recording of \"problem absent\" or of \"problems unknown\".",
"comment": "Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The Condition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA ClinicalFindingCode ValueSet that is preferred for this element.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.",
"requirements": "0..1 to account for primarily narrative only resources.",
"alias": [
"type"
],
"min": 1,
"max": "1",
"base": {
"path": "Condition.code",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept",
"profile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
],
"condition": [
"ele-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isModifier": false,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ConditionKind"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD9CM"
},
{
"url": "documentation",
"valueMarkdown": "Any code from ICD-9 CM. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD10CA"
},
{
"url": "documentation",
"valueMarkdown": "Any Code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-problems-uv-ips"
},
{
"url": "documentation",
"valueMarkdown": "Absent problem or unknown problem."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"description": "Identification of the condition or diagnosis.",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/healthconditioncode"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.code"
},
{
"identity": "w5",
"map": "FiveWs.what[x]"
},
{
"identity": "sct-concept",
"map": "code 246090004 |Associated finding| (< 404684003 |Clinical finding| MINUS\n<< 420134006 |Propensity to adverse reactions| MINUS \n<< 473010000 |Hypersensitivity condition| MINUS \n<< 79899007 |Drug interaction| MINUS\n<< 69449002 |Drug action| MINUS \n<< 441742003 |Evaluation finding| MINUS \n<< 307824009 |Administrative status| MINUS \n<< 385356007 |Tumor stage finding|) \nOR < 413350009 |Finding with explicit context|\nOR < 272379006 |Event|"
},
{
"identity": "v2",
"map": "PRB-3"
},
{
"identity": "rim",
"map": ".value"
},
{
"identity": "sct-attr",
"map": "246090004"
},
{
"identity": "rim",
"map": "n/a"
},
{
"identity": "v2",
"map": "CE/CNE/CWE"
},
{
"identity": "rim",
"map": "CD"
},
{
"identity": "orim",
"map": "fhir:CodeableConcept rdfs:subClassOf dt:CD"
}
]
},
{
"id": "Condition.bodySite",
"path": "Condition.bodySite",
"short": "Anatomical location, if relevant",
"definition": "The anatomical location where this condition manifests itself.",
"comment": "Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension [bodySite](extension-bodysite.html). May be a summary code, or a reference to a very precise definition of the location, or both.",
"min": 0,
"max": "*",
"base": {
"path": "Condition.bodySite",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "BodySite"
}
],
"strength": "preferred",
"description": "Codes describing anatomical locations. May include laterality.",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/anatomicaloracquiredbodystructurecode"
},
"mapping": [
{
"identity": "sct-concept",
"map": "< 442083009 |Anatomical or acquired body structure|"
},
{
"identity": "rim",
"map": ".targetBodySiteCode"
},
{
"identity": "sct-attr",
"map": "363698007"
}
]
},
{
"id": "Condition.subject",
"path": "Condition.subject",
"short": "Who has the condition?",
"definition": "Indicates the patient or group who the condition record is associated with.",
"requirements": "Group is typically used for veterinary or public health use cases.",
"alias": [
"patient"
],
"min": 1,
"max": "1",
"base": {
"path": "Condition.subject",
"min": 1,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps"
]
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.subject"
},
{
"identity": "w5",
"map": "FiveWs.subject[x]"
},
{
"identity": "v2",
"map": "PID-3"
},
{
"identity": "rim",
"map": ".participation[typeCode=SBJ].role[classCode=PAT]"
},
{
"identity": "w5",
"map": "FiveWs.subject"
}
]
},
{
"id": "Condition.subject.id",
"path": "Condition.subject.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Condition.subject.extension",
"path": "Condition.subject.extension",
"slicing": {
"discriminator": [
{
"type": "value",
"path": "url"
}
],
"description": "Extensions are always sliced by (at least) url",
"rules": "open"
},
"short": "Additional content defined by implementations",
"definition": "May 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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Condition.subject.reference",
"path": "Condition.subject.reference",
"short": "Literal reference, Relative, internal or absolute URL",
"definition": "A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.",
"comment": "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.",
"min": 1,
"max": "1",
"base": {
"path": "Reference.reference",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"condition": [
"ref-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Condition.subject.type",
"path": "Condition.subject.type",
"short": "Type the reference refers to (e.g. \"Patient\")",
"definition": "The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.\n\nThe type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. \"Patient\" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "uri"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "FHIRResourceTypeExt"
}
],
"strength": "extensible",
"description": "Aa resource (or, for logical models, the URI of the logical model).",
"valueSet": "http://hl7.org/fhir/ValueSet/resource-types"
},
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Condition.subject.identifier",
"path": "Condition.subject.identifier",
"short": "Logical reference, when literal reference is not known",
"definition": "An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.",
"comment": "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. \n\nWhen 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\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference 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).",
"min": 0,
"max": "1",
"base": {
"path": "Reference.identifier",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Identifier"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": ".identifier"
}
]
},
{
"id": "Condition.subject.display",
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable",
"valueBoolean": true
}
],
"path": "Condition.subject.display",
"short": "Text alternative for the resource",
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "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.",
"min": 0,
"max": "1",
"base": {
"path": "Reference.display",
"min": 0,
"max": "1"
},
"type": [
{
"code": "string"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Condition.encounter",
"path": "Condition.encounter",
"short": "Encounter created as part of",
"definition": "The Encounter during which this Condition was created or to which the creation of this record is tightly associated.",
"comment": "This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a \"new\" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first \"known\".",
"min": 0,
"max": "1",
"base": {
"path": "Condition.encounter",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Encounter"
]
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.context"
},
{
"identity": "w5",
"map": "FiveWs.context"
},
{
"identity": "v2",
"map": "PV1-19 (+PV1-54)"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]"
}
]
},
{
"id": "Condition.onset[x]",
"path": "Condition.onset[x]",
"slicing": {
"discriminator": [
{
"type": "type",
"path": "$this"
}
],
"rules": "open"
},
"short": "Estimated or actual date, date-time, or age",
"definition": "Estimated or actual date or date-time the condition began, in the opinion of the clinician.",
"comment": "IPS-UV constrains the condition onset element to only DateTime and Period data types. Both IPS-UV and PS-CA prefer the use of onsetDateTime",
"min": 0,
"max": "1",
"base": {
"path": "Condition.onset[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
},
{
"code": "Age"
},
{
"code": "Period"
},
{
"code": "Range"
},
{
"code": "string"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.occurrence[x]"
},
{
"identity": "w5",
"map": "FiveWs.init"
},
{
"identity": "v2",
"map": "PRB-16"
},
{
"identity": "rim",
"map": ".effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"age at onset\"].value"
}
]
},
{
"id": "Condition.onset[x]:onsetDateTime",
"path": "Condition.onset[x]",
"sliceName": "onsetDateTime",
"short": "Estimated or actual date, date-time, or age",
"definition": "Estimated or actual date or date-time the condition began, in the opinion of the clinician.",
"comment": "Age is generally used when the patient reports an age at which the Condition began to occur.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.onset[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"mustSupport": true,
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "workflow",
"map": "Event.occurrence[x]"
},
{
"identity": "w5",
"map": "FiveWs.init"
},
{
"identity": "v2",
"map": "PRB-16"
},
{
"identity": "rim",
"map": ".effectiveTime.low or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"age at onset\"].value"
}
]
},
{
"id": "Condition.abatement[x]",
"path": "Condition.abatement[x]",
"short": "When in resolution/remission",
"definition": "The date or estimated date that the condition resolved or went into remission. This is called \"abatement\" because of the many overloaded connotations associated with \"remission\" or \"resolution\" - Conditions are never really resolved, but they can abate.",
"comment": "There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.abatement[x]",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
},
{
"code": "Age"
},
{
"code": "Period"
},
{
"code": "Range"
},
{
"code": "string"
}
],
"condition": [
"con-4"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.done[x]"
},
{
"identity": "rim",
"map": ".effectiveTime.high or .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"age at remission\"].value or .inboundRelationship[typeCode=SUBJ]source[classCode=CONC, moodCode=EVN].status=completed"
}
]
},
{
"id": "Condition.recordedDate",
"path": "Condition.recordedDate",
"short": "Date record was first recorded",
"definition": "The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.recordedDate",
"min": 0,
"max": "1"
},
"type": [
{
"code": "dateTime"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.recorded"
},
{
"identity": "v2",
"map": "REL-11"
},
{
"identity": "rim",
"map": ".participation[typeCode=AUT].time"
}
]
},
{
"id": "Condition.recorder",
"path": "Condition.recorder",
"short": "Who recorded the condition",
"definition": "Individual who recorded the record and takes responsibility for its content.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.recorder",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.author"
},
{
"identity": "rim",
"map": ".participation[typeCode=AUT].role"
}
]
},
{
"id": "Condition.asserter",
"path": "Condition.asserter",
"short": "Person who asserts this condition",
"definition": "Individual who is making the condition statement.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.asserter",
"min": 0,
"max": "1"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.source"
},
{
"identity": "v2",
"map": "REL-7.1 identifier + REL-7.12 type code"
},
{
"identity": "rim",
"map": ".participation[typeCode=INF].role"
}
]
},
{
"id": "Condition.stage",
"path": "Condition.stage",
"short": "Stage/grade, usually assessed formally",
"definition": "Clinical stage or grade of a condition. May include formal severity assessments.",
"min": 0,
"max": "*",
"base": {
"path": "Condition.stage",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "con-1",
"severity": "error",
"human": "Stage SHALL have summary or assessment",
"expression": "summary.exists() or assessment.exists()",
"xpath": "exists(f:summary) or exists(f:assessment)"
},
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"stage/grade\"]"
}
]
},
{
"id": "Condition.stage.id",
"path": "Condition.stage.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Condition.stage.extension",
"path": "Condition.stage.extension",
"short": "Additional content defined by implementations",
"definition": "May 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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Condition.stage.modifierExtension",
"path": "Condition.stage.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Condition.stage.summary",
"path": "Condition.stage.summary",
"short": "Simple summary (disease specific)",
"definition": "A simple summary of the stage such as \"Stage 3\". The determination of the stage is disease-specific.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.stage.summary",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"con-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ConditionStage"
}
],
"strength": "example",
"description": "Codes describing condition stages (e.g. Cancer stages).",
"valueSet": "http://hl7.org/fhir/ValueSet/condition-stage"
},
"mapping": [
{
"identity": "sct-concept",
"map": "< 254291000 |Staging and scales|"
},
{
"identity": "v2",
"map": "PRB-14"
},
{
"identity": "rim",
"map": ".value"
}
]
},
{
"id": "Condition.stage.assessment",
"path": "Condition.stage.assessment",
"short": "Formal record of assessment",
"definition": "Reference to a formal record of the evidence on which the staging assessment is based.",
"min": 0,
"max": "*",
"base": {
"path": "Condition.stage.assessment",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/ClinicalImpression",
"http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
"http://hl7.org/fhir/StructureDefinition/Observation"
]
}
],
"condition": [
"con-1"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": ".self"
}
]
},
{
"id": "Condition.stage.type",
"path": "Condition.stage.type",
"short": "Kind of staging",
"definition": "The kind of staging, such as pathological or clinical staging.",
"min": 0,
"max": "1",
"base": {
"path": "Condition.stage.type",
"min": 0,
"max": "1"
},
"type": [
{
"code": "CodeableConcept"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ConditionStageType"
}
],
"strength": "example",
"description": "Codes describing the kind of condition staging (e.g. clinical or pathological).",
"valueSet": "http://hl7.org/fhir/ValueSet/condition-stage-type"
},
"mapping": [
{
"identity": "rim",
"map": "./inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"stage type\"]"
}
]
},
{
"id": "Condition.evidence",
"path": "Condition.evidence",
"short": "Supporting evidence",
"definition": "Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.",
"comment": "The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.",
"min": 0,
"max": "*",
"base": {
"path": "Condition.evidence",
"min": 0,
"max": "*"
},
"type": [
{
"code": "BackboneElement"
}
],
"constraint": [
{
"key": "con-2",
"severity": "error",
"human": "evidence SHALL have code or details",
"expression": "code.exists() or detail.exists()",
"xpath": "exists(f:code) or exists(f:detail)"
},
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": ".outboundRelationship[typeCode=SPRT].target[classCode=OBS, moodCode=EVN]"
}
]
},
{
"id": "Condition.evidence.id",
"path": "Condition.evidence.id",
"representation": [
"xmlAttr"
],
"short": "Unique id for inter-element referencing",
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
"min": 0,
"max": "1",
"base": {
"path": "Element.id",
"min": 0,
"max": "1"
},
"type": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type",
"valueUrl": "string"
}
],
"code": "http://hl7.org/fhirpath/System.String"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Condition.evidence.extension",
"path": "Condition.evidence.extension",
"short": "Additional content defined by implementations",
"definition": "May 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.",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"alias": [
"extensions",
"user content"
],
"min": 0,
"max": "*",
"base": {
"path": "Element.extension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "rim",
"map": "n/a"
}
]
},
{
"id": "Condition.evidence.modifierExtension",
"path": "Condition.evidence.modifierExtension",
"short": "Extensions that cannot be ignored even if unrecognized",
"definition": "May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element 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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.",
"requirements": "Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the [definition of modifier extensions](extensibility.html#modifierExtension).",
"alias": [
"extensions",
"user content",
"modifiers"
],
"min": 0,
"max": "*",
"base": {
"path": "BackboneElement.modifierExtension",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Extension"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
},
{
"key": "ext-1",
"severity": "error",
"human": "Must have either extensions or value[x], not both",
"expression": "extension.exists() != value.exists()",
"xpath": "exists(f:extension)!=exists(f:*[starts-with(local-name(.), \"value\")])",
"source": "http://hl7.org/fhir/StructureDefinition/Extension"
}
],
"isModifier": true,
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
"isSummary": true,
"mapping": [
{
"identity": "rim",
"map": "N/A"
}
]
},
{
"id": "Condition.evidence.code",
"path": "Condition.evidence.code",
"short": "Manifestation/symptom",
"definition": "A manifestation or symptom that led to the recording of this condition.",
"min": 0,
"max": "*",
"base": {
"path": "Condition.evidence.code",
"min": 0,
"max": "*"
},
"type": [
{
"code": "CodeableConcept"
}
],
"condition": [
"con-2"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"binding": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName",
"valueString": "ManifestationOrSymptom"
}
],
"strength": "example",
"description": "Codes that describe the manifestation or symptoms of a condition.",
"valueSet": "http://hl7.org/fhir/ValueSet/manifestation-or-symptom"
},
"mapping": [
{
"identity": "workflow",
"map": "Event.reasonCode"
},
{
"identity": "w5",
"map": "FiveWs.why[x]"
},
{
"identity": "sct-concept",
"map": "< 404684003 |Clinical finding|"
},
{
"identity": "rim",
"map": "[code=\"diagnosis\"].value"
}
]
},
{
"id": "Condition.evidence.detail",
"path": "Condition.evidence.detail",
"short": "Supporting information found elsewhere",
"definition": "Links to other relevant information, including pathology reports.",
"min": 0,
"max": "*",
"base": {
"path": "Condition.evidence.detail",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Reference",
"targetProfile": [
"http://hl7.org/fhir/StructureDefinition/Resource"
]
}
],
"condition": [
"con-2"
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": true,
"mapping": [
{
"identity": "w5",
"map": "FiveWs.why[x]"
},
{
"identity": "rim",
"map": ".self"
}
]
},
{
"id": "Condition.note",
"path": "Condition.note",
"short": "Additional information about the Condition",
"definition": "Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.",
"min": 0,
"max": "*",
"base": {
"path": "Condition.note",
"min": 0,
"max": "*"
},
"type": [
{
"code": "Annotation"
}
],
"constraint": [
{
"key": "ele-1",
"severity": "error",
"human": "All FHIR elements must have a @value or children",
"expression": "hasValue() or (children().count() > id.count())",
"xpath": "@value|f:*|h:div",
"source": "http://hl7.org/fhir/StructureDefinition/Element"
}
],
"isModifier": false,
"isSummary": false,
"mapping": [
{
"identity": "workflow",
"map": "Event.note"
},
{
"identity": "v2",
"map": "NTE child of PRB"
},
{
"identity": "rim",
"map": ".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=\"annotation\"].value"
}
]
}
]
},
"differential": {
"element": [
{
"id": "Condition.clinicalStatus",
"path": "Condition.clinicalStatus",
"comment": "While the IPS-UV specification considers this a Must Support element, some systems will not have a field directly representing clinicalStatus, but have other means of differentiating between current and historical conditions. Implementers are expected to be able to differentiate between active and inactive conditions. However, the valueSet that is required in the base specification does not provide an 'unknown' concept to support legacy data without a clinicalStatus. This has resulted in additional burdens that some participating systems could not meet with their legacy data.\n\n The requirement from the base FHIR specification to provide a system and value from the bound value set means the PS-CA CodeableConcept data type profile does not need to be applied on this particular element.\n\nIn the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed.",
"mustSupport": true
},
{
"id": "Condition.verificationStatus",
"path": "Condition.verificationStatus",
"comment": "IPS-UV no longer flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.\n\nFHIR Base Note: This element is a modifier element with a required vocabulary binding in the base FHIR specification.\n\nIPS-UV Note: In the scope of the IPS-UV the entered-in-error concept is not allowed and so the modifier on this element has been removed."
},
{
"id": "Condition.category",
"path": "Condition.category",
"definition": "A category assigned to the condition. In this profile, a health problem of the patient, therefore a 'problem-list-item'.",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received. \n\n Implementers should be aware that IPS encourages the use of 'problem-list-item'. This is identified through the additionalBinding extension as a component value set (which provides a subset of values from the base valueSet and context around their use). \n\n IPS also provides an additionalBinding to the LOINC value of 75326-9 for backwards compatibility. While not preferred for continued use this is also identified as a additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach).",
"binding": {
"extension": [
{
"extension": [
{
"url": "purpose",
"valueCode": "component"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/problem-type-uv-ips"
},
{
"url": "documentation",
"valueMarkdown": "Component of extensible valueSet put forth in IPS to encourage the use condition records with the category code of 'problem-list-item' for use in the Problems Section and History of Past Illness Section."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/problem-type-loinc"
},
{
"url": "documentation",
"valueMarkdown": "Codes put forth in IPS to supply an additional binding to the LOINC \"Problem\" code - retained for backward compatibility. While not preferred for continued use this is also identified as an additional binding to reflect what legacy IPS instances may include (in alignment to IPS approach)."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "extensible",
"valueSet": "http://hl7.org/fhir/ValueSet/condition-category"
}
},
{
"id": "Condition.severity",
"path": "Condition.severity",
"comment": "IPS-UV flags this as a Must Support element. It is not currently flagged as Must Support in PS-CA, as stakeholders have indicated the element may not be supported by the majority of systems today. Systems that do support the element are encouraged to include it in generated Patient Summary documents, and support it when received.",
"binding": {
"extension": [
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/ValueSet/condition-severity"
},
{
"url": "documentation",
"valueMarkdown": "Codes representing the severity of a problem using the preferred value set from base FHIR."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/severitycode"
}
},
{
"id": "Condition.code",
"path": "Condition.code",
"definition": "Identification of the condition, problem or diagnosis or recording of \"problem absent\" or of \"problems unknown\".",
"comment": "Many Canadian implementations use codes from either SNOMED CT and the SNOMED CT Canada Extension to describe this concept, while others may still be using localized code systems or text descriptions. The Condition - IPS ValueSet contains codes that are subsumed within the SNOMED CT CA ClinicalFindingCode ValueSet that is preferred for this element.\n\nFuture releases of PS-CA may require use of coded entries. In this release, however, implementations that support codings are encouraged to send the codings for codeable concepts if they are available. Consistent with FHIR best practice, receivers should not produce failures or rejections if codings are received. Vendors should expect that some jurisdictions may further constrain support of this element within the context of their own jurisdictional content.",
"min": 1,
"type": [
{
"code": "CodeableConcept",
"profile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/CodeableConcept-ca-ps"
]
}
],
"mustSupport": true,
"binding": {
"extension": [
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD9CM"
},
{
"url": "documentation",
"valueMarkdown": "Any code from ICD-9 CM. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://fhir.infoway-inforoute.ca/io/psca/ValueSet/ICD10CA"
},
{
"url": "documentation",
"valueMarkdown": "Any Code from ICD-10 CA. While not the preferred terminology for broader pan-Canadian exchange use cases, this additional binding is surfaced to socialize the value sets that may be more commonly in use. Where multiple codings can be supplied, it is encouraged to supply the original coding alongside the pan-Canadian preferred terminology."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
},
{
"extension": [
{
"url": "purpose",
"valueCode": "candidate"
},
{
"url": "valueSet",
"valueCanonical": "http://hl7.org/fhir/uv/ips/ValueSet/absent-or-unknown-problems-uv-ips"
},
{
"url": "documentation",
"valueMarkdown": "Absent problem or unknown problem."
}
],
"url": "http://hl7.org/fhir/tools/StructureDefinition/additional-binding"
}
],
"strength": "preferred",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/healthconditioncode"
}
},
{
"id": "Condition.bodySite",
"path": "Condition.bodySite",
"binding": {
"strength": "preferred",
"valueSet": "https://fhir.infoway-inforoute.ca/ValueSet/anatomicaloracquiredbodystructurecode"
}
},
{
"id": "Condition.subject",
"path": "Condition.subject",
"type": [
{
"code": "Reference",
"targetProfile": [
"http://fhir.infoway-inforoute.ca/io/psca/StructureDefinition/patient-ca-ps"
]
}
],
"mustSupport": true
},
{
"id": "Condition.subject.reference",
"path": "Condition.subject.reference",
"min": 1,
"mustSupport": true
},
{
"id": "Condition.onset[x]",
"path": "Condition.onset[x]",
"slicing": {
"discriminator": [
{
"type": "type",
"path": "$this"
}
],
"rules": "open"
},
"comment": "IPS-UV constrains the condition onset element to only DateTime and Period data types. Both IPS-UV and PS-CA prefer the use of onsetDateTime",
"mustSupport": true
},
{
"id": "Condition.onset[x]:onsetDateTime",
"path": "Condition.onset[x]",
"sliceName": "onsetDateTime",
"type": [
{
"code": "dateTime"
}
],
"mustSupport": true
}
]
}
}

Terminology bindings (Differential)

PathConformanceValueSet
Condition.categoryextensiblehttp://hl7.org/fhir/ValueSet/condition-category
Condition.severitypreferredhttps://fhir.infoway-inforoute.ca/ValueSet/severitycode
Condition.codepreferredhttps://fhir.infoway-inforoute.ca/ValueSet/healthconditioncode
Condition.bodySitepreferredhttps://fhir.infoway-inforoute.ca/ValueSet/anatomicaloracquiredbodystructurecode

Terminology bindings (Snapshot)

PathConformanceValueSet
Condition.languagepreferredhttp://hl7.org/fhir/ValueSet/languages
Condition.clinicalStatusrequiredhttp://hl7.org/fhir/ValueSet/condition-clinical|4.0.1
Condition.verificationStatusrequiredhttp://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1
Condition.categoryextensiblehttp://hl7.org/fhir/ValueSet/condition-category
Condition.severitypreferredhttps://fhir.infoway-inforoute.ca/ValueSet/severitycode
Condition.codepreferredhttps://fhir.infoway-inforoute.ca/ValueSet/healthconditioncode
Condition.bodySitepreferredhttps://fhir.infoway-inforoute.ca/ValueSet/anatomicaloracquiredbodystructurecode
Condition.subject.typeextensiblehttp://hl7.org/fhir/ValueSet/resource-types
Condition.stage.summaryexamplehttp://hl7.org/fhir/ValueSet/condition-stage
Condition.stage.typeexamplehttp://hl7.org/fhir/ValueSet/condition-stage-type
Condition.evidence.codeexamplehttp://hl7.org/fhir/ValueSet/manifestation-or-symptom

Constraints

Obligations

Key Differences between the IPS-UV and PS-CA

Must Support Differences:

The following elements are considered Must Support in the Condition (IPS) profile that are relaxed in this version of the PS-CA profile:

  • Condition.category

  • Condition.severity

    Note: Systems that support these elements are encouraged to send them in patient summaries

Cardinality Differences:

There are no cardinality differences between this profile and IPS 2.0.0-ballot release.

Vocabulary Differences:

  • Condition.severity

    • additionalBindings added for:
      • Condition severity Condition/DiagnosisSeverity
  • Condition.code

    • additionalBindings added for:
      • ICD-9 CM ICD9CMAllCode,
      • ICD-10 CA ICD10CAAllCode,
      • absent or unknown problems AbsentOrUnknownProblemsUvIps IPS absent/unknown ValueSets have been deprecated as of IPS 2.0.0-ballot and subsumed into their ProblemsUvIps. This change is pending analysis & alignment in a future update.
  • Condition.bodySite

    • SNOMED CT Canadian Edition AnatomicalOrAcquiredBodyStructureCode indicated as preferred

Other differences between the IPS and PS-CA Include:

  • Data type profiles (e.g., CodeableConcept) and reference targets (e.g., Patient) replaced with PS-CA equivalents when appropriate

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