Evidence Based Medicine on FHIR Implementation Guide
2.0.0-ballot - ballot International flag

Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions

Resource Profile: NetEffectContributions - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the net-effect-contributions resource profile.

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

0. Group
2. Group.code
4. Group.code.text
Pattern ValueNet Effect Contribution
6. Group.characteristic
Control1..1
8. Group.characteristic.code
10. Group.characteristic.code.text
Pattern ValueMember of
12. Group.characteristic.value[x]
[x] NoteSeeChoice of Data Typesfor further information about how to use [x]
SlicingThis element introduces a set of slices on Group.characteristic.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • type @ $this
  • 14. Group.characteristic.value[x]:valueReference
    Slice NamevalueReference
    Control0..1
    TypeReference(NetEffectContributionList)
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]

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

    0. Group
    Definition

    Represents a defined collection of entities that may be discussed or acted upon collectively but which are not expected to act collectively, and are not formally or legally recognized; i.e. a collection of entities that isn't an Organization.

    ShortGroup of multiple entities
    Comments

    If both Group.characteristic and Group.member are present, then the members are the individuals who were found who met the characteristic. It's possible that there might be other candidate members who meet the characteristic and aren't (yet) in the list. All members SHALL have the listed characteristics.

    Control0..*
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantscnl-2: Group.type SHALL be defined if Group.membership is either 'definitional' or 'enumerated' (Group.type.exists() or (Group.membership = 'conceptual'))
    2. Group.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 its 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 its meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    4. Group.contained
    Definition

    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

    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..*
    This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
    TypeResource
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesinline resources, anonymous resources, contained resources
    6. Group.extension:author
    Slice Nameauthor
    Definition

    An individual or organization primarily involved in the creation and maintenance of the artifact.

    ShortWho authored the artifact
    Control0..*
    TypeExtension(Artifact Author) (Extension Type: ContactDetail)
    Is Modifierfalse
    Must Supportfalse
    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())
    8. Group.extension:relatedArtifact
    Slice NamerelatedArtifact
    Definition

    Related artifacts such as additional documentation, justification, dependencies, bibliographic references, and predecessor and successor artifacts.

    ShortAdditional documentation, citations, etc.
    Comments

    Each related artifact is either an attachment, or a reference to another resource, but not both.

    Control0..*
    TypeExtension(Artifact related artifact) (Extension Type: RelatedArtifact)
    Is Modifierfalse
    Must Supportfalse
    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())
    10. Group.extension:characteristicExpression
    Slice NamecharacteristicExpression
    Definition

    An expression that defines the criteria for group membership. This extension can only be used on a Group resource with a membership of definitional. When this expression is used, the Group resource cannot have any characteristic elements; this mechanism is exclusive with characteristics. The result of the expression SHALL be boolean-valued. The expression SHALL be parameterized with a %context variable that represents the subject being tested for membership. If evaluation of the expression results in true, the subject is considered a member of the group.

    ShortCriteria for group membership
    Control0..1
    TypeExtension(Characteristic Expression) (Extension Type: Expression)
    Is Modifierfalse
    Must Supportfalse
    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())
    12. Group.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

    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
    Must Supportfalse
    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
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. Group.status
    Definition

    The current state of this Group.

    Shortdraft | active | retired | unknown
    Comments

    A nominal state-transition diagram can be found in the Definition pattern documentation.

    Unknown does not represent 'other' - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

    See guidance around (not) making local changes to elements here.


    A nominal state-transition diagram can be found in the Definition pattern documentation.

    Unknown does not represent 'other' - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

    See guidance around (not) making local changes to elements here.

    Control0..1
    BindingThe codes SHALL be taken from PublicationStatushttp://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

    The lifecycle status of an artifact.

    Typecode
    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired Group without due consideration
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    Enables tracking the life-cycle of the content and filtering of Groups that are appropriate for use versus not.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. Group.membership
    Definition

    Basis for membership in the Group:

    • 'definitional': The Group.characteristics specified are both necessary and sufficient to determine membership. All entities that meet the criteria are considered to be members of the group, whether referenced by the group or not. If members are present, they are individuals that happen to be known as meeting the Group.characteristics. The list cannot be presumed to be complete.
    • 'conceptual': The Group.characteristics specified are both necessary and sufficient to determine membership. The 'conceptual' Group is a 'definitional' Group in which the Group.type is not bound to FHIR types.
    • 'enumerated': The Group.characteristics are necessary but not sufficient to determine membership. Membership is determined by being listed as one of the Group.member.
    Shortdefinitional | conceptual | enumerated
    Control1..1
    BindingThe codes SHALL be taken from GroupMembershipBasishttp://hl7.org/fhir/ValueSet/group-membership-basis|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/group-membership-basis|6.0.0-ballot2)

    The basis for membership in a group

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Requirements

    There are use-cases for groups that define specific collections of individuals, and other groups that define "types" of intended individuals. The requirements for both kinds of groups are similar, so we use a single resource, distinguished by this element.

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

    Used to specify how two or more characteristics are combined.

    Shortall-of | any-of | at-least | at-most | except-subset
    Control0..1
    BindingThe codes SHALL be taken from GroupCharacteristicCombinationhttp://hl7.org/fhir/ValueSet/group-characteristic-combination|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/group-characteristic-combination|6.0.0-ballot2)
    Typecode
    Is Modifiertrue because Changing the combinationMethod from all-of to any other value changes the interpretation of multiple characteristics.
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. Group.characteristic
    Definition

    Identifies traits whose presence r absence is shared by members of the group.

    ShortInclude / Exclude group members by Trait
    Comments

    All the identified characteristics must be true for an entity to a member of the group.

    Control10..1*
    TypeBackboneElement
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Needs to be a generic mechanism for identifying what individuals can be part of a group.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. Group.characteristic.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

    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()))
    24. Group.characteristic.code
    Definition

    A code that identifies the kind of trait being asserted.

    ShortKind of characteristic
    Control1..1
    Binding

    List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.

    TypeCodeableConcept
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    Need a formal way of identifying the characteristic being described.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    26. Group.characteristic.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
    Summaryfalse
    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.

    Pattern ValueMember of
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    28. Group.characteristic.value[x]
    Definition

    The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

    ShortValue held by characteristic
    Comments

    For Range, it means members of the group have a value that falls somewhere within the specified range.

    Control1..1
    Binding

    Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.

    TypeChoice of: CodeableConcept, boolean, Quantity, Range, Reference, uri, Expression
    [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 Supportfalse
    Summarytrue
    Requirements

    The value of the characteristic is what determines group membership.

    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 Group.characteristic.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ $this
    • 30. Group.characteristic.value[x]:valueReference
      Slice NamevalueReference
      Definition

      The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

      ShortValue held by characteristic
      Comments

      For Range, it means members of the group have a value that falls somewhere within the specified range.

      Control01..1
      TypeReference(NetEffectContributionList), boolean, Expression, Quantity, Range, uri, CodeableConcept
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      The value of the characteristic is what determines group membership.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      32. Group.characteristic.exclude
      Definition

      If true, indicates the characteristic is one that is NOT held by members of the group.

      ShortGroup includes or excludes
      Comments

      This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa.

      Control1..1
      Typeboolean
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      Sometimes group membership is determined by characteristics not possessed.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      34. Group.characteristic.offset
      Definition

      Defines the reference point for comparison when other than 0.

      ShortReference point for comparison
      Control0..1
      BindingFor example codes, see CharacteristicOffsethttp://hl7.org/fhir/ValueSet/characteristic-offset
      (example to http://hl7.org/fhir/ValueSet/characteristic-offset)
      TypeCodeableConcept
      Is Modifiertrue because If offset is present it must be included to interpret the characteristic value.
      Must Supportfalse
      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. Group
      Definition

      Represents a defined collection of entities that may be discussed or acted upon collectively but which are not expected to act collectively, and are not formally or legally recognized; i.e. a collection of entities that isn't an Organization.

      ShortGroup of multiple entities
      Comments

      If both Group.characteristic and Group.member are present, then the members are the individuals who were found who met the characteristic. It's possible that there might be other candidate members who meet the characteristic and aren't (yet) in the list. All members SHALL have the listed characteristics.

      Control0..*
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantscnl-2: Group.type SHALL be defined if Group.membership is either 'definitional' or 'enumerated' (Group.type.exists() or (Group.membership = 'conceptual'))
      2. Group.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

      Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

      Control0..1
      Typeid
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      4. Group.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
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      6. Group.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 its 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 its meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      8. Group.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 SHALL be taken from AllLanguages
      (required to http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot2)

      IETF language tag for a human language

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      10. Group.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 a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

      Control0..1
      This element is affected by the following invariants: dom-6
      TypeNarrative
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesnarrative, html, xhtml, display
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. Group.contained
      Definition

      These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

      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..*
      This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
      TypeResource
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Alternate Namesinline resources, anonymous resources, contained resources
      14. Group.extension
      Definition

      An Extension

      ShortExtension
      Control0..*
      TypeExtension
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      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 Group.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Group.extension:author
        Slice Nameauthor
        Definition

        An individual or organization primarily involved in the creation and maintenance of the artifact.

        ShortWho authored the artifact
        Control0..*
        TypeExtension(Artifact Author) (Extension Type: ContactDetail)
        Is Modifierfalse
        Must Supportfalse
        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. Group.extension:relatedArtifact
        Slice NamerelatedArtifact
        Definition

        Related artifacts such as additional documentation, justification, dependencies, bibliographic references, and predecessor and successor artifacts.

        ShortAdditional documentation, citations, etc.
        Comments

        Each related artifact is either an attachment, or a reference to another resource, but not both.

        Control0..*
        TypeExtension(Artifact related artifact) (Extension Type: RelatedArtifact)
        Is Modifierfalse
        Must Supportfalse
        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())
        20. Group.extension:characteristicExpression
        Slice NamecharacteristicExpression
        Definition

        An expression that defines the criteria for group membership. This extension can only be used on a Group resource with a membership of definitional. When this expression is used, the Group resource cannot have any characteristic elements; this mechanism is exclusive with characteristics. The result of the expression SHALL be boolean-valued. The expression SHALL be parameterized with a %context variable that represents the subject being tested for membership. If evaluation of the expression results in true, the subject is considered a member of the group.

        ShortCriteria for group membership
        Control0..1
        TypeExtension(Characteristic Expression) (Extension Type: Expression)
        Is Modifierfalse
        Must Supportfalse
        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())
        22. Group.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

        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
        Must Supportfalse
        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
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        24. Group.url
        Definition

        An absolute URI that is used to identify this Group when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which an authoritative instance of this Group is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the Group is stored on different servers.

        ShortCanonical identifier for this Group, represented as an absolute URI (globally unique)
        Comments

        Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple instances may share the same URL if they have a distinct version.

        The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

        In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

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

        Allows the Group to be referenced by a single globally unique identifier.

        Invariantscnl-1: URL should not contain | or # - these characters make processing canonical references problematic (exists() implies matches('^[^|# ]+$'))
        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. Group.identifier
        Definition

        Business identifiers assigned to this participant by one of the applications involved. These identifiers remain constant as the resource is updated and propagates from server to server.

        ShortBusiness Identifier for this Group
        Comments

        Note: 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.

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

        Allows identification of the group 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()))
        28. Group.version
        Definition

        The identifier that is used to identify this version of the Group when it is referenced in a specification, model, design or instance. This is an arbitrary value managed by the Group author and is not expected to be globally unique. For example, it might be a timestamp (e.g. yyyymmdd) if a managed version is not available. There is also no expectation that versions can be placed in a lexicographical sequence without additional knowledge.

        ShortBusiness version of the Group
        Comments

        There may be different Groups that have the same url but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the Group with the format [url]|[version]. The version SHOULD NOT contain a '#' - see Business Version.

        NoteThis is a business version Id, not a resource version Id (see discussion)
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Group.versionAlgorithm[x]
        Definition

        Indicates the mechanism used to compare versions to determine which is more current.

        ShortHow to compare versions
        Comments

        If set as a string, this is a FHIRPath expression that has two additional context variables passed in - %version1 and %version2 and will return a negative number if version1 is newer, a positive number if version2 and a 0 if the version ordering can't be successfully be determined.

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from VersionAlgorithm
        (extensible to http://hl7.org/fhir/ValueSet/version-algorithm)
        TypeChoice of: string, Coding
        [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 Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Group.name
        Definition

        A label assigned to the group for human identification and communication.

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

        Used to identify the group in human communication.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Group.title
        Definition

        A short, descriptive, user-friendly title for the Group.

        ShortName for this Group (human friendly)
        Comments

        This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Group.status
        Definition

        The current state of this Group.

        Shortdraft | active | retired | unknown
        Comments

        A nominal state-transition diagram can be found in the Definition pattern documentation.

        Unknown does not represent 'other' - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

        See guidance around (not) making local changes to elements here.

        Control0..1
        BindingThe codes SHALL be taken from PublicationStatus
        (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

        The lifecycle status of an artifact.

        Typecode
        Is Modifiertrue because This is labeled as "Is Modifier" because applications should not use a retired Group without due consideration
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Enables tracking the life-cycle of the content and filtering of Groups that are appropriate for use versus not.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Group.experimental
        Definition

        A Boolean value to indicate that this Group is authored for testing purposes (or education/evaluation/marketing) and is not intended for genuine usage.

        ShortFor testing purposes, not real usage
        Comments

        Allows filtering of Groups that are appropriate for use versus not.

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

        Enables experimental content to be developed following the same lifecycle that would be used for a production-level Group.

        Meaning if MissingIf absent, this resource is treated as though it is not experimental.
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Group.date
        Definition

        The date (and optionally time) when the Group was last significantly changed. The date must change when the business version changes and it must change if the status code changes. In addition, it should change when the substantive content of the Group changes.

        ShortDate last changed
        Comments

        The date is often not tracked until the resource is published, but may be present on draft content. Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the Group. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

        See guidance around (not) making local changes to elements here.

        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Alternate NamesRevision Date
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        42. Group.publisher
        Definition

        The name of the organization or individual responsible for the release and ongoing maintenance of the Group.

        ShortName of the publisher/steward (organization or individual)
        Comments

        Usually an organization but may be an individual. The publisher (or steward) of the Group is the organization or individual primarily responsible for the maintenance and upkeep of the Group. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the Group. This item SHOULD be populated unless the information is available from context.

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

        Helps establish the "authority/credibility" of the Group. May also allow for contact.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        44. Group.contact
        Definition

        Contact details to assist a user in finding and communicating with the publisher.

        ShortContact details for the publisher
        Comments

        May be a web site, an email address, a telephone number, etc.

        See guidance around (not) making local changes to elements here.

        Control0..*
        TypeContactDetail
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. Group.description
        Definition

        Explanation of what the group represents and how it is intended to be used.

        ShortNatural language description of the group
        Control0..1
        Typemarkdown
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. Group.useContext
        Definition

        The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate Groups.

        ShortThe context that the content is intended to support
        Comments

        When multiple useContexts are specified, there is no expectation that all or even any of the contexts apply.

        Control0..*
        TypeUsageContext
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Requirements

        Assist in searching for appropriate content.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. Group.purpose
        Definition

        Explanation of why this Group is needed and why it has been designed as it has.

        ShortWhy this Group is defined
        Comments

        This element does not describe the usage of the Group. Instead, it provides traceability of "why" the resource is either needed or "why" it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this Group.

        Control0..1
        Typemarkdown
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        52. Group.copyright
        Definition

        A copyright statement relating to the Group and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the Group.

        ShortUse and/or publishing restrictions
        Comments

        The short copyright declaration (e.g. (c) '2015+ xyz organization' should be sent in the copyrightLabel element.

        Control0..1
        Typemarkdown
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summaryfalse
        Requirements

        Consumers must be able to determine any legal restrictions on the use of the Group and/or its content.

        Alternate NamesLicense, Restrictions
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        54. Group.copyrightLabel
        Definition

        A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are resctricted. (e.g. 'All rights reserved', 'Some rights reserved').

        ShortCopyright holder and year(s)
        Comments

        The (c) symbol should NOT be included in this string. It will be added by software when rendering the notation. Full details about licensing, restrictions, warrantees, etc. goes in the more general 'copyright' element.

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

        Defines the content expected to be rendered in all representations of the artifact.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        56. Group.type
        Definition

        Identifies the broad classification of the kind of resources the group includes.

        Shortperson | animal | practitioner | device | careteam | healthcareservice | location | organization | relatedperson | specimen
        Comments

        Group members SHALL be of the appropriate resource type (Patient for person or animal; or Practitioner, PractitionerRole, Device, CareTeam, HealthcareService, Location, Organization, RelatedPerson, or Specimen for the other types.), or a Group of the resources of the appropriate type.

        Control0..1
        BindingThe codes SHALL be taken from GroupType
        (required to http://hl7.org/fhir/ValueSet/group-type|6.0.0-ballot2)

        Types of resources that are part of group.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        Identifies what type of resources the group is made up of.

        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. Group.membership
        Definition

        Basis for membership in the Group:

        • 'definitional': The Group.characteristics specified are both necessary and sufficient to determine membership. All entities that meet the criteria are considered to be members of the group, whether referenced by the group or not. If members are present, they are individuals that happen to be known as meeting the Group.characteristics. The list cannot be presumed to be complete.
        • 'conceptual': The Group.characteristics specified are both necessary and sufficient to determine membership. The 'conceptual' Group is a 'definitional' Group in which the Group.type is not bound to FHIR types.
        • 'enumerated': The Group.characteristics are necessary but not sufficient to determine membership. Membership is determined by being listed as one of the Group.member.
        Shortdefinitional | conceptual | enumerated
        Control1..1
        BindingThe codes SHALL be taken from GroupMembershipBasis
        (required to http://hl7.org/fhir/ValueSet/group-membership-basis|6.0.0-ballot2)

        The basis for membership in a group

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supportfalse
        Summarytrue
        Requirements

        There are use-cases for groups that define specific collections of individuals, and other groups that define "types" of intended individuals. The requirements for both kinds of groups are similar, so we use a single resource, distinguished by this element.

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

        A code that describes the use of the group. The use of the group usually dictates what kind of entities can be members of the group.

        ShortUse of the Group (and by implication, kind of members)
        Comments

        The types of entities that can be members needs to align with Group.type

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from GroupCode
        (extensible to http://hl7.org/fhir/ValueSet/group-code)

        A code that describes the kind of group, which usually dictates what kind if entities can be in the group.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supportfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. Group.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
        This element is affected by the following invariants: ele-1
        Typeid
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        64. Group.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

        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()))
        SlicingThis element introduces a set of slices on Group.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 66. Group.code.coding
          Definition

          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
          Summaryfalse
          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()))
          68. Group.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
          Summaryfalse
          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.

          Pattern ValueNet Effect Contribution
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          70. Group.quantity
          Definition

          A count of the number of resource instances that are part of the group.

          ShortNumber of members
          Comments

          Note that the quantity may be less than the number of members if some of the members are not active.

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

          Group size is a common defining characteristic.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          72. Group.managingEntity
          Definition

          Entity responsible for defining and maintaining Group characteristics and/or registered members.

          ShortEntity that is the custodian of the Group's definition
          Comments

          This does not strictly align with ownership of a herd or flock, but may suffice to represent that relationship in simple cases. More complex cases will require an extension.

          Control0..1
          TypeReference(Organization, RelatedPerson, Practitioner, PractitionerRole)
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          74. Group.combinationMethod
          Definition

          Used to specify how two or more characteristics are combined.

          Shortall-of | any-of | at-least | at-most | except-subset
          Control0..1
          BindingThe codes SHALL be taken from GroupCharacteristicCombination
          (required to http://hl7.org/fhir/ValueSet/group-characteristic-combination|6.0.0-ballot2)
          Typecode
          Is Modifiertrue because Changing the combinationMethod from all-of to any other value changes the interpretation of multiple characteristics.
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          76. Group.combinationThreshold
          Definition

          Provides the value of "n" when "at-least" or "at-most" codes are used for combinationMethod.

          ShortProvides the value of "n" when "at-least" or "at-most" codes are used
          Control0..1
          TypepositiveInt
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          78. Group.characteristic
          Definition

          Identifies traits whose presence r absence is shared by members of the group.

          ShortInclude / Exclude group members by Trait
          Comments

          All the identified characteristics must be true for an entity to a member of the group.

          Control1..1
          TypeBackboneElement
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Needs to be a generic mechanism for identifying what individuals can be part of a group.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          80. Group.characteristic.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
          This element is affected by the following invariants: ele-1
          Typestring
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          82. Group.characteristic.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          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()))
          84. Group.characteristic.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

          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()))
          86. Group.characteristic.code
          Definition

          A code that identifies the kind of trait being asserted.

          ShortKind of characteristic
          Control1..1
          Binding

          List of characteristics used to describe group members; e.g. gender, age, owner, location, etc.

          TypeCodeableConcept
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          Need a formal way of identifying the characteristic being described.

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          88. Group.characteristic.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
          This element is affected by the following invariants: ele-1
          Typeid
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          90. Group.characteristic.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          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()))
          SlicingThis element introduces a set of slices on Group.characteristic.code.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 92. Group.characteristic.code.coding
            Definition

            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
            Summaryfalse
            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()))
            94. Group.characteristic.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
            Summaryfalse
            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.

            Pattern ValueMember of
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            96. Group.characteristic.value[x]
            Definition

            The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

            ShortValue held by characteristic
            Comments

            For Range, it means members of the group have a value that falls somewhere within the specified range.

            Control1..1
            Binding

            Value of descriptive member characteristic; e.g. red, male, pneumonia, Caucasian, etc.

            TypeChoice of: CodeableConcept, boolean, Quantity, Range, Reference, uri, Expression
            [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 Supportfalse
            Summarytrue
            Requirements

            The value of the characteristic is what determines group membership.

            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 Group.characteristic.value[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • 98. Group.characteristic.value[x]:valueReference
              Slice NamevalueReference
              Definition

              The value of the trait that holds (or does not hold - see 'exclude') for members of the group.

              ShortValue held by characteristic
              Comments

              For Range, it means members of the group have a value that falls somewhere within the specified range.

              Control0..1
              TypeReference(NetEffectContributionList)
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Requirements

              The value of the characteristic is what determines group membership.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              100. Group.characteristic.exclude
              Definition

              If true, indicates the characteristic is one that is NOT held by members of the group.

              ShortGroup includes or excludes
              Comments

              This is labeled as "Is Modifier" because applications cannot wrongly include excluded members as included or vice versa.

              Control1..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              Requirements

              Sometimes group membership is determined by characteristics not possessed.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              102. Group.characteristic.description
              Definition

              A short, natural language description of the characteristic that could be used to communicate the criteria to an end-user.

              ShortNatural language description of the characteristic
              Control0..1
              Typemarkdown
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Requirements

              Need to be able to describe characteristics in natural language so that end users can understand the criteria.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              104. Group.characteristic.method
              Definition

              Method for how the characteristic value was determined.

              ShortMethod for how the characteristic value was determined
              Control0..*
              BindingFor example codes, see DefinitionMethod
              (example to http://hl7.org/fhir/ValueSet/definition-method)
              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              106. Group.characteristic.determinedBy[x]
              Definition

              Defines the characteristic (without using type and value) by either a Reference or an Expression.

              ShortDefines the characteristic
              Control0..1
              TypeChoice of: Reference(Device, DeviceDefinition, DeviceMetric), Expression
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              The value of the characteristic is what determines group membership.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              108. Group.characteristic.offset
              Definition

              Defines the reference point for comparison when other than 0.

              ShortReference point for comparison
              Control0..1
              BindingFor example codes, see CharacteristicOffset
              (example to http://hl7.org/fhir/ValueSet/characteristic-offset)
              TypeCodeableConcept
              Is Modifiertrue because If offset is present it must be included to interpret the characteristic value.
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              110. Group.characteristic.instances[x]
              Definition

              Number of occurrences meeting the characteristic.

              ShortNumber of occurrences meeting the characteristic
              Control0..1
              TypeChoice of: Quantity, Range
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              112. Group.characteristic.duration[x]
              Definition

              Length of time in which the characteristic is met.

              ShortLength of time in which the characteristic is met
              Control0..1
              TypeChoice of: Duration, Range
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              114. Group.characteristic.period
              Definition

              The period over which the characteristic is tested; e.g. the patient had an operation during the month of June.

              ShortPeriod over which characteristic is tested
              Control0..1
              TypePeriod
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              116. Group.characteristic.timing
              Definition

              Timing in which the characteristic is determined.

              ShortTiming in which the characteristic is determined
              Control0..*
              TypeRelativeTime
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              118. Group.member
              Definition

              Identifies the resource instances that are members of the group.

              ShortWho or what is in group
              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Often the only thing of interest about a group is "who's in it".

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              120. Group.member.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
              This element is affected by the following invariants: ele-1
              Typestring
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              122. Group.member.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

              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()))
              124. Group.member.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 managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

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

              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()))
              126. Group.member.entity
              Definition

              A reference to the entity that is a member of the group. Must be consistent with Group.type. If the entity is another group, then the type must be the same.

              ShortReference to the group member
              Control1..1
              TypeReference(CareTeam, Device, Group, HealthcareService, Location, Organization, Patient, Practitioner, PractitionerRole, RelatedPerson, Specimen)
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              128. Group.member.involvement
              Definition

              A code that describes how a user is involved in the group. Some groups (e.g. exposure-group) typically don't have variance between members, or it is not tracked, while for other groups (e.g. family, household) this may be meaningful.

              ShortCode that describes how user is part of the group
              Control0..*
              BindingFor example codes, see GroupInvolvement
              (example to http://hl7.org/fhir/ValueSet/group-involvement-set)

              A code that describes how a user is involved in the group

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              130. Group.member.period
              Definition

              The period that the member was in the group, if known.

              ShortPeriod member belonged to the group
              Control0..1
              TypePeriod
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Requirements

              Need to track who was in a group at a particular time.

              Meaning if MissingThe member is in the group at this time
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              132. Group.member.inactive
              Definition

              A flag to indicate that the member is no longer in the group, but previously may have been a member.

              ShortIf member is no longer in group
              Control0..1
              Typeboolean
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summaryfalse
              Requirements

              Sometimes you don't know when someone stopped being in a group, but not when.

              Meaning if MissingMembers are considered active unless explicitly specified otherwise
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))