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StructureDefinition: ClinicalDocument - XML

Structured Documents Work Group Maturity Level: 1Trial UseUse Context: Any

ClinicalDocument

<?xml version="1.0" encoding="UTF-8"?>

<StructureDefinition xmlns="http://hl7.org/fhir">
  <id value="clinicaldocument"/> 
  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">to do</div> 
  </text> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
    <valueInteger value="2"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="sd"/> 
  </extension> 
  <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
    <valueCode value="trial-use"/> 
  </extension> 
  <url value="http://hl7.org/fhir/StructureDefinition/clinicaldocument"/> 
  <version value="3.6.0"/> 
  <name value="CDA on FHIR"/> 
  <status value="draft"/> 
  <experimental value="false"/> 
  <date value="2015-03-17"/> 
  <publisher value="Health Level Seven, Inc. - Structured Documents WG"/> 
  <contact> 
    <telecom> 
      <system value="url"/> 
      <value value="http://hl7.org/special/committees/structure"/> 
    </telecom> 
  </contact> 
  <description value="The CDA-in-FHIR profile constrains Composition to match CDA and specify a clinical document.
   

The base Composition is a general resource for compositions or documents about any kind
   of subject that might be encountered in healthcare including such things as guidelines,
   medicines, etc. A clinical document is focused on documents related to the provision of
   care process, where the subject is a patient, a group of patients, or a closely related
   concept. A clinical document has additional requirements around confidentiality that do
   not apply in the same way to other kinds of documents"/> 
  <fhirVersion value="3.6.0"/> 
  <mapping> 
    <identity value="workflow"/> 
    <uri value="http://hl7.org/fhir/workflow"/> 
    <name value="Workflow Pattern"/> 
  </mapping> 
  <mapping> 
    <identity value="rim"/> 
    <uri value="http://hl7.org/v3"/> 
    <name value="RIM Mapping"/> 
  </mapping> 
  <mapping> 
    <identity value="cda"/> 
    <uri value="http://hl7.org/v3/cda"/> 
    <name value="CDA (R2)"/> 
  </mapping> 
  <mapping> 
    <identity value="fhirdocumentreference"/> 
    <uri value="http://hl7.org/fhir/documentreference"/> 
    <name value="FHIR DocumentReference"/> 
  </mapping> 
  <mapping> 
    <identity value="w5"/> 
    <uri value="http://hl7.org/fhir/fivews"/> 
    <name value="FiveWs Pattern Mapping"/> 
  </mapping> 
  <kind value="resource"/> 
  <abstract value="false"/> 
  <type value="Composition"/> 
  <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Composition"/> 
  <derivation value="constraint"/> 
  <snapshot> 
    <element id="Composition">
      <path value="Composition"/> 
      <short value="A set of resources composed into a single coherent clinical statement with clinical attestation"/> 
      <definition value="A set of healthcare-related information that is assembled together into a single logical
       package that provides a single coherent statement of meaning, establishes its own context
       and that has clinical attestation with regard to who is making the statement. A Composition
       defines the structure and narrative content necessary for a document. However, a Composition
       alone does not constitute a document. Rather, the Composition must be the first entry
       in a Bundle where Bundle.type=document, and any other resources referenced from Composition
       must be included as subsequent entries in the Bundle (for example Patient, Practitioner,
       Encounter, etc.)."/> 
      <comment value="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."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <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="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="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(canonica
        l) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(refer
        ence = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(c
        anonical) = '#').exists()).not()).trace('unmatched', id).empty()"/> 
        <xpath value="not(exists(for $contained in f:contained return $contained[not(parent::*/descendant::f:reference/@va
        lue=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))"/> 
        <source value="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="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="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="rim"/> 
        <map value="Document[classCode=&quot;DOC&quot; and moodCode=&quot;EVN&quot; and isNormalAct()]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="ClinicalDocument"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="when described by DocumentReference"/> 
      </mapping> 
    </element> 
    <element id="Composition.id">
      <path value="Composition.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> 
        <code value="id"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Composition.meta">
      <path value="Composition.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> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
    </element> 
    <element id="Composition.implicitRules">
      <path value="Composition.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> 
      <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="Composition.language">
      <path value="Composition.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> 
      <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="Composition.text">
      <path value="Composition.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 &quot;clinically
       safe&quot; 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 &quot;text blob&quot;
       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> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="Act.text?"/> 
      </mapping> 
    </element> 
    <element id="Composition.contained">
      <path value="Composition.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="Composition.extension">
      <path value="Composition.extension"/> 
      <slicing id="8">
        <discriminator> 
          <type value="value"/> 
          <path value="url"/> 
        </discriminator> 
        <ordered value="false"/> 
        <rules value="open"/> 
      </slicing> 
      <short value="Extension"/> 
      <definition value="An Extension"/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="DomainResource.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
    </element> 
    <element id="Composition.extension:versionNumber">
      <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="Composition.extension"/> 
      <sliceName value="versionNumber"/> 
      <short value="Version-specific identifier for composition"/> 
      <definition value="Version specific identifier for the composition, assigned when each version is created/updated."/> 
      <comment value="While each resource, including the composition itself, has its own version identifier,
       this is a formal identifier for the logical version of the composition as a whole. It
       would remain constant if the resources were moved to a new server, and all got new individual
       resource versions, for example."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="DomainResource.extension"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Extension"/> 
        <profile value="http://hl7.org/fhir/StructureDefinition/composition-cda-versionNumber"/> 
      </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() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="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="Extension"/> 
      </constraint> 
      <isModifier value="false"/> 
    </element> 
    <element id="Composition.modifierExtension">
      <path value="Composition.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.

Modifier 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.ht
      ml#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> 
      <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="Composition.identifier">
      <path value="Composition.identifier"/> 
      <short value="Version-independent identifier for the Composition"/> 
      <definition value="A version-independent identifier for the Composition. This identifier stays constant as
       the composition is changed over time."/> 
      <comment value="Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how
       these relate."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.identifier"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Identifier"/> 
      </type> 
      <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="Document.id / Document.setId"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".setId"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.masterIdentifier"/> 
      </mapping> 
    </element> 
    <element id="Composition.status">
      <path value="Composition.status"/> 
      <short value="preliminary | final | amended | entered-in-error"/> 
      <definition value="The workflow/clinical status of this composition. The status is a marker for the clinical
       standing of the document."/> 
      <comment value="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 &quot;entered-in-error&quot; 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."/> 
      <requirements value="Need to be able to mark interim, amended, or withdrawn compositions or documents."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.status"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <isModifier value="true"/> 
      <isModifierReason value="This element is labelled as a modifier because it is a status element that contains status
       entered-in-error which means that the resource should not be treated as valid"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="CompositionStatus"/> 
        </extension> 
        <strength value="required"/> 
        <description value="The workflow/clinical status of the composition."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/composition-status"/> 
      </binding> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.status"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.status"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="interim: .completionCode=&quot;IN&quot; &amp; ./statusCode[isNormalDatatype()]=&quot;active&quot;;
          final: .completionCode=&quot;AU&quot; &amp;&amp;  ./statusCode[isNormalDatatype()]=&quot;complete&q
        uot; and not(./inboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()]/source[su
        bsumesCode(&quot;ActClass#CACT&quot;) and moodCode=&quot;EVN&quot; and domainMember(&quot;ReviseCompo
        sition&quot;, code) and isNormalAct()]);  amended: .completionCode=&quot;AU&quot; &amp;&amp;
          ./statusCode[isNormalDatatype()]=&quot;complete&quot; and ./inboundRelationship[typeCode=&quot;SUBJ
        &quot; and isNormalActRelationship()]/source[subsumesCode(&quot;ActClass#CACT&quot;) and
         moodCode=&quot;EVN&quot; and domainMember(&quot;ReviseComposition&quot;, code) and isNormalAct()
         and statusCode=&quot;completed&quot;];  withdrawn : .completionCode=NI &amp;&amp;  ./statusCode[isNo
        rmalDatatype()]=&quot;obsolete&quot;"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.status"/> 
      </mapping> 
    </element> 
    <element id="Composition.type">
      <path value="Composition.type"/> 
      <short value="Kind of composition (LOINC if possible)"/> 
      <definition value="Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary,
       Progress Note). This usually equates to the purpose of making the composition."/> 
      <comment value="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."/> 
      <requirements value="Key metadata element describing the composition, used in searching/filtering."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.type"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DocumentType"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="Type of a composition."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/doc-typecodes"/> 
      </binding> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.code"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.class"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./code"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".code"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.type"/> 
      </mapping> 
    </element> 
    <element id="Composition.category">
      <path value="Composition.category"/> 
      <short value="Categorization of Composition"/> 
      <definition value="A categorization for the type of the composition - helps for indexing and searching. This
       may be implied by or derived from the code specified in the Composition Type."/> 
      <comment value="This is a metadata field from [XDS/MHD](http://wiki.ihe.net/index.php?title=Mobile_access_to_Health_
      Documents_(MHD))."/> 
      <requirements value="Helps humans to assess whether the composition is of interest when viewing an index of
       compositions or documents."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.category"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DocumentCategory"/> 
        </extension> 
        <strength value="example"/> 
        <description value="High-level kind of a clinical document at a macro level."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/document-classcodes"/> 
      </binding> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.subject"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.class"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=&quot;COMP].target[classCode=&quot;LIST&quot;, moodCode=&quot;EVN&quo
        t;].code"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumenttReference.category"/> 
      </mapping> 
    </element> 
    <element id="Composition.subject">
      <path value="Composition.subject"/> 
      <short value="Who and/or what the composition is about"/> 
      <definition value="Who or what the composition is about. The composition can be about a person, (patient
       or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such
       as a document about a herd of livestock, or a set of patients that share a common exposure)."/> 
      <comment value="For clinical documents, this is usually the patient."/> 
      <requirements value="Essential metadata for searching for the composition. Identifies who and/or what the composition/doc
      ument is about."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.subject"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.subject[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;SBJ&quot;].role[typeCode=&quot;PAT&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".recordTarget"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.subject"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.subject"/> 
      </mapping> 
    </element> 
    <element id="Composition.encounter">
      <path value="Composition.encounter"/> 
      <short value="Context of the Composition"/> 
      <definition value="Describes the clinical encounter or type of care this documentation is associated with."/> 
      <requirements value="Provides context for the composition and supports searching."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.encounter"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Encounter"/> 
      </type> 
      <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="rim"/> 
        <map value="unique(highest(./outboundRelationship[typeCode=&quot;SUBJ&quot; and isNormalActRelationship()],
         priorityNumber)/target[moodCode=&quot;EVN&quot; and classCode=(&quot;ENC&quot;, &quot;PCPR&quot;)
         and isNormalAct])"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".componentOf.encompassingEncounter"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.context.encounter"/> 
      </mapping> 
    </element> 
    <element id="Composition.date">
      <path value="Composition.date"/> 
      <short value="Composition editing time"/> 
      <definition value="The composition editing time, when the composition was last logically changed by the author."/> 
      <comment value="The Last Modified Date on the composition may be after the date of the document was attested
       without being changed."/> 
      <requirements value="dateTime is used for tracking, organizing versions and searching. Note that this is the
       time of *authoring*. When packaged in a document, [Bundle.timestamp](bundle-definitions.html#Bundle.
      timestamp) is the date of packaging."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.date"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="dateTime"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.occurrence[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.done[x]"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".effectiveTime[type=&quot;TS&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".effectiveTime"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.content.attachment.date, DocumentReference.created"/> 
      </mapping> 
    </element> 
    <element id="Composition.author">
      <path value="Composition.author"/> 
      <short value="Who and/or what authored the composition"/> 
      <definition value="Identifies who is responsible for the information in the composition, not necessarily
       who typed it in."/> 
      <requirements value="Identifies who is responsible for the content."/> 
      <min value="1"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.author"/> 
        <min value="1"/> 
        <max value="*"/> 
      </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/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="workflow"/> 
        <map value="Event.performer"/> 
      </mapping> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.author"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;AUT&quot;].role[classCode=&quot;ASSIGNED&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".author.assignedAuthor"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.agent"/> 
      </mapping> 
    </element> 
    <element id="Composition.title">
      <path value="Composition.title"/> 
      <short value="Human Readable name/title"/> 
      <definition value="Official human-readable label for the composition."/> 
      <comment value="For many compositions, the title is the same as the text or a display name of Composition.type
       (e.g. a &quot;consultation&quot; or &quot;progress note&quot;). 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."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.title"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./title"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".title"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.description, DocumentReference.content.attachment.title"/> 
      </mapping> 
    </element> 
    <element id="Composition.confidentiality">
      <path value="Composition.confidentiality"/> 
      <short value="As defined by affinity domain"/> 
      <definition value="The code specifying the level of confidentiality of the Composition."/> 
      <comment value="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."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.confidentiality"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DocumentConfidentiality"/> 
        </extension> 
        <strength value="required"/> 
        <description value="Codes specifying the level of confidentiality of the composition."/> 
        <valueSet value="http://terminology.hl7.org/ValueSet/v3-ConfidentialityClassification"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".confidentialityCode"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".confidentialityCode"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.securityLabel"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester">
      <path value="Composition.attester"/> 
      <short value="Attests to accuracy of composition"/> 
      <definition value="A participant who has attested to the accuracy of the composition/document."/> 
      <comment value="Only list each attester once."/> 
      <requirements value="Identifies responsibility for the accuracy of the composition content."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.attester"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </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() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;AUTHEN&quot;].role[classCode=&quot;ASSIGNED&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".authenticator/.legalAuthenticator"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.authenticator"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.id">
      <path value="Composition.attester.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> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.extension">
      <path value="Composition.attester.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> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.modifierExtension">
      <path value="Composition.attester.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.

Modifier 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.ht
      ml#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> 
      <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="Composition.attester.mode">
      <path value="Composition.attester.mode"/> 
      <short value="personal | professional | legal | official"/> 
      <definition value="The type of attestation the authenticator offers."/> 
      <requirements value="Indicates the level of authority of the attestation."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.attester.mode"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="CompositionAttestationMode"/> 
        </extension> 
        <strength value="required"/> 
        <description value="The way in which a person authenticated a composition."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/composition-attestation-mode"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value="unique(./modeCode)"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="implied by .authenticator/.legalAuthenticator"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.time">
      <path value="Composition.attester.time"/> 
      <short value="When the composition was attested"/> 
      <definition value="When the composition was attested by the party."/> 
      <requirements value="Identifies when the information in the composition was deemed accurate.  (Things may have
       changed since then.)."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.attester.time"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="dateTime"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./time[type=&quot;TS&quot; and isNormalDatatype()]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".authenticator.time"/> 
      </mapping> 
    </element> 
    <element id="Composition.attester.party">
      <path value="Composition.attester.party"/> 
      <short value="Who attested the composition"/> 
      <definition value="Who attested the composition in the specified way."/> 
      <requirements value="Identifies who has taken on the responsibility for accuracy of the composition content."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.attester.party"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.witness"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./role[classCode=&quot;ASSIGNED&quot; and isNormalRole]/player[determinerCode=&quot;INST&quot;
         and classCode=(&quot;DEV&quot;, &quot;PSN&quot;) and isNormalEntity()] or ./role[classCode=&quot;ASS
        IGNED&quot; and isNormalRole and not(player)]/scoper[determinerCode=&quot;INST&quot; and
         classCode=&quot;ORG&quot; and isNormalEntity()]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".authenticator.assignedEnttty"/> 
      </mapping> 
    </element> 
    <element id="Composition.custodian">
      <path value="Composition.custodian"/> 
      <short value="Organization which maintains the composition"/> 
      <definition value="Identifies the organization or group who is responsible for ongoing maintenance of and
       access to the composition/document information."/> 
      <comment value="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."/> 
      <requirements value="Identifies where to go to find the current version, where to report issues, etc."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.custodian"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;RCV&quot;].role[classCode=&quot;CUST&quot;].scoper[classCode=&quot;ORG
        &quot; and determinerCode=&quot;INST&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".custodian.assignedCustodian"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.custodian"/> 
      </mapping> 
    </element> 
    <element id="Composition.relatesTo">
      <path value="Composition.relatesTo"/> 
      <short value="Relationships to other compositions/documents"/> 
      <definition value="Relationships that this composition has with other compositions or documents that already
       exist."/> 
      <comment value="A document is a version specific composition."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.relatesTo"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </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() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".relatedDocument"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.relatesTo"/> 
      </mapping> 
    </element> 
    <element id="Composition.relatesTo.id">
      <path value="Composition.relatesTo.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> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.relatesTo.extension">
      <path value="Composition.relatesTo.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> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.relatesTo.modifierExtension">
      <path value="Composition.relatesTo.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.

Modifier 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.ht
      ml#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> 
      <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="Composition.relatesTo.code">
      <path value="Composition.relatesTo.code"/> 
      <short value="replaces | transforms | signs | appends"/> 
      <definition value="The type of relationship that this composition has with anther composition or document."/> 
      <comment value="If this document appends another document, then the document cannot be fully understood
       without also accessing the referenced document."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.relatesTo.code"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DocumentRelationshipType"/> 
        </extension> 
        <strength value="required"/> 
        <description value="The type of relationship between documents."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/document-relationship-type"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship.typeCode"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".relatedDocument.typeCode"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.relatesTo.code"/> 
      </mapping> 
    </element> 
    <element id="Composition.relatesTo.target[x]">
      <path value="Composition.relatesTo.target[x]"/> 
      <short value="Target of the relationship"/> 
      <definition value="The target composition/document of this relationship."/> 
      <min value="1"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.relatesTo.target[x]"/> 
        <min value="1"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Identifier"/> 
      </type> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Composition"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".target[classCode=&quot;DOC&quot;, moodCode=&quot;EVN&quot;].id"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".relatedDocument.id"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.relatesTo.target"/> 
      </mapping> 
    </element> 
    <element id="Composition.event">
      <path value="Composition.event"/> 
      <short value="The clinical service(s) being documented"/> 
      <definition value="The clinical service, such as a colonoscopy or an appendectomy, being documented."/> 
      <comment value="The event needs to be consistent with the type element, though can provide further information
       if desired."/> 
      <requirements value="Provides context for the composition and creates a linkage between a resource describing
       an event and the composition created describing the event."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.event"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </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() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="outboundRelationship[typeCode=&quot;SUBJ&quot;].target[classCode&lt;'ACT']"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".documentationOf.serviceEvent"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.event"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.id">
      <path value="Composition.event.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> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.extension">
      <path value="Composition.event.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> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.modifierExtension">
      <path value="Composition.event.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.

Modifier 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.ht
      ml#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> 
      <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="Composition.event.code">
      <path value="Composition.event.code"/> 
      <short value="Code(s) that apply to the event being documented"/> 
      <definition value="This list of codes represents the main clinical acts, such as a colonoscopy or an appendectomy,
       being documented. In some cases, the event is inherent in the typeCode, such as a &quot;History
       and Physical Report&quot; in which the procedure being documented is necessarily a &quot;History
       and Physical&quot; act."/> 
      <comment value="An event can further specialize the act inherent in the typeCode, such as where it is
       simply &quot;Procedure Report&quot; and the procedure was a &quot;colonoscopy&quot;. 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."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.event.code"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="DocumentEventType"/> 
        </extension> 
        <strength value="example"/> 
        <description value="This list of codes represents the main clinical acts being documented."/> 
        <valueSet value="http://terminology.hl7.org/ValueSet/v3-ActCode"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".code"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".code"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.event.code"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.period">
      <path value="Composition.event.period"/> 
      <short value="The period covered by the documentation"/> 
      <definition value="The period of time covered by the documentation. There is no assertion that the documentation
       is a complete representation for this period, only that it documents events during this
       time."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.event.period"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Period"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".effectiveTime"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".effectiveTime"/> 
      </mapping> 
      <mapping> 
        <identity value="fhirdocumentreference"/> 
        <map value="DocumentReference.event.period"/> 
      </mapping> 
    </element> 
    <element id="Composition.event.detail">
      <path value="Composition.event.detail"/> 
      <short value="The event(s) being documented"/> 
      <definition value="The description and/or reference of the event(s) being documented. For example, this could
       be used to document such a colonoscopy or an appendectomy."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.event.detail"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="true"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=&quot;SUBJ&quot;].target"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section">
      <extension url="http://hl7.org/fhir/StructureDefinition/structuredefinition-explicit-type-name">
        <valueString value="Section"/> 
      </extension> 
      <path value="Composition.section"/> 
      <short value="Composition is broken into sections"/> 
      <definition value="The root of the sections that make up the composition."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.section"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="BackboneElement"/> 
      </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() &gt; id.count())"/> 
        <xpath value="@value|f:*|h:div"/> 
        <source value="Element"/> 
      </constraint> 
      <constraint> 
        <key value="cmp-1"/> 
        <severity value="error"/> 
        <human value="A section must contain at least one of text, entries, or sub-sections"/> 
        <expression value="text.exists() or entry.exists() or section.exists()"/> 
        <xpath value="exists(f:text) or exists(f:entry) or exists(f:section)"/> 
      </constraint> 
      <constraint> 
        <key value="cmp-2"/> 
        <severity value="error"/> 
        <human value="A section can only have an emptyReason if it is empty"/> 
        <expression value="emptyReason.empty() or entry.empty()"/> 
        <xpath value="not(exists(f:emptyReason) and exists(f:entry))"/> 
      </constraint> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./outboundRelationship[typeCode=&quot;COMP&quot; and isNormalActRelationship()]/target[moodCode=&quo
        t;EVN&quot; and classCode=&quot;DOCSECT&quot; and isNormalAct]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".component.structuredBody.component.section"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.id">
      <path value="Composition.section.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> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.extension">
      <path value="Composition.section.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> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.modifierExtension">
      <path value="Composition.section.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.

Modifier 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.ht
      ml#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> 
      <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="Composition.section.title">
      <path value="Composition.section.title"/> 
      <short value="Label for section (e.g. for ToC)"/> 
      <definition value="The label for this particular section.  This will be part of the rendered content for
       the document, and is often used to build a table of contents."/> 
      <comment value="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."/> 
      <requirements value="Section headings are often standardized for different types of documents.  They give guidance
       to humans on how the document is organized."/> 
      <alias value="header"/> 
      <alias value="label"/> 
      <alias value="caption"/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.title"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="string"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./title"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".title"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.code">
      <path value="Composition.section.code"/> 
      <short value="Classification of section (recommended)"/> 
      <definition value="A code identifying the kind of content contained within the section. This must be consistent
       with the section title."/> 
      <comment value="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."/> 
      <requirements value="Provides computable standardized labels to topics within the document."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.code"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="CompositionSectionType"/> 
        </extension> 
        <strength value="example"/> 
        <description value="Classification of a section of a composition/document."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/doc-section-codes"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./code"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".code"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.author">
      <path value="Composition.section.author"/> 
      <short value="Who and/or what authored the section"/> 
      <definition value="Identifies who is responsible for the information in this section, not necessarily who
       typed it in."/> 
      <requirements value="Identifies who is responsible for the content."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.section.author"/> 
        <min value="0"/> 
        <max value="*"/> 
      </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/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Organization"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.author"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".participation[typeCode=&quot;AUT&quot;].role[classCode=&quot;ASSIGNED&quot;]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".author.assignedAuthor"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.focus">
      <path value="Composition.section.focus"/> 
      <short value="Who/what the section is about, when it is not about the subject of composition"/> 
      <definition value="The actual focus of the section when it is not the subject of the composition, but instead
       represents something or someone associated with the subject such as (for a patient subject)
       a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to
       be focus of the parent section, or, for a section in the Composition itself, the subject
       of the composition. Sections with a focus SHALL only include resources where the logical
       subject (patient, subject, focus, etc.) matches the section focus, or the resources have
       no logical subject (few resources)."/> 
      <comment value="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."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.focus"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".subject? (CDA did not differentiate between subject and focus)"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.text">
      <path value="Composition.section.text"/> 
      <short value="Text summary of the section, for human interpretation"/> 
      <definition value="A human-readable narrative that contains the attested content of the section, 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 &quot;clinically
       safe&quot; for a human to just read the narrative."/> 
      <comment value="Document profiles may define what content should be represented in the narrative to ensure
       clinical safety."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.text"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="Narrative"/> 
      </type> 
      <condition value="cmp-1"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".text"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".text"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.mode">
      <path value="Composition.section.mode"/> 
      <short value="working | snapshot | changes"/> 
      <definition value="How the entry list was prepared - whether it is a working list that is suitable for being
       maintained on an ongoing basis, or if it represents a snapshot of a list of items from
       another source, or whether it is a prepared list where items may be marked as added, modified
       or deleted."/> 
      <comment value="This element is labeled as a modifier because a change list must not be misunderstood
       as a complete list."/> 
      <requirements value="Sections are used in various ways, and it must be known in what way it is safe to use
       the entries in them."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.mode"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="code"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="SectionMode"/> 
        </extension> 
        <strength value="required"/> 
        <description value="The processing mode that applies to this section."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/list-mode"/> 
      </binding> 
      <mapping> 
        <identity value="w5"/> 
        <map value="FiveWs.class"/> 
      </mapping> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outBoundRelationship[typeCode=COMP].target[classCode=OBS&quot;].value"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.orderedBy">
      <path value="Composition.section.orderedBy"/> 
      <short value="Order of section entries"/> 
      <definition value="Specifies the order applied to the items in the section entries."/> 
      <comment value="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."/> 
      <requirements value="Important for presentation and rendering.  Lists may be sorted to place more important
       information first or to group related entries."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.orderedBy"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="SectionEntryOrder"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="What order applies to the items in the entry."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/list-order"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=COMP].sequenceNumber &gt; 1"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.entry">
      <path value="Composition.section.entry"/> 
      <short value="A reference to data that supports this section"/> 
      <definition value="A reference to the actual resource from which the narrative in the section is derived."/> 
      <comment value="If there are no entries in the list, an emptyReason SHOULD be provided."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.section.entry"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Resource"/> 
      </type> 
      <condition value="cmp-2"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".outboundRelationship[typeCode=COMP] or  .participation[typeCode=SBJ]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".entry"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.emptyReason">
      <path value="Composition.section.emptyReason"/> 
      <short value="Why the section is empty"/> 
      <definition value="If the section is empty, why the list is empty. An empty section typically has some text
       explaining the empty reason."/> 
      <comment value="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."/> 
      <requirements value="Allows capturing things like &quot;none exist&quot; or &quot;not asked&quot; which can
       be important for most lists."/> 
      <min value="0"/> 
      <max value="1"/> 
      <base> 
        <path value="Composition.section.emptyReason"/> 
        <min value="0"/> 
        <max value="1"/> 
      </base> 
      <type> 
        <code value="CodeableConcept"/> 
      </type> 
      <condition value="cmp-2"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <binding> 
        <extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
          <valueString value="SectionEmptyReason"/> 
        </extension> 
        <strength value="preferred"/> 
        <description value="If a section is empty, why it is empty."/> 
        <valueSet value="http://hl7.org/fhir/ValueSet/list-empty-reason"/> 
      </binding> 
      <mapping> 
        <identity value="rim"/> 
        <map value=".inboundRelationship[typeCode=SUBJ,code&lt;ListEmptyReason].value[type=CD]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value="n/a"/> 
      </mapping> 
    </element> 
    <element id="Composition.section.section">
      <path value="Composition.section.section"/> 
      <short value="Nested Section"/> 
      <definition value="A nested sub-section within this section."/> 
      <comment value="Nested sections are primarily used to help human readers navigate to particular portions
       of the document."/> 
      <min value="0"/> 
      <max value="*"/> 
      <base> 
        <path value="Composition.section.section"/> 
        <min value="0"/> 
        <max value="*"/> 
      </base> 
      <contentReference value="#Composition.section"/> 
      <condition value="cmp-1"/> 
      <isModifier value="false"/> 
      <isSummary value="false"/> 
      <mapping> 
        <identity value="rim"/> 
        <map value="./outboundRelationship[typeCode=&quot;COMP&quot; and isNormalActRelationship()]/target[moodCode=&quo
        t;EVN&quot; and classCode=&quot;DOCSECT&quot; and isNormalAct]"/> 
      </mapping> 
      <mapping> 
        <identity value="cda"/> 
        <map value=".component.section"/> 
      </mapping> 
    </element> 
  </snapshot> 
  <differential> 
    <element id="Composition">
      <path value="Composition"/> 
      <min value="0"/> 
      <max value="*"/> 
    </element> 
    <element id="Composition.extension:versionNumber">
      <path value="Composition.extension"/> 
      <sliceName value="versionNumber"/> 
      <short value="Version-specific identifier for composition"/> 
      <definition value="Version specific identifier for the composition, assigned when each version is created/updated."/> 
      <comment value="While each resource, including the composition itself, has its own version identifier,
       this is a formal identifier for the logical version of the composition as a whole. It
       would remain constant if the resources were moved to a new server, and all got new individual
       resource versions, for example."/> 
      <type> 
        <code value="Extension"/> 
        <profile value="http://hl7.org/fhir/StructureDefinition/composition-cda-versionNumber"/> 
      </type> 
    </element> 
    <element id="Composition.subject">
      <path value="Composition.subject"/> 
      <type> 
        <code value="Reference"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Patient"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Practitioner"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Device"/> 
        <targetProfile value="http://hl7.org/fhir/StructureDefinition/Location"/> 
      </type> 
    </element> 
  </differential> 
</StructureDefinition>