StructureDefinition UKCore-Composition

While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.

• 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().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-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()

• rim: Entity. Role, or Act
• workflow: Event
• rim: Document[classCode="DOC" and moodCode="EVN" and isNormalAct()]
• cda: ClinicalDocument
• fhirdocumentreference: when described by DocumentReference

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

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

• rim: n/a
• rim: N/A

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

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

• rim: n/a

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

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

• rim: n/a

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

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

• rim: n/a
• rim: N/A
• rim: Act.text?

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

• rim: Entity. Role, or Act
• rim: N/A

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

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

• rim: n/a
• rim: N/A

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

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

• rim: n/a
• rim: N/A

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

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

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

• rim: n/a
• rim: N/A

Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.

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

• 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: Event.identifier
• w5: FiveWs.identifier
• rim: Document.id / Document.setId
• cda: .setId
• fhirdocumentreference: DocumentReference.masterIdentifier

Need to be able to mark interim, amended, or withdrawn compositions or documents.

If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements.

Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.

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

• rim: n/a
• workflow: Event.status
• w5: FiveWs.status
• rim: interim: .completionCode="IN" & ./statusCode[isNormalDatatype()]="active"; final: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and not(./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct()]); amended: .completionCode="AU" && ./statusCode[isNormalDatatype()]="complete" and ./inboundRelationship[typeCode="SUBJ" and isNormalActRelationship()]/source[subsumesCode("ActClass#CACT") and moodCode="EVN" and domainMember("ReviseComposition", code) and isNormalAct() and statusCode="completed"]; withdrawn : .completionCode=NI && ./statusCode[isNormalDatatype()]="obsolete"
• cda: n/a
• fhirdocumentreference: DocumentReference.status

Key metadata element describing the composition, used in searching/filtering.

For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.

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

• rim: n/a
• v2: CE/CNE/CWE
• rim: CD
• orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
• workflow: Event.code
• w5: FiveWs.class
• rim: ./code
• cda: .code
• fhirdocumentreference: DocumentReference.type

Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.

This is a metadata field from XDS/MHD.

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

• rim: n/a
• v2: CE/CNE/CWE
• rim: CD
• orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
• workflow: Event.subject
• w5: FiveWs.class
• rim: .outboundRelationship[typeCode="COMP].target[classCode="LIST", moodCode="EVN"].code
• cda: n/a
• fhirdocumentreference: DocumenttReference.category

Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.

For clinical documents, this is usually the patient.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• w5: FiveWs.subject[x]
• rim: .participation[typeCode="SBJ"].role[typeCode="PAT"]
• cda: .recordTarget
• fhirdocumentreference: DocumentReference.subject
• w5: FiveWs.subject

Provides context for the composition and supports searching.

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• workflow: Event.context
• w5: FiveWs.context
• rim: unique(highest(./outboundRelationship[typeCode="SUBJ" and isNormalActRelationship()], priorityNumber)/target[moodCode="EVN" and classCode=("ENC", "PCPR") and isNormalAct])
• cda: .componentOf.encompassingEncounter
• fhirdocumentreference: DocumentReference.context.encounter

dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring. When packaged in a document, Bundle.timestamp is the date of packaging.

The Last Modified Date on the composition may be after the date of the document was attested without being changed.

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

• rim: n/a
• workflow: Event.occurrence[x]
• w5: FiveWs.done[x]
• rim: .effectiveTime[type="TS"]
• cda: .effectiveTime
• fhirdocumentreference: DocumentReference.content.attachment.date, DocumentReference.created

Identifies who is responsible for the content.

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• workflow: Event.performer
• w5: FiveWs.author
• rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"]
• cda: .author.assignedAuthor
• fhirdocumentreference: DocumentReference.agent

For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.

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

• rim: n/a
• rim: ./title
• cda: .title
• fhirdocumentreference: DocumentReference.description, DocumentReference.content.attachment.title

The exact use of this element, and enforcement and issues related to highly sensitive documents are out of scope for the base specification, and delegated to implementation profiles (see security section). This element is labeled as a modifier because highly confidential documents must not be treated as if they are not.

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

• rim: n/a
• rim: .confidentialityCode
• cda: .confidentialityCode
• fhirdocumentreference: DocumentReference.securityLabel

Identifies responsibility for the accuracy of the composition content.

Only list each attester once.

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

• rim: n/a
• rim: .participation[typeCode="AUTHEN"].role[classCode="ASSIGNED"]
• cda: .authenticator/.legalAuthenticator
• fhirdocumentreference: DocumentReference.authenticator

• rim: n/a

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

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

• rim: n/a
• rim: N/A

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

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

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

• rim: n/a
• rim: N/A

Indicates the level of authority of the attestation.

Note that FHIR strings SHALL NOT exceed 1MB in size

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

• rim: n/a
• rim: unique(./modeCode)
• cda: implied by .authenticator/.legalAuthenticator

Identifies when the information in the composition was deemed accurate. (Things may have changed since then.).

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

• rim: n/a
• rim: ./time[type="TS" and isNormalDatatype()]
• cda: .authenticator.time

Identifies who has taken on the responsibility for accuracy of the composition content.

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• w5: FiveWs.witness
• rim: ./role[classCode="ASSIGNED" and isNormalRole]/player[determinerCode="INST" and classCode=("DEV", "PSN") and isNormalEntity()] or ./role[classCode="ASSIGNED" and isNormalRole and not(player)]/scoper[determinerCode="INST" and classCode="ORG" and isNormalEntity()]
• cda: .authenticator.assignedEnttty

Identifies where to go to find the current version, where to report issues, etc.

This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• rim: .participation[typeCode="RCV"].role[classCode="CUST"].scoper[classCode="ORG" and determinerCode="INST"]
• cda: .custodian.assignedCustodian
• fhirdocumentreference: DocumentReference.custodian

A document is a version specific composition.

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

• rim: n/a
• rim: .outboundRelationship
• cda: .relatedDocument
• fhirdocumentreference: DocumentReference.relatesTo

• rim: n/a

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

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

• rim: n/a
• rim: N/A

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

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

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

• rim: n/a
• rim: N/A

If this document appends another document, then the document cannot be fully understood without also accessing the referenced document.

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

• rim: n/a
• rim: .outboundRelationship.typeCode
• cda: .relatedDocument.typeCode
• fhirdocumentreference: DocumentReference.relatesTo.code

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

• rim: n/a
• rim: .target[classCode="DOC", moodCode="EVN"].id
• cda: .relatedDocument.id
• fhirdocumentreference: DocumentReference.relatesTo.target

Provides context for the composition and creates a linkage between a resource describing an event and the composition created describing the event.

The event needs to be consistent with the type element, though can provide further information if desired.

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

• rim: n/a
• rim: outboundRelationship[typeCode="SUBJ"].target[classCode<'ACT']
• cda: .documentationOf.serviceEvent
• fhirdocumentreference: DocumentReference.event

• rim: n/a

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

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

• rim: n/a
• rim: N/A

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

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

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

• rim: n/a
• rim: N/A

An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more eventCodes are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.

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

• rim: n/a
• v2: CE/CNE/CWE
• rim: CD
• orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
• rim: .code
• cda: .code
• fhirdocumentreference: DocumentReference.event.code

A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times").

Period is not used for a duration (a measure of elapsed time). See Duration.

• 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 value than end
  start.hasValue().not() or end.hasValue().not() or (start <= end)

• rim: n/a
• v2: DR
• rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"]
• rim: .effectiveTime
• cda: .effectiveTime
• fhirdocumentreference: DocumentReference.event.period

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• rim: .outboundRelationship[typeCode="SUBJ"].target
• cda: n/a

• ele-1: All FHIR elements must have a @value or children
  hasValue() or (children().count() > id.count())
• cmp-1: A section must contain at least one of text, entries, or sub-sections
  text.exists() or entry.exists() or section.exists()
• cmp-2: A section can only have an emptyReason if it is empty
  emptyReason.empty() or entry.empty()

• rim: n/a
• rim: ./outboundRelationship[typeCode="COMP" and isNormalActRelationship()]/target[moodCode="EVN" and classCode="DOCSECT" and isNormalAct]
• cda: .component.structuredBody.component.section

• rim: n/a

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

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

• rim: n/a
• rim: N/A

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

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

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

• rim: n/a
• rim: N/A

Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized.

The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.

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

• rim: n/a
• rim: ./title
• cda: .title

Provides computable standardized labels to topics within the document.

The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document.

If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.

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

• rim: n/a
• v2: CE/CNE/CWE
• rim: CD
• orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
• rim: ./code
• cda: .code

Identifies who is responsible for the content.

References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• w5: FiveWs.author
• rim: .participation[typeCode="AUT"].role[classCode="ASSIGNED"]
• cda: .author.assignedAuthor

Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• cda: .subject? (CDA did not differentiate between subject and focus)

Document profiles may define what content should be represented in the narrative to ensure clinical safety.

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

• rim: n/a
• rim: N/A
• rim: .text
• cda: .text

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

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

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

• rim: n/a
• w5: FiveWs.class
• rim: .outBoundRelationship[typeCode=COMP].target[classCode=OBS"].value
• cda: n/a

Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.

Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.

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

• rim: n/a
• v2: CE/CNE/CWE
• rim: CD
• orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
• rim: .outboundRelationship[typeCode=COMP].sequenceNumber > 1
• cda: n/a

If there are no entries in the list, an emptyReason SHOULD be provided.

• 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.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))

• rim: n/a
• rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity)
• rim: .outboundRelationship[typeCode=COMP] or .participation[typeCode=SBJ]
• cda: .entry

Allows capturing things like "none exist" or "not asked" which can be important for most lists.

The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.

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

• rim: n/a
• v2: CE/CNE/CWE
• rim: CD
• orim: fhir:CodeableConcept rdfs:subClassOf dt:CD
• rim: .inboundRelationship[typeCode=SUBJ,code<ListEmptyReason].value[type=CD]
• cda: n/a

Nested sections are primarily used to help human readers navigate to particular portions of the document.

• rim: ./outboundRelationship[typeCode="COMP" and isNormalActRelationship()]/target[moodCode="EVN" and classCode="DOCSECT" and isNormalAct]
• cda: .component.section