Singapore Core Data for Interoperability (SGCDI)

MedicalDirective

This resource represents a written instruction or order that authorizes specific healthcare actions or interventions for a patient, often under defined circumstances and sometimes in advance of need. Medical directives can include standing orders for treatments, protocols for certain clinical situations, or advance directives that express a patient’s wishes regarding future medical care (such as resuscitation preferences or end-of-life care).

Resource Structure

MedicalDirective (CarePlan)	C		CarePlan	There are no (further) constraints on this element Element id CarePlan Short description Healthcare plan for patient or group Alternate names Care Team Definition Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions. Data type CarePlan Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().ofType(canonical) \| %resource.descendants().ofType(uri) \| %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: n/a rim: Entity. Role, or Act rim: Entity, Role, or Act workflow: Request w5: clinical.careprovision rim: Act[classCode=PCPR, moodCode=INT]
id	Σ	0..1	id	There are no (further) constraints on this element Element id CarePlan.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 Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case. Data type id
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id CarePlan.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())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id CarePlan.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 its 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())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id CarePlan.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 IETF language tag for a human language AllLanguages (required) Additional bindings CommonLanguages (starter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text	C	0..1	Narrative	There are no (further) constraints on this element Element id CarePlan.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 a 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 Conditions The cardinality or value of this element may be affected by these constraints: dom-6 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained	C	0..*	Resource	There are no (further) constraints on this element Element id CarePlan.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, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning. 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 Conditions The cardinality or value of this element may be affected by these constraints: dom-2, dom-4, dom-3, dom-5 Mappings rim: n/a rim: Entity. Role, or Act rim: N/A
extension	C	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.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 managable, 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 rim: N/A
modifierExtension	Σ ?! C	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.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 managable, 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 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 rim: N/A
identifier	Σ C	0..*	Identifier	There are no (further) constraints on this element Element id CarePlan.identifier Short description External Ids for this plan Definition Business identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server. Requirements Allows identification of the care plan 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())` ident-1: Identifier with no value has limited utility. If communicating that an identifier value has been suppressed or missing, the value element SHOULD be present with an extension indicating the missing semantic - e.g. data-absent-reason `value.exists()` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Request.identifier w5: FiveWs.identifier v2: PTH-3 rim: .id
instantiatesCanonical	Σ	0..*	canonical(ActivityDefinition \| Measure \| OperationDefinition \| PlanDefinition \| Questionnaire)	There are no (further) constraints on this element Element id CarePlan.instantiatesCanonical Short description Instantiates FHIR protocol or definition Definition The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. Comments see Canonical References Data type canonical(ActivityDefinition \| Measure \| OperationDefinition \| PlanDefinition \| Questionnaire) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.instantiatesCanonical rim: .outboundRelationship[typeCode=DEFN].target
instantiatesUri	Σ	0..*	uri	There are no (further) constraints on this element Element id CarePlan.instantiatesUri Short description Instantiates external protocol or definition Definition The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan. Comments This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.instantiatesUri rim: .outboundRelationship[typeCode=DEFN].target
basedOn	Σ C	0..*	Reference(CarePlan \| NutritionOrder \| RequestOrchestration \| ServiceRequest)	There are no (further) constraints on this element Element id CarePlan.basedOn Short description Fulfills plan, proposal or order Alternate names fulfills Definition A higher-level request resource (i.e. a plan, proposal or order) that is fulfilled in whole or in part by this care plan. Requirements Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(CarePlan \| NutritionOrder \| RequestOrchestration \| ServiceRequest) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.basedOn
replaces	Σ C	0..*	Reference(CarePlan)	There are no (further) constraints on this element Element id CarePlan.replaces Short description CarePlan replaced by this CarePlan Alternate names supersedes Definition Completed or terminated care plan whose function is taken by this new care plan. Requirements Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans. Comments The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing. Data type Reference(CarePlan) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.replaces
partOf	Σ C	0..*	Reference(CarePlan)	There are no (further) constraints on this element Element id CarePlan.partOf Short description Part of referenced CarePlan Definition A larger care plan of which this particular care plan is a component or step. Comments Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed. Data type Reference(CarePlan) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id CarePlan.status Short description draft \| active \| on-hold \| revoked \| completed \| entered-in-error \| unknown Definition Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. Requirements Allows clinicians to determine whether the plan is actionable or not. Comments The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan. This element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid. Data type code Binding Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record. RequestStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.status {uses different ValueSet} w5: FiveWs.status v2: PTH-5 rim: .statusCode planned = new active = active completed = completed
intent	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id CarePlan.intent Short description proposal \| plan \| order \| option \| directive Definition Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain. Requirements Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain. Comments This element is labeled as a modifier because the intent alters when and how the resource is actually applicable. This element is expected to be immutable. E.g. A "proposal" instance should never change to be a "plan" instance or "order" instance. Instead, a new instance 'basedOn' the prior instance should be created with the new 'intent' value. Data type code Binding Codes indicating the degree of authority/intentionality associated with a care plan. CarePlanIntent (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.intent
category	Σ	0..*	CodeableConcept	There are no (further) constraints on this element Element id CarePlan.category Short description Type of plan Definition Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc. Requirements Used for filtering what plan(s) are retrieved and displayed to different types of users. Comments There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.addresses. Data type CodeableConcept Binding Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc. CarePlanCategory (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD w5: FiveWs.class
title	Σ	0..1	string	There are no (further) constraints on this element Element id CarePlan.title Short description Human-friendly name for the care plan Definition Human-friendly name for the care plan. Comments Note that FHIR strings SHALL NOT exceed 1,048,576 (10241024) characters in size 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
description	Σ	0..1	string	There are no (further) constraints on this element Element id CarePlan.description Short description Summary of nature of plan Definition A description of the scope and nature of the plan. Requirements Provides more detail than conveyed by category. Comments Note that FHIR strings SHALL NOT exceed 1,048,576 (10241024) characters in size 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 w5: FiveWs.what[x]
subject	Σ C	1..1	Reference(Group \| Patient)	There are no (further) constraints on this element Element id CarePlan.subject Short description Who the care plan is for Alternate names patient Definition Identifies the patient or group whose intended care is described by the plan. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Group \| Patient) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.subject w5: FiveWs.subject[x] v2: PID-3 rim: .participation[typeCode=PAT].role[classCode=PAT]
encounter	Σ C	0..1	Reference(Encounter)	There are no (further) constraints on this element Element id CarePlan.encounter Short description The Encounter during which this CarePlan was created Definition The Encounter during which this CarePlan 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. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters. Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.encounter w5: FiveWs.context v2: Associated PV1 rim: .
period	Σ C	0..1	Period	There are no (further) constraints on this element Element id CarePlan.period Short description Time period plan covers Alternate names timing Definition Indicates when the plan did (or is intended to) come into effect and end. Requirements Allows tracking what plan(s) are in effect at a particular time. Comments Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition). Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower or equal value than end `start.hasValue().not() or end.hasValue().not() or (start.lowBoundary() <= end.highBoundary())` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] workflow: Request.occurrence[x] w5: FiveWs.planned v2: GOL-7 / GOL-8 rim: .effectiveTime
created	Σ	0..1	dateTime	There are no (further) constraints on this element Element id CarePlan.created Short description Date record was first recorded Alternate names authoredOn Definition Represents when this particular CarePlan record was created in the system, which is often a system-generated date. Comments UTC offset is allowed for dates and partial dates Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.authoredOn w5: FiveWs.recorded rim: .participation[typeCode=AUT].time
custodian	Σ C	0..1	Reference(CareTeam \| Device \| Organization \| Patient \| Practitioner \| PractitionerRole \| RelatedPerson)	There are no (further) constraints on this element Element id CarePlan.custodian Short description Who is the designated responsible party Definition When populated, the custodian is responsible for the care plan. The care plan is attributed to the custodian. Comments The custodian might or might not be a contributor. Data type Reference(CareTeam \| Device \| Organization \| Patient \| Practitioner \| PractitionerRole \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.requester w5: FiveWs.author
contributor	C	0..*	Reference(CareTeam \| Device \| Organization \| Patient \| Practitioner \| PractitionerRole \| RelatedPerson)	There are no (further) constraints on this element Element id CarePlan.contributor Short description Who provided the content of the care plan Definition Identifies the individual(s), organization or device who provided the contents of the care plan. Comments Collaborative care plans may have multiple contributors. Data type Reference(CareTeam \| Device \| Organization \| Patient \| Practitioner \| PractitionerRole \| RelatedPerson) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
careTeam	C	0..*	Reference(CareTeam)	There are no (further) constraints on this element Element id CarePlan.careTeam Short description Who's involved in plan? Definition Identifies all people and organizations who are expected to be involved in the care envisioned by this plan. Requirements Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolvable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(CareTeam) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.performer {similar but does not entail CareTeam} w5: FiveWs.actor
addresses	Σ	0..*	CodeableReference(Condition)	There are no (further) constraints on this element Element id CarePlan.addresses Short description Health issues this plan addresses Definition Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan. Requirements The element can identify risks addressed by the plan as well as concerns. Also scopes plans - multiple plans may exist addressing different concerns. Comments Use CarePlan.addresses.concept when a code sufficiently describes the concern (e.g. condition, problem, diagnosis, risk). Use CarePlan.addresses.reference when referencing a resource, which allows more information to be conveyed, such as onset date. CarePlan.addresses.concept and CarePlan.addresses.reference are not meant to be duplicative. For a single concern, either CarePlan.addresses.concept or CarePlan.addresses.reference can be used. CarePlan.addresses.concept may be a summary code, or CarePlan.addresses.reference may be used to reference a very precise definition of the concern using Condition. Both CarePlan.addresses.concept and CarePlan.addresses.reference can be used if they are describing different concerns for the care plan. Data type CodeableReference(Condition) Binding Codes that describe the health issues this plan addresses. SNOMEDCTClinicalFindings (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Request.reason w5: FiveWs.why[x] v2: PRB-4 rim: .actRelationship[typeCode=SUBJ].target[classCode=CONC, moodCode=EVN]
supportingInfo	C	0..*	Reference(Resource)	There are no (further) constraints on this element Element id CarePlan.supportingInfo Short description Information considered as part of plan Definition Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc. Requirements Identifies barriers and other considerations associated with the care plan. Comments Use "concern" to identify specific conditions addressed by the care plan. supportingInfo can be used to convey one or more Advance Directives or Medical Treatment Consent Directives by referencing Consent or any other request resource with intent = directive. Data type Reference(Resource) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Request.supportingInfo
goal	C	0..*	Reference(Goal)	There are no (further) constraints on this element Element id CarePlan.goal Short description Desired outcome of plan Definition Describes the intended objective(s) of carrying out the care plan. Requirements Provides context for plan. Allows plan effectiveness to be evaluated by clinicians. Comments Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline. Data type Reference(Goal) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: GOL-1 rim: .outboundRelationship[typeCode<=OBJ].
activity		0..*	BackboneElement	There are no (further) constraints on this element Element id CarePlan.activity Short description Action to occur or has occurred as part of plan Definition Identifies an action that has occurred or is a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring that has occurred, education etc. Requirements Allows systems to prompt for performance of planned activities, and validate plans against best practice. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: {no mapping NOTE: This is a list of contained Request-Event tuples!} rim: .outboundRelationship[typeCode=COMP].target
id		0..1	string	There are no (further) constraints on this element Element id CarePlan.activity.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 Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Mappings rim: n/a
extension	C	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.activity.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 managable, 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 rim: N/A
modifierExtension	Σ ?! C	0..*	Extension	There are no (further) constraints on this element Element id CarePlan.activity.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 managable, 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 rim: N/A
performedActivity		0..*	CodeableReference(Resource)	There are no (further) constraints on this element Element id CarePlan.activity.performedActivity Short description Results of the activity (concept, or Appointment, Encounter, Procedure, etc.) Definition Identifies the activity that was performed. For example, an activity could be patient education, exercise, or a medication administration. The reference to an "event" resource, such as Procedure or Encounter or Observation, represents the activity that was performed. The requested activity can be conveyed using the CarePlan.activity.plannedActivityReference (a reference to a “request” resource). Requirements Links plan to resulting actions. Comments Note that this should not duplicate the activity status (e.g. completed or in progress). The activity performed is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to exercise, then the activity performed could be amount and intensity of exercise performed whereas the goal outcome is an observation for the actual body weight measured. Data type CodeableReference(Resource) Binding Identifies the results of the activity. CarePlanActivityPerformed (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: {Event that is outcome of Request in activity.plannedActivityReference} rim: .inboundRelationship[typeCode=FLFS].source
progress		0..*	Annotation	There are no (further) constraints on this element Element id CarePlan.activity.progress Short description Comments about the activity status/progress Definition Notes about the adherence/status/progress of the activity. Requirements Can be used to capture information about adherence, progress, concerns, etc. Comments This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description. Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act v2: NTE? rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value
plannedActivityReference	C	0..1	Reference(Appointment \| CommunicationRequest \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| RequestOrchestration \| ServiceRequest \| SupplyRequest \| Task \| VisionPrescription)	There are no (further) constraints on this element Element id CarePlan.activity.plannedActivityReference Short description Activity that is intended to be part of the care plan Definition The details of the proposed activity represented in a specific resource. Requirements Details in a form consistent with other applications and contexts of use. Comments Standard extension exists (http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.plannedActivityReference. The goal should be visible when the resource referenced by CarePlan.activity.plannedActivityReference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should not point to this CarePlan using the "basedOn" element. i.e. Requests that are part of a CarePlan are not "based on" the CarePlan. Data type Reference(Appointment \| CommunicationRequest \| DeviceRequest \| ImmunizationRecommendation \| MedicationRequest \| NutritionOrder \| RequestOrchestration \| ServiceRequest \| SupplyRequest \| Task \| VisionPrescription) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.exists() implies (reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids')) or (reference='#' and %rootResource!=%resource))` ref-2: At least one of reference, identifier and display SHALL be present (unless an extension is provided). `reference.exists() or identifier.exists() or display.exists() or extension.exists()` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: {Request that resulted in Event in activity.performedActivity} rim: .outboundRelationship[typeCode=COMP].target
note		0..*	Annotation	There are no (further) constraints on this element Element id CarePlan.note Short description Comments about the plan Definition General notes about the care plan not covered elsewhere. Requirements Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements. Comments For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: Request.note v2: NTE? rim: .inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code="annotation"].value

Terminologies

Path	Binding Strength	Value Set (Code System)	Description
CarePlan.language	required	http://hl7.org/fhir/ValueSet/all-languages\|5.0.0	IETF language tag for a human language
CarePlan.status	required	http://hl7.org/fhir/ValueSet/request-status\|5.0.0	Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
CarePlan.intent	required	http://hl7.org/fhir/ValueSet/care-plan-intent\|5.0.0	Codes indicating the degree of authority/intentionality associated with a care plan.
CarePlan.category	example	http://hl7.org/fhir/ValueSet/care-plan-category	Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.
CarePlan.addresses	example	http://hl7.org/fhir/ValueSet/clinical-findings	Codes that describe the health issues this plan addresses.
CarePlan.activity.performedActivity	example	http://hl7.org/fhir/ValueSet/care-plan-activity-performed	Identifies the results of the activity.