Cancer Pathology Data Sharing
2.0.0 - STU 2

Cancer Pathology Data Sharing, published by HL7 International / Orders and Observations. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/cancer-reporting/ and changes regularly. See the Directory of published versions

## Resource Profile: US Pathology Composition Laboratory Report

Official URL: http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/us-pathology-composition | Version: 2.0.0
Standards status: Trial-use | Maturity Level: 2 | Computable Name: USPathologyComposition

This Composition profile represents a Laboratory Report for the Clinical Pathology Data Sharing Implementation Guide.

## Introduction

This US Pathology Composition profile defines how to structure pathology reports based on CAP electronic Cancer Protocols (eCPs) within FHIR.

## Key Elements and Binding Requirements

- extension:diagnosticReportReference:
  - DiagnosticReport is bound to both the Observations AND the Composition through this extension
- type:
  - Bound to the CAP eCP Form Codes ValueSet
  - Allows unique identification of the specific CAP Protocol
- section.code:

- Bound to the CAP eCP Section Codes ValueSet

- section.entry:
  - Each entry references a section in the report

Usages:

- Use this Profile: US Pathology Bundle
- Examples for this Profile: Composition/composition-invasive-carcinoma-of-the-breast

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

- Differential Table
- Key Elements Table
- Snapshot Table
- Statistics/References
- All

This structure is derived from Composition

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  |  | Composition |
text |  | 0..1 | Narrative | Narrative text
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:diagnosticReport-reference |  | 0..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference
value[x] |  | 1..1 | Reference(US Pathology Diagnostic Report) | Value of extension
reference |  | 1..1 | string | Literal reference, Relative, internal or absolute URL
identifier |  | 0..1 | Identifier | Report identifier
status |  | 1..1 | code | Status of the Report
type |  | 1..1 | CodeableConcept | CAP Form Identifier Binding: CAP eCP Form Codes (extensible)
subject |  | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter |  | 0..1 | Reference(US Core Encounter Profile) | The healthcare event which this Report is about (when test ordered).
author |  | 1..* | Reference(US Pathology Related Practitioner Role) | Who and/or what authored the Report
title |  | 1..1 | string | CAP Form Title
attester |  | 0..* | BackboneElement | Attests the report accuracy
event |  |  |  |
code |  | 0..* | CodeableConcept | Code(s) that apply to the event being documented Binding: ActCode (3.0.0) (required)
section | S | 1..* | BackboneElement | Composition is broken into sections
title |  | 0..1 | string | Title should be the display of the section code
code |  | 0..1 | CodeableConcept | CAP Form Section Identifier Binding: CAP eCP Section Codes (extensible)
entry |  | 1..* | Reference(US Pathology Observation) | An Observation representing this section in the report and containing (hasMember) Observations representing the question/answers in the section.
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Composition.type | Base | extensible | CAP eCP Form Codes | 📦2.0.0 | This IG
Composition.event.code | Base | required | v3 Code System ActCode | 📍3.0.0 | THO v6.5
Composition.section.​code | Base | extensible | CAP eCP Section Codes | 📦2.0.0 | This IG

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | Composition | A set of resources composed into a single coherent clinical statement with clinical attestation
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
text |  | 0..1 | Narrative | Narrative text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:diagnosticReport-reference |  | 0..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference
extension |  | 0..0 |  |
url |  | 1..1 | uri | "http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference"
value[x] |  | 1..1 | Reference(US Pathology Diagnostic Report) | Value of extension
reference | Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..1 | Identifier | Report identifier
status | ?!Σ | 1..1 | code | Status of the Report Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type | Σ | 1..1 | CodeableConcept | CAP Form Identifier Binding: CAP eCP Form Codes (extensible)
subject | Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter | Σ | 0..1 | Reference(US Core Encounter Profile) | The healthcare event which this Report is about (when test ordered).
date | Σ | 1..1 | dateTime | Composition editing time
author | Σ | 1..* | Reference(US Pathology Related Practitioner Role) | Who and/or what authored the Report
title | Σ | 1..1 | string | CAP Form Title
attester |  | 0..* | BackboneElement | Attests the report accuracy
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
mode |  | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
section | S C | 1..* | BackboneElement | Composition is broken into sections Constraints: cmp-1, cmp-2
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
title |  | 0..1 | string | Title should be the display of the section code
code |  | 0..1 | CodeableConcept | CAP Form Section Identifier Binding: CAP eCP Section Codes (extensible)
entry | C | 1..* | Reference(US Pathology Observation) | An Observation representing this section in the report and containing (hasMember) Observations representing the question/answers in the section.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Composition.status | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std.
Composition.type | Base | extensible | CAP eCP Form Codes | 📦2.0.0 | This IG
Composition.attester.​mode | Base | required | CompositionAttestationMode | 📍4.0.1 | FHIR Std.
Composition.section.​code | Base | extensible | CAP eCP Section Codes | 📦2.0.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
cmp-1 | error | Composition.section | A section must contain at least one of text, entries, or sub-sections | `text.exists() or entry.exists() or section.exists()`
cmp-2 | error | Composition.section | A section can only have an emptyReason if it is empty | `emptyReason.empty() or entry.empty()`
dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Composition | 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 | error | Composition | 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 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Composition | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | Composition | A set of resources composed into a single coherent clinical statement with clinical attestation
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Narrative text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:diagnosticReport-reference |  | 0..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference"
value[x] |  | 1..1 | Reference(US Pathology Diagnostic Report) | Value of extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..1 | Identifier | Report identifier
status | ?!Σ | 1..1 | code | Status of the Report Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type | Σ | 1..1 | CodeableConcept | CAP Form Identifier Binding: CAP eCP Form Codes (extensible)
category | Σ | 0..* | CodeableConcept | Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter | Σ | 0..1 | Reference(US Core Encounter Profile) | The healthcare event which this Report is about (when test ordered).
date | Σ | 1..1 | dateTime | Composition editing time
author | Σ | 1..* | Reference(US Pathology Related Practitioner Role) | Who and/or what authored the Report
title | Σ | 1..1 | string | CAP Form Title
confidentiality | Σ | 0..1 | code | As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.
attester |  | 0..* | BackboneElement | Attests the report accuracy
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
mode |  | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time |  | 0..1 | dateTime | When the composition was attested
party |  | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the composition
custodian | Σ | 0..1 | Reference(Organization) | Organization which maintains the composition
relatesTo |  | 0..* | BackboneElement | Relationships to other compositions/documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x] |  | 1..1 |  | Target of the relationship
targetIdentifier |  |  | Identifier |
targetReference |  |  | Reference(Composition) |
event | Σ | 0..* | BackboneElement | The clinical service(s) being documented
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 0..* | CodeableConcept | Code(s) that apply to the event being documented Binding: ActCode (3.0.0) (required)
period | Σ | 0..1 | Period | The period covered by the documentation
detail | Σ | 0..* | Reference(Resource) | The event(s) being documented
section | S C | 1..* | BackboneElement | Composition is broken into sections Constraints: cmp-1, cmp-2
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
title |  | 0..1 | string | Title should be the display of the section code
code |  | 0..1 | CodeableConcept | CAP Form Section Identifier Binding: CAP eCP Section Codes (extensible)
author |  | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the section
focus |  | 0..1 | Reference(Resource) | Who/what the section is about, when it is not about the subject of composition
text | C | 0..1 | Narrative | Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode |  | 0..1 | code | working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy |  | 0..1 | CodeableConcept | Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry | C | 1..* | Reference(US Pathology Observation) | An Observation representing this section in the report and containing (hasMember) Observations representing the question/answers in the section.
emptyReason | C | 0..1 | CodeableConcept | Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section | C | 0..* | See section (Composition) | Nested Section
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Composition.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Composition.extension:diagnosticReport-reference.​value[x].type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Composition.status | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std.
Composition.type | Base | extensible | CAP eCP Form Codes | 📦2.0.0 | This IG
Composition.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
Composition.confidentiality | Base | required | V3 Value SetConfidentialityClassification | 📍2014-03-26 | FHIR Std.
Composition.attester.​mode | Base | required | CompositionAttestationMode | 📍4.0.1 | FHIR Std.
Composition.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
Composition.event.code | Base | required | v3 Code System ActCode | 📍3.0.0 | THO v6.5
Composition.section.​code | Base | extensible | CAP eCP Section Codes | 📦2.0.0 | This IG
Composition.section.​mode | Base | required | ListMode | 📍4.0.1 | FHIR Std.
Composition.section.​orderedBy | Base | preferred | List Order Codes | 📍4.0.1 | FHIR Std.
Composition.section.​emptyReason | Base | preferred | List Empty Reasons | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cmp-1 | error | Composition.section | A section must contain at least one of text, entries, or sub-sections | `text.exists() or entry.exists() or section.exists()`
cmp-2 | error | Composition.section | A section can only have an emptyReason if it is empty | `emptyReason.empty() or entry.empty()`
dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Composition | 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 | error | Composition | 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 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Composition | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Composition

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 1 element

Structures

This structure refers to these other structures:

- US Pathology Diagnostic Report (http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/us-pathology-diagnostic-report)
- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)
- US Pathology Related Practitioner Role (http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/us-pathology-related-practitioner-role)
- US Pathology Observation (http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/us-pathology-observation)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference

Maturity: 2

Differential View

This structure is derived from Composition

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  |  | Composition |
text |  | 0..1 | Narrative | Narrative text
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:diagnosticReport-reference |  | 0..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference
value[x] |  | 1..1 | Reference(US Pathology Diagnostic Report) | Value of extension
reference |  | 1..1 | string | Literal reference, Relative, internal or absolute URL
identifier |  | 0..1 | Identifier | Report identifier
status |  | 1..1 | code | Status of the Report
type |  | 1..1 | CodeableConcept | CAP Form Identifier Binding: CAP eCP Form Codes (extensible)
subject |  | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter |  | 0..1 | Reference(US Core Encounter Profile) | The healthcare event which this Report is about (when test ordered).
author |  | 1..* | Reference(US Pathology Related Practitioner Role) | Who and/or what authored the Report
title |  | 1..1 | string | CAP Form Title
attester |  | 0..* | BackboneElement | Attests the report accuracy
event |  |  |  |
code |  | 0..* | CodeableConcept | Code(s) that apply to the event being documented Binding: ActCode (3.0.0) (required)
section | S | 1..* | BackboneElement | Composition is broken into sections
title |  | 0..1 | string | Title should be the display of the section code
code |  | 0..1 | CodeableConcept | CAP Form Section Identifier Binding: CAP eCP Section Codes (extensible)
entry |  | 1..* | Reference(US Pathology Observation) | An Observation representing this section in the report and containing (hasMember) Observations representing the question/answers in the section.
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
Composition.type | Base | extensible | CAP eCP Form Codes | 📦2.0.0 | This IG
Composition.event.code | Base | required | v3 Code System ActCode | 📍3.0.0 | THO v6.5
Composition.section.​code | Base | extensible | CAP eCP Section Codes | 📦2.0.0 | This IG

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | Composition | A set of resources composed into a single coherent clinical statement with clinical attestation
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
text |  | 0..1 | Narrative | Narrative text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:diagnosticReport-reference |  | 0..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference
extension |  | 0..0 |  |
url |  | 1..1 | uri | "http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference"
value[x] |  | 1..1 | Reference(US Pathology Diagnostic Report) | Value of extension
reference | Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..1 | Identifier | Report identifier
status | ?!Σ | 1..1 | code | Status of the Report Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type | Σ | 1..1 | CodeableConcept | CAP Form Identifier Binding: CAP eCP Form Codes (extensible)
subject | Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter | Σ | 0..1 | Reference(US Core Encounter Profile) | The healthcare event which this Report is about (when test ordered).
date | Σ | 1..1 | dateTime | Composition editing time
author | Σ | 1..* | Reference(US Pathology Related Practitioner Role) | Who and/or what authored the Report
title | Σ | 1..1 | string | CAP Form Title
attester |  | 0..* | BackboneElement | Attests the report accuracy
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
mode |  | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
section | S C | 1..* | BackboneElement | Composition is broken into sections Constraints: cmp-1, cmp-2
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
title |  | 0..1 | string | Title should be the display of the section code
code |  | 0..1 | CodeableConcept | CAP Form Section Identifier Binding: CAP eCP Section Codes (extensible)
entry | C | 1..* | Reference(US Pathology Observation) | An Observation representing this section in the report and containing (hasMember) Observations representing the question/answers in the section.
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Composition.status | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std.
Composition.type | Base | extensible | CAP eCP Form Codes | 📦2.0.0 | This IG
Composition.attester.​mode | Base | required | CompositionAttestationMode | 📍4.0.1 | FHIR Std.
Composition.section.​code | Base | extensible | CAP eCP Section Codes | 📦2.0.0 | This IG

#### Constraints

Id | Grade | Path(s) | Description | Expression
cmp-1 | error | Composition.section | A section must contain at least one of text, entries, or sub-sections | `text.exists() or entry.exists() or section.exists()`
cmp-2 | error | Composition.section | A section can only have an emptyReason if it is empty | `emptyReason.empty() or entry.empty()`
dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Composition | 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 | error | Composition | 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 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Composition | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | Composition | A set of resources composed into a single coherent clinical statement with clinical attestation
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language |  | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Narrative text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:diagnosticReport-reference |  | 0..1 | (Complex) | Extension URL: http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..0 |  |
url |  | 1..1 | uri | "http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference"
value[x] |  | 1..1 | Reference(US Pathology Diagnostic Report) | Value of extension
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations Slice: Unordered, Open by value:url
reference | Σ C | 1..1 | string | Literal reference, Relative, internal or absolute URL
type | Σ | 0..1 | uri | Type the reference refers to (e.g. "Patient") Binding: ResourceType (extensible): Aa resource (or, for logical models, the URI of the logical model).
identifier | Σ | 0..1 | Identifier | Logical reference, when literal reference is not known
display | Σ | 0..1 | string | Text alternative for the resource
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | Σ | 0..1 | Identifier | Report identifier
status | ?!Σ | 1..1 | code | Status of the Report Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type | Σ | 1..1 | CodeableConcept | CAP Form Identifier Binding: CAP eCP Form Codes (extensible)
category | Σ | 0..* | CodeableConcept | Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject | Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter | Σ | 0..1 | Reference(US Core Encounter Profile) | The healthcare event which this Report is about (when test ordered).
date | Σ | 1..1 | dateTime | Composition editing time
author | Σ | 1..* | Reference(US Pathology Related Practitioner Role) | Who and/or what authored the Report
title | Σ | 1..1 | string | CAP Form Title
confidentiality | Σ | 0..1 | code | As defined by affinity domain Binding: v3.ConfidentialityClassification (2014-03-26) (required): Codes specifying the level of confidentiality of the composition.
attester |  | 0..* | BackboneElement | Attests the report accuracy
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
mode |  | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time |  | 0..1 | dateTime | When the composition was attested
party |  | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the composition
custodian | Σ | 0..1 | Reference(Organization) | Organization which maintains the composition
relatesTo |  | 0..* | BackboneElement | Relationships to other compositions/documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x] |  | 1..1 |  | Target of the relationship
targetIdentifier |  |  | Identifier |
targetReference |  |  | Reference(Composition) |
event | Σ | 0..* | BackboneElement | The clinical service(s) being documented
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 0..* | CodeableConcept | Code(s) that apply to the event being documented Binding: ActCode (3.0.0) (required)
period | Σ | 0..1 | Period | The period covered by the documentation
detail | Σ | 0..* | Reference(Resource) | The event(s) being documented
section | S C | 1..* | BackboneElement | Composition is broken into sections Constraints: cmp-1, cmp-2
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
title |  | 0..1 | string | Title should be the display of the section code
code |  | 0..1 | CodeableConcept | CAP Form Section Identifier Binding: CAP eCP Section Codes (extensible)
author |  | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the section
focus |  | 0..1 | Reference(Resource) | Who/what the section is about, when it is not about the subject of composition
text | C | 0..1 | Narrative | Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode |  | 0..1 | code | working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy |  | 0..1 | CodeableConcept | Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry | C | 1..* | Reference(US Pathology Observation) | An Observation representing this section in the report and containing (hasMember) Observations representing the question/answers in the section.
emptyReason | C | 0..1 | CodeableConcept | Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section | C | 0..* | See section (Composition) | Nested Section
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
Composition.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
Composition.extension:diagnosticReport-reference.​value[x].type | Base | extensible | ResourceType | 📍4.0.1 | FHIR Std.
Composition.status | Base | required | CompositionStatus | 📍4.0.1 | FHIR Std.
Composition.type | Base | extensible | CAP eCP Form Codes | 📦2.0.0 | This IG
Composition.category | Base | example | Document Class Value Set | 📍4.0.1 | FHIR Std.
Composition.confidentiality | Base | required | V3 Value SetConfidentialityClassification | 📍2014-03-26 | FHIR Std.
Composition.attester.​mode | Base | required | CompositionAttestationMode | 📍4.0.1 | FHIR Std.
Composition.relatesTo.​code | Base | required | DocumentRelationshipType | 📍4.0.1 | FHIR Std.
Composition.event.code | Base | required | v3 Code System ActCode | 📍3.0.0 | THO v6.5
Composition.section.​code | Base | extensible | CAP eCP Section Codes | 📦2.0.0 | This IG
Composition.section.​mode | Base | required | ListMode | 📍4.0.1 | FHIR Std.
Composition.section.​orderedBy | Base | preferred | List Order Codes | 📍4.0.1 | FHIR Std.
Composition.section.​emptyReason | Base | preferred | List Empty Reasons | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cmp-1 | error | Composition.section | A section must contain at least one of text, entries, or sub-sections | `text.exists() or entry.exists() or section.exists()`
cmp-2 | error | Composition.section | A section can only have an emptyReason if it is empty | `emptyReason.empty() or entry.empty()`
dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | Composition | 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 | error | Composition | 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 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | Composition | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`

This structure is derived from Composition

Summary

Mandatory: 3 elements(2 nested mandatory elements)
Must-Support: 1 element

Structures

This structure refers to these other structures:

- US Pathology Diagnostic Report (http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/us-pathology-diagnostic-report)
- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)
- US Pathology Related Practitioner Role (http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/us-pathology-related-practitioner-role)
- US Pathology Observation (http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/us-pathology-observation)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/cancer-reporting/StructureDefinition/composition-diagnosticReportReference

Maturity: 2

Other representations of profile: CSV, Excel, Schematron