This profile, largely based on the CCDA on FHIR US Realm Header profile, defines requirements that address specific exchange requirements for a composition containing a person's advance care plan information.

Conformance:

In the cases where the patient is not able to "write" the PACP contents due to literacy constraints or physical disability, e.g. hemiplegia, the patient/subject is still considered author of the content, and a data enterer will fill the role of physically creating the document by entering the author’s requested information into the system used to create the document.

Advance Directive Information versionNumber represents a numeric value used to version successive replacement documents. Best practice for systems that support distributed document creation and updating is to populate the versionNumber with the timestamp created from the date/time when the version of the document is created in the system. Note: this may or may not be equivalent to the timestamp integer for Composition.date. the versionNumber timestamp always will be equivalent to the Bundle.timestamp for the document.

To better align with CDA, versionNumber should be a string label generated by converting the ClinicalDocument.effectiveTime (or Composition.date) to UTC time (-0000) and then using the YYYYMMDDhhmmss as the version.

For documents created within a system will follow the pattern that the timestamp-label versionNumber will be equivalent to the timestamp of the Composition.date and the Bundle.timestamp. However, for unstructured historical documents uploaded into a system, the timestamp-label versionNumber will be equivalent to the timestamp of the the Bundle.timestamp, but the Composition.date will reflect the creation date of the original document.

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

This structure is derived from Clinical Document

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Clinical Document	This is an abstractprofile. Childprofiles: ADIPACPComposition, ADIPMOComposition A set of resources composed into a single coherent clinical statement with clinical attestation
language	S	1..1	code	Language of the resource content
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:versionNumber	S	1..1	CDVersionNumber(5.2.0-ballot)	Version-specific identifier for composition
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
identifier	S	1..1	Identifier	Version-independent identifier for the Composition
status		1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	S	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	S	0..1	CodeableConcept	Categorization of Composition Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		1..1	string	Representation defined by the system Fixed Value: Advance directives
subject	S	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter		0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	S	1..1	dateTime	Composition editing time
author	S	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition
title	S	1..1	string	Human Readable name/title
confidentiality		0..0
custodian	S	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
event
code		0..*	CodeableConcept	Code(s) that apply to the event being documented Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: acp-services
display		1..1	string	Representation defined by the system Fixed Value: Advance care planning services
Slices for detail		0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator		0..1	Reference(ADI Facilitator)	ADI Facilitator
section
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Composition.status	required	ADICompositionStatusVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS from this IG
Composition.type	extensible	AdvanceDirectivesCategories http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4 from https://vsac.nlm.nih.gov

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Clinical Document	This is an abstractprofile. Childprofiles: ADIPACPComposition, ADIPMOComposition 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
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
versionNumber	S	1..1	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		1..1	string	Representation defined by the system Fixed Value: Advance directives
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Composition.status	required	ADICompositionStatusVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS from this IG
Composition.type	extensible	AdvanceDirectivesCategories http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4 from https://vsac.nlm.nih.gov
Composition.category	example	Pattern: LOINC Code 42348-3("Advance directives") http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Clinical Document	This is an abstractprofile. Childprofiles: ADIPACPComposition, ADIPMOComposition 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	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
versionNumber	S	1..1	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		1..1	string	Representation defined by the system Fixed Value: Advance directives
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
attester		0..*	BackboneElement	Attests to accuracy of composition
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	SΣ	1..1	Reference(US Core Organization Profile)	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: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: acp-services
display		1..1	string	Representation defined by the system Fixed Value: Advance care planning services
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
period	Σ	0..1	Period	The period covered by the documentation
Slices for detail	Σ	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator	Σ	0..1	Reference(ADI Facilitator)	ADI Facilitator
section	C	0..*	BackboneElement	Composition is broken into sections cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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
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	0..*	Reference(Resource)	A reference to data that supports this 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	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Composition.status	required	ADICompositionStatusVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS from this IG
Composition.type	extensible	AdvanceDirectivesCategories http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4 from https://vsac.nlm.nih.gov
Composition.category	example	Pattern: LOINC Code 42348-3("Advance directives") http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
Composition.event.code	example	Pattern: acp-services("Advance care planning services") http://terminology.hl7.org/ValueSet/v3-ActCode
Composition.section.code	example	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard

Differential View

This structure is derived from Clinical Document

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Clinical Document	This is an abstractprofile. Childprofiles: ADIPACPComposition, ADIPMOComposition A set of resources composed into a single coherent clinical statement with clinical attestation
language	S	1..1	code	Language of the resource content
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:versionNumber	S	1..1	CDVersionNumber(5.2.0-ballot)	Version-specific identifier for composition
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
identifier	S	1..1	Identifier	Version-independent identifier for the Composition
status		1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	S	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	S	0..1	CodeableConcept	Categorization of Composition Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		1..1	string	Representation defined by the system Fixed Value: Advance directives
subject	S	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter		0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	S	1..1	dateTime	Composition editing time
author	S	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition
title	S	1..1	string	Human Readable name/title
confidentiality		0..0
custodian	S	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
event
code		0..*	CodeableConcept	Code(s) that apply to the event being documented Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
code		1..1	code	Symbol in syntax defined by the system Fixed Value: acp-services
display		1..1	string	Representation defined by the system Fixed Value: Advance care planning services
Slices for detail		0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator		0..1	Reference(ADI Facilitator)	ADI Facilitator
section
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Composition.status	required	ADICompositionStatusVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS from this IG
Composition.type	extensible	AdvanceDirectivesCategories http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4 from https://vsac.nlm.nih.gov

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Clinical Document	This is an abstractprofile. Childprofiles: ADIPACPComposition, ADIPMOComposition 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
language	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
versionNumber	S	1..1	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		1..1	string	Representation defined by the system Fixed Value: Advance directives
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
custodian	SΣ	1..1	Reference(US Core Organization Profile)	Organization which maintains the composition
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Composition.status	required	ADICompositionStatusVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS from this IG
Composition.type	extensible	AdvanceDirectivesCategories http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4 from https://vsac.nlm.nih.gov
Composition.category	example	Pattern: LOINC Code 42348-3("Advance directives") http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	Clinical Document	This is an abstractprofile. Childprofiles: ADIPACPComposition, ADIPMOComposition 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	S	1..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
versionNumber	S	1..1	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
EffectiveDateExtension		0..1	Period	Effective Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
Jurisdiction		0..*	CodeableConcept	Jurisdiction URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension Binding: Jurisdiction ValueSet (extensible)
DataEntererExtension		0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
InformantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
ParticipantExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson)	Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
PerformerExtension		0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
DocumentRevokeStatus	S	0..1	code	Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	Version-independent identifier for the Composition
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type	SΣ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: Advance Directives Categories (extensible)
category	SΣ	0..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 42348-3
display		1..1	string	Representation defined by the system Fixed Value: Advance directives
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who and/or what the composition is about
encounter	Σ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	Composition editing time
author	SΣ	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition
title	SΣ	1..1	string	Human Readable name/title
attester		0..*	BackboneElement	Attests to accuracy of composition
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	SΣ	1..1	Reference(US Core Organization Profile)	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: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: acp-services
display		1..1	string	Representation defined by the system Fixed Value: Advance care planning services
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
period	Σ	0..1	Period	The period covered by the documentation
Slices for detail	Σ	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator	Σ	0..1	Reference(ADI Facilitator)	ADI Facilitator
section	C	0..*	BackboneElement	Composition is broken into sections cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
ClauseExtension		0..*	(Complex)	Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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
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	0..*	Reference(Resource)	A reference to data that supports this 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	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding http://hl7.org/fhir/ValueSet/languages from the FHIR Standard
Composition.status	required	ADICompositionStatusVS http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS from this IG
Composition.type	extensible	AdvanceDirectivesCategories http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4 from https://vsac.nlm.nih.gov
Composition.category	example	Pattern: LOINC Code 42348-3("Advance directives") http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
Composition.event.code	example	Pattern: acp-services("Advance care planning services") http://terminology.hl7.org/ValueSet/v3-ActCode
Composition.section.code	example	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard

This structure is derived from Clinical Document

Summary

Mandatory: 6 elements
Must-Support: 11 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• 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 Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
• US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• ADI Facilitator (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Facilitator)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-effective-date-extension
• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-jurisdiction-extension
• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-participant-extension
• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Composition.event.detail