Canadian Baseline
1.1.0 - CI Build Canada flag

Canadian Baseline, published by HL7 Canada - FHIR Implementation Work Group. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-Canada/ca-baseline/ and changes regularly. See the Directory of published versions

Resource Profile: ConditionProfile - Detailed Descriptions

Draft as of 2020-07-21

Definitions for the profile-condition resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Condition
Definition

The Condition Profile is based upon the core FHIR Condition Resource

ShortCondition Profile
2. Condition.clinicalStatus
Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
Must Supporttrue
4. Condition.verificationStatus
Comments

This profile is seeking community and implementer feedback on whether further constraints on use of verificationStatus are needed. Feedback on current utilization practices is encouraged to support this effort.

Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
6. Condition.code
Definition

Identification of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.

Comments

The larger SNOMED CT CA data exchange value set (ClinicalFinding) has been included as a preferred binding for this element. However, HealthConcernCode (which is a subset of SCTCA) has been maintained as a slice to recognize that the subset is is commonly used by Primary Health Care EMRs and was developed and reinforced through inclusion in CIHI Pan-Canadian Primary Health Care EMR Minimum Data Set

BindingThe codes SHOULD be taken from https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode
(preferred to https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode)

Codes for problems from the SNOMED CT Canadian edition value set

Must Supporttrue
8. Condition.code.coding
Definition

Identification of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.

Must Supporttrue
SlicingThis element introduces a set of slices on Condition.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ binding.valueSet
  • 10. Condition.code.coding:HealthConcernCode
    Slice NameHealthConcernCode
    Definition

    The code that represents relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider shall be taken from CHI Health Concern Code

    ShortCHI identification of the condition, problem or diagnosis
    Comments

    HealthConcernCode is a subset of the larger SNOMED CT CA data exchange value set (ClinicalFinding) that is preferred binding for the parent element. HealthConcernCode has been maintained as a slice to recognize that the subset is is commonly used by Primary Health Care EMRs and was developed and reinforced through inclusion in CIHI Pan-Canadian Primary Health Care EMR Minimum Data Set

    Control0..1
    BindingThe codes SHALL be taken from https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
    (required to https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode)

    Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.

    TypeCoding
    12. Condition.code.coding:@default
    Slice Name@default
    Definition

    Other identifications of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.

    ShortOther identifications of the condition, problem or diagnosis
    Control0..1
    BindingFor example codes, see Condition/Problem/DiagnosisCodes
    (example to http://hl7.org/fhir/ValueSet/condition-code)
    TypeCoding
    14. Condition.subject
    TypeReference(Patient Profile)
    Must Supporttrue
    16. Condition.encounter
    TypeReference(Encounter Profile)
    18. Condition.onset[x]
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    Must Supporttrue
    20. Condition.recorder
    TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Patient Profile, RelatedPerson)
    22. Condition.asserter
    TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Patient Profile, RelatedPerson)

    Guidance on how to interpret the contents of this table can be found here

    0. Condition
    Definition

    The Condition Profile is based upon the core FHIR Condition Resource


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

    ShortCondition ProfileDetailed information about conditions, problems or diagnoses
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
    con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
    con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
    con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
    con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
    2. Condition.implicitRules
    Definition

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

    ShortA set of rules under which this content was created
    Comments

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

    Control0..1
    Typeuri
    Is Modifiertrue because 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
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. Condition.modifierExtension
    Definition

    May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

    Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

    ShortExtensions that cannot be ignored
    Comments

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

    Control0..*
    TypeExtension
    Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
    Summaryfalse
    Requirements

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

    Alternate Namesextensions, user content
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    6. Condition.clinicalStatus
    Definition

    The clinical status of the condition.

    Shortactive | recurrence | relapse | inactive | remission | resolved
    Comments

    The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

    Control0..1
    This element is affected by the following invariants: con-3, con-4, con-5
    BindingThe codes SHALL be taken from ConditionClinicalStatusCodeshttp://hl7.org/fhir/ValueSet/condition-clinical|4.0.1
    (required to http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1)

    The clinical status of the condition or diagnosis.

    TypeCodeableConcept
    Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
    Must Supporttrue
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. Condition.verificationStatus
    Definition

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

    Shortunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
    Comments

    This profile is seeking community and implementer feedback on whether further constraints on use of verificationStatus are needed. Feedback on current utilization practices is encouraged to support this effort.


    verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

    Control0..1
    This element is affected by the following invariants: con-3, con-5
    BindingThe codes SHALL be taken from ConditionVerificationStatushttp://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1
    (required to http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1)

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

    TypeCodeableConcept
    Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. Condition.code
    Definition

    Identification of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.


    Identification of the condition, problem or diagnosis.

    ShortIdentification of the condition, problem or diagnosis
    Comments

    The larger SNOMED CT CA data exchange value set (ClinicalFinding) has been included as a preferred binding for this element. However, HealthConcernCode (which is a subset of SCTCA) has been maintained as a slice to recognize that the subset is is commonly used by Primary Health Care EMRs and was developed and reinforced through inclusion in CIHI Pan-Canadian Primary Health Care EMR Minimum Data Set

    Control0..1
    BindingThe codes SHOULD be taken from For example codes, see https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcodehttp://hl7.org/fhir/ValueSet/condition-code
    (preferred to https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode)

    Codes for problems from the SNOMED CT Canadian edition value set


    Identification of the condition or diagnosis.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

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

    Alternate Namestype
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. Condition.code.coding
    Definition

    Identification of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.


    A reference to a code defined by a terminology system.

    ShortCode defined by a terminology system
    Comments

    Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

    Control0..*
    TypeCoding
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

    Allows for alternative encodings within a code system, and translations to other code systems.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Condition.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ binding.valueSet
    • 14. Condition.code.coding:HealthConcernCode
      Slice NameHealthConcernCode
      Definition

      The code that represents relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider shall be taken from CHI Health Concern Code


      A reference to a code defined by a terminology system.

      ShortCHI identification of the condition, problem or diagnosisCode defined by a terminology system
      Comments

      HealthConcernCode is a subset of the larger SNOMED CT CA data exchange value set (ClinicalFinding) that is preferred binding for the parent element. HealthConcernCode has been maintained as a slice to recognize that the subset is is commonly used by Primary Health Care EMRs and was developed and reinforced through inclusion in CIHI Pan-Canadian Primary Health Care EMR Minimum Data Set


      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

      Control0..1*
      BindingThe codes SHALL be taken from For codes, see https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
      (required to https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode)

      Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.

      TypeCoding
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows for alternative encodings within a code system, and translations to other code systems.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. Condition.code.coding:@default
      Slice Name@default
      Definition

      Other identifications of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.


      A reference to a code defined by a terminology system.

      ShortOther identifications of the condition, problem or diagnosisCode defined by a terminology system
      Comments

      Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

      Control0..1*
      BindingFor example codes, see For codes, see Condition/Problem/DiagnosisCodes
      (example to http://hl7.org/fhir/ValueSet/condition-code)
      TypeCoding
      Is Modifierfalse
      Summarytrue
      Requirements

      Allows for alternative encodings within a code system, and translations to other code systems.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. Condition.subject
      Definition

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

      ShortWho has the condition?
      Control1..1
      TypeReference(Patient Profile, Patient, Group)
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

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

      Alternate Namespatient
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Condition.encounter
      Definition

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

      ShortEncounter created as part of
      Comments

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

      Control0..1
      TypeReference(Encounter Profile, Encounter)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Condition.onset[x]
      Definition

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

      ShortEstimated or actual date, date-time, or age
      Comments

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

      Control0..1
      TypeChoice of: dateTime, Age, Period, Range, string
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Condition.recorder
      Definition

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

      ShortWho recorded the condition
      Control0..1
      TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Patient Profile, RelatedPerson, Practitioner, PractitionerRole, Patient)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Condition.asserter
      Definition

      Individual who is making the condition statement.

      ShortPerson who asserts this condition
      Control0..1
      TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Patient Profile, RelatedPerson, Practitioner, PractitionerRole, Patient)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. Condition
      Definition

      The Condition Profile is based upon the core FHIR Condition Resource

      ShortCondition Profile
      Control0..*
      Is Modifierfalse
      Summaryfalse
      Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
      con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
      con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
      dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      2. Condition.id
      Definition

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

      ShortLogical id of this artifact
      Comments

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

      Control0..1
      Typeid
      Is Modifierfalse
      Summarytrue
      4. Condition.meta
      Definition

      The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

      ShortMetadata about the resource
      Control0..1
      TypeMeta
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. Condition.implicitRules
      Definition

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

      ShortA set of rules under which this content was created
      Comments

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

      Control0..1
      Typeuri
      Is Modifiertrue because 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
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. Condition.language
      Definition

      The base language in which the resource is written.

      ShortLanguage of the resource content
      Comments

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

      Control0..1
      BindingThe codes SHOULD be taken from CommonLanguages
      (preferred to http://hl7.org/fhir/ValueSet/languages)

      A human language.

      Additional BindingsPurpose
      AllLanguagesMax Binding
      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. Condition.text
      Definition

      A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

      ShortText summary of the resource, for human interpretation
      Comments

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

      Control0..1
      TypeNarrative
      Is Modifierfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. Condition.contained
      Definition

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

      ShortContained, inline Resources
      Comments

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

      Control0..*
      TypeResource
      Is Modifierfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. Condition.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      Comments

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

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      16. Condition.modifierExtension
      Definition

      May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

      Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

      ShortExtensions that cannot be ignored
      Comments

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

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Summaryfalse
      Requirements

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

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      18. Condition.identifier
      Definition

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

      ShortExternal Ids for this condition
      Comments

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

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Condition.clinicalStatus
      Definition

      The clinical status of the condition.

      Shortactive | recurrence | relapse | inactive | remission | resolved
      Comments

      The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

      Control0..1
      This element is affected by the following invariants: con-3, con-4, con-5
      BindingThe codes SHALL be taken from ConditionClinicalStatusCodes
      (required to http://hl7.org/fhir/ValueSet/condition-clinical|4.0.1)

      The clinical status of the condition or diagnosis.

      TypeCodeableConcept
      Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Condition.verificationStatus
      Definition

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

      Shortunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
      Comments

      This profile is seeking community and implementer feedback on whether further constraints on use of verificationStatus are needed. Feedback on current utilization practices is encouraged to support this effort.

      Control0..1
      This element is affected by the following invariants: con-3, con-5
      BindingThe codes SHALL be taken from ConditionVerificationStatus
      (required to http://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1)

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

      TypeCodeableConcept
      Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Condition.category
      Definition

      A category assigned to the condition.

      Shortproblem-list-item | encounter-diagnosis
      Comments

      The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

      Control0..*
      BindingUnless not suitable, these codes SHALL be taken from ConditionCategoryCodes
      (extensible to http://hl7.org/fhir/ValueSet/condition-category)

      A category assigned to the condition.

      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Condition.severity
      Definition

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

      ShortSubjective severity of condition
      Comments

      Coding of the severity with a terminology is preferred, where possible.

      Control0..1
      BindingThe codes SHOULD be taken from Condition/DiagnosisSeverity
      (preferred to http://hl7.org/fhir/ValueSet/condition-severity)

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

      TypeCodeableConcept
      Is Modifierfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Condition.code
      Definition

      Identification of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.

      ShortIdentification of the condition, problem or diagnosis
      Comments

      The larger SNOMED CT CA data exchange value set (ClinicalFinding) has been included as a preferred binding for this element. However, HealthConcernCode (which is a subset of SCTCA) has been maintained as a slice to recognize that the subset is is commonly used by Primary Health Care EMRs and was developed and reinforced through inclusion in CIHI Pan-Canadian Primary Health Care EMR Minimum Data Set

      Control0..1
      BindingThe codes SHOULD be taken from https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode
      (preferred to https://fhir.infoway-inforoute.ca/ValueSet/clinicalfindingcode)

      Codes for problems from the SNOMED CT Canadian edition value set

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

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

      Alternate Namestype
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Condition.code.id
      Definition

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

      ShortUnique id for inter-element referencing
      Control0..1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      32. Condition.code.extension
      Definition

      May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

      ShortAdditional content defined by implementations
      Comments

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

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      SlicingThis element introduces a set of slices on Condition.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 34. Condition.code.coding
        Definition

        Identification of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.

        ShortCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control0..*
        TypeCoding
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Condition.code.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ binding.valueSet
        • 36. Condition.code.coding:HealthConcernCode
          Slice NameHealthConcernCode
          Definition

          The code that represents relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider shall be taken from CHI Health Concern Code

          ShortCHI identification of the condition, problem or diagnosis
          Comments

          HealthConcernCode is a subset of the larger SNOMED CT CA data exchange value set (ClinicalFinding) that is preferred binding for the parent element. HealthConcernCode has been maintained as a slice to recognize that the subset is is commonly used by Primary Health Care EMRs and was developed and reinforced through inclusion in CIHI Pan-Canadian Primary Health Care EMR Minimum Data Set

          Control0..1
          BindingThe codes SHALL be taken from https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode
          (required to https://fhir.infoway-inforoute.ca/ValueSet/healthconcerncode)

          Represents the patient's relevant clinical problems, conditions, diagnoses, symptoms, findings and complaints, as interpreted by the provider.

          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          38. Condition.code.coding:@default
          Slice Name@default
          Definition

          Other identifications of the patient's relevant condition, problem or diagnosis or recording of 'problem absent' or of 'problems unknown', as interpreted by the provider.

          ShortOther identifications of the condition, problem or diagnosis
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control0..1
          BindingFor example codes, see Condition/Problem/DiagnosisCodes
          (example to http://hl7.org/fhir/ValueSet/condition-code)
          TypeCoding
          Is Modifierfalse
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          40. Condition.code.text
          Definition

          A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

          ShortPlain text representation of the concept
          Comments

          Very often the text is the same as a displayName of one of the codings.

          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          42. Condition.bodySite
          Definition

          The anatomical location where this condition manifests itself.

          ShortAnatomical location, if relevant
          Comments

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

          Control0..*
          BindingFor example codes, see SNOMEDCTBodyStructures
          (example to http://hl7.org/fhir/ValueSet/body-site)

          Codes describing anatomical locations. May include laterality.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. Condition.subject
          Definition

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

          ShortWho has the condition?
          Control1..1
          TypeReference(Patient Profile)
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

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

          Alternate Namespatient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          46. Condition.encounter
          Definition

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

          ShortEncounter created as part of
          Comments

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

          Control0..1
          TypeReference(Encounter Profile)
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          48. Condition.onset[x]
          Definition

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

          ShortEstimated or actual date, date-time, or age
          Comments

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

          Control0..1
          TypeChoice of: dateTime, Age, Period, Range, string
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Must Support TypesNo must-support rules about the choice of types/profiles
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          50. Condition.abatement[x]
          Definition

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

          ShortWhen in resolution/remission
          Comments

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

          Control0..1
          This element is affected by the following invariants: con-4
          TypeChoice of: dateTime, Age, Period, Range, string
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          52. Condition.recordedDate
          Definition

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

          ShortDate record was first recorded
          Control0..1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          54. Condition.recorder
          Definition

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

          ShortWho recorded the condition
          Control0..1
          TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Patient Profile, RelatedPerson)
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          56. Condition.asserter
          Definition

          Individual who is making the condition statement.

          ShortPerson who asserts this condition
          Control0..1
          TypeReference(Practitioner Profile (General), PractitionerRole Profile (General), Patient Profile, RelatedPerson)
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          58. Condition.stage
          Definition

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

          ShortStage/grade, usually assessed formally
          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Summaryfalse
          Invariantscon-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
          ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          60. Condition.stage.id
          Definition

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

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          62. Condition.stage.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

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

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          64. Condition.stage.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

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

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

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

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          66. Condition.stage.summary
          Definition

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

          ShortSimple summary (disease specific)
          Control0..1
          This element is affected by the following invariants: con-1
          BindingFor example codes, see ConditionStage
          (example to http://hl7.org/fhir/ValueSet/condition-stage)

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

          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          68. Condition.stage.assessment
          Definition

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

          ShortFormal record of assessment
          Control0..*
          This element is affected by the following invariants: con-1
          TypeReference(ClinicalImpression, DiagnosticReport, Observation)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. Condition.stage.type
          Definition

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

          ShortKind of staging
          Control0..1
          BindingFor example codes, see ConditionStageType
          (example to http://hl7.org/fhir/ValueSet/condition-stage-type)

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

          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          72. Condition.evidence
          Definition

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

          ShortSupporting evidence
          Comments

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

          Control0..*
          TypeBackboneElement
          Is Modifierfalse
          Summaryfalse
          Invariantscon-2: evidence SHALL have code or details (code.exists() or detail.exists())
          ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          74. Condition.evidence.id
          Definition

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

          ShortUnique id for inter-element referencing
          Control0..1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          76. Condition.evidence.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

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

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          78. Condition.evidence.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

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

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
          Summarytrue
          Requirements

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

          Alternate Namesextensions, user content, modifiers
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          80. Condition.evidence.code
          Definition

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

          ShortManifestation/symptom
          Control0..*
          This element is affected by the following invariants: con-2
          BindingFor example codes, see ManifestationAndSymptomCodes
          (example to http://hl7.org/fhir/ValueSet/manifestation-or-symptom)

          Codes that describe the manifestation or symptoms of a condition.

          TypeCodeableConcept
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          82. Condition.evidence.detail
          Definition

          Links to other relevant information, including pathology reports.

          ShortSupporting information found elsewhere
          Control0..*
          This element is affected by the following invariants: con-2
          TypeReference(Resource)
          Is Modifierfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          84. Condition.note
          Definition

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

          ShortAdditional information about the Condition
          Control0..*
          TypeAnnotation
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))