PACIO Advance Healthcare Directive Interoperability Implementation Guide
2.0.0-ballot - STU 2 – Ballot US

PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. 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/fhir-pacio-adi/ and changes regularly. See the Directory of published versions

Resource Profile: ADI Person-Authored Composition

Official URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-PACPComposition Version: 2.0.0-ballot
Standards status: Trial-use Maturity Level: 2 Computable Name: ADIPACPComposition

This Composition profile is used to represent a Person-Authored advance healthcare directive document. A Person-Authored advance healthcare directive document is categorized as a personal advance care plan (Personal ACP) document. This subset of advance healthcare directive documents expresses the person’s own preferences and consent to appoint a healthcare agent(s) and permit or deny the healthcare agent’s powers to make decisions when the person can’t communicate.

The Personal ACP subset of advance healthcare directive documents is always authored by the subject of the document (the person or patient). If care team members are involved in the creation of advance healthcare directive types of documents, they may be included as “facilitators” or contributors to the process, but they may or may not be signers of the resultant document. The person (or their representative) is required to sign the Personal ACP document and is represented as personal attester. Others who sign the document are represented as attesters, with their role of witness (official) or notary (professional). The Personal ACP Composition which is being exchanged or made accessible includes a representation of the completed source form. The Composition can also include information about:

  • The person’s appointed healthcare agent(s),
  • Treatment intervention and care experience preferences, with the ability to further specify those preferences under potential, future health scenarios
  • Administrative information; Completion information; Additional Documentation; and Upon death preferences; and
  • Witness and notary information (if that information is required for the specific form being represented to be considered valid.)

An advance healthcare directive document must always contain the source form representation in the Source Form section. It may include other textual information organized in standard structural sections, which may or may not include machine processable encoded entries.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Composition C 0..* ADICompositionHeader A set of resources composed into a single coherent clinical statement with clinical attestation
Constraints: clindoc-limit-participantType, HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
... 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 BindingsPurpose
AllLanguages Max Binding
... text S 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... extension:R5-Composition-version S 0..1 string Optional Extensions Element
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.version
.... extension:data-enterer S 0..1 (Complex) A Data Enterer represents the person who transferred the content, written or dictated, into the clinical document. To clarify, an author provides the content, subject to their own interpretation; a dataEnterer adds an author's information to the electronic system.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/data-enterer-extension
.... extension:informant S 0..* (Complex) An Informant is an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/informant-extension
.... extension:information-recipient S 0..* (Complex) An Information Recipient is the intended recipient of the information at the time the document was created.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/information-recipient-extension
.... extension:participant S 0..* (Complex) A Participant that is not a data-enter, information-recipient nor an informant
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension
.... extension:consent S 0..* Reference(Consent) consent
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/consent-extension
.... extension:basedOn S 0..* Reference(Resource) The clinical action, such as a plan, proposal or order that is fulfilled by or precipitated this FHIR Clinical Document, such as a radiologists report of an x-ray.
URL: http://hl7.org/fhir/StructureDefinition/event-basedOn
.... extension:change-made S 0..1 (Complex) Note of changes made, calculating changes maybe required for safety as this extension may not contain all changes. Experimental, may overlap with other elements such as FHIR R6 note.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
.... extension:ExpirationDateExtension 0..1 dateTime ADI Expiration Date
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
.... extension:Jurisdiction 0..* CodeableConcept US State or local jurisdiction
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction
Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
.... extension: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
.... 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
.... extension:ParticipantExtension 0..* Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) Participant
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
.... 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
.... extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
.... 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)
... Slices for modifierExtension ?! 0..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:R5-Composition-status ?!S 0..1 base64Binary, boolean, canonical(), code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference(), SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta This allows for additional status values found in R5. However, exercise caution as the R4 Composition.status is required.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.status
... 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 Directive Document Types . (extensible)
... Slices for category SΣ 2..* CodeableConcept Categorization of Composition
Slice: Unordered, Open by value:$this
Binding: Advance Healthcare Directive Categories LOINC . (extensible)
.... category:clinicalnotecategory SΣ 1..1 CodeableConcept Category for Clinical Note
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: 107903-7
...... display 1..1 string Representation defined by the system
Fixed Value: Clinical note
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... category:advanceDirectiveCategory SΣ 1..1 CodeableConcept Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC . (extensible)

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 healthcare 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
... date SΣ 1..1 dateTime Composition editing time
... author SΣ 1..* Reference(US Core Patient Profile) Who and/or what authored the composition
... title SΣ 1..1 string Human Readable name/title
... Slices for attester S 1..* BackboneElement Attests to accuracy of composition
Slice: Unordered, Open by value:mode
.... attester:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... mode S 1..1 code personal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
Required Pattern: personal
..... time S 0..1 dateTime When the composition was attested
..... party S 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:legal_attester S 0..1 BackboneElement aka legal authenticator
..... 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.
Required Pattern: legal
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:professional_attester S 0..* BackboneElement aka authenticator
..... 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.
Required Pattern: professional
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
... custodian SΣ 1..1 Reference(US Core Organization Profile) Organization which maintains the composition
... Slices for relatesTo S 0..* BackboneElement Relationships to other compositions/documents
Slice: Unordered, Open by value:code, type:target
.... relatesTo:All Slices Content/Rules for all slices
..... 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.
..... Slices for target[x] 1..1 Target of the relationship
Slice: Unordered, Open by type:$this
...... targetIdentifier Identifier
...... targetReference Reference(Composition)
...... target[x]:targetIdentifier 0..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being appended, or to some other identifier of a non FHIR document
.... relatesTo:replaced_document S 0..* BackboneElement The document(s) being superceded
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... code 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
Required Pattern: replaces
..... Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this
...... target[x]:targetIdentifier 1..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being replaced, or to some other identifier of a non FHIR document
....... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
....... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
....... value Σ 1..1 string The value that is unique
Example General: 123456
.... relatesTo:appended_document S 0..* BackboneElement The document(s) being appended too
..... 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.
Required Pattern: appends
..... Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this
...... target[x]:targetIdentifier 1..1 Identifier Target of the relationship
....... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
... Slices for section SC 2..* BackboneElement Composition is broken into sections
Slice: Unordered, Open by pattern:code
Constraints: cmp-1, cmp-2
.... section:All Slices Content/Rules for all slices
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 0..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... section:advance_directive_source_form SC 1..1 BackboneElement Advance directive source form
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: advance_directive_source_form
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... section:healthcare_agent SC 1..1 BackboneElement Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations
Constraints: cmp-1, cmp-2, HCA-section-entries
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81335-2
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant) A reference to data that supports this section
..... emptyReason C 0..1 CodeableConcept This is only MS (must support) if the document types are supported.
Binding: No Healthcare Agent Included Reason (required)
.... section:gpp_for_certain_health_condition SC 0..1 BackboneElement Preference care plans defined for specific situations and/or conditions
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 107905-2
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Preference Care Plan | ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Personal Goal) A reference to data that supports this section
.... section:gpp_personal_care_experience SC 0..1 BackboneElement Quality of Life related personal care experiences, personal goals, and priorities
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81338-6
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Person-Authored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal) A reference to data that supports this section
.... section:gpp_upon_death SC 0..1 BackboneElement Goals, preferences, and priorities upon death
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81337-8
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences) A reference to data that supports this section
.... section:additional_documentation SC 0..1 BackboneElement Observations regarding the existence of other advance directive related information
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 77599-9
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(US Core Observation ADI Documentation Profile) A reference to data that supports this section
.... section:witness_and_notary SC 0..1 BackboneElement Witness and notary information. The first witness should be the author of the document
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81339-4
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Witness | ADI Notary) A reference to data that supports this section
.... section:administrative_information SC 0..1 BackboneElement Administrative information associated with this personal advance care plan
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 107904-5
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Composition.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Composition.status Base required ADI Composition Status 📦2.0.0-ballot This IG
Composition.type Base extensible Advance Directive Document Types . 📦20240712 VSAC v0.24
Composition.category Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.category:clinicalnotecategory Base example Document Class Value Set 📍4.0.1 FHIR Std.
Composition.category:advanceDirectiveCategory Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.attester:legal_attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.attester:professional_attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.relatesTo.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​target[x]:targetIdentifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​target[x]:targetIdentifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Composition.section.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​emptyReason Base required No Healthcare Agent Included Reason 📦2.0.0-ballot This IG
Composition.section:gpp_for_certain_health_condition.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​code Base example Document Section Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
Composition-section-code-equals-type error Composition Composition section code must equal Composition type when section is portable_medical_orders section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type
HCA-section-cardinality error Composition If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required error Composition section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries error Composition.section:healthcare_agent If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())
clindoc-limit-participantType error Composition The R4 FHIR Clinical Document Composition Profile contains specific extensions for data entry person, informant, information recipient, primary information recipient and tracker. So, they are not allowed in the participant extension in the R4 profile. In R6, the intention is to have dedicated-named slices of a backbone element. extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='ENT').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='INF').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='IRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='PRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='TRC').not()
cmp-1 error Composition.section, Composition.section:advance_directive_source_form, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information A section must contain at least one of text, entries, or sub-sections text.exists() or entry.exists() or section.exists()
cmp-2 error Composition.section, Composition.section:advance_directive_source_form, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information A section can only have an emptyReason if it is empty emptyReason.empty() or entry.empty()
dom-2 error Composition If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Composition If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Composition If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Composition If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Composition A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ADICompositionHeader

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Composition C 0..* ADICompositionHeader A set of resources composed into a single coherent clinical statement with clinical attestation
Constraints: HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
... type 1..1 CodeableConcept Kind of composition (LOINC if possible)
Binding: Advance Directive Document Types . (extensible)
... category 2..* CodeableConcept Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC . (extensible)
... author 1..* Reference(US Core Patient Profile) Who and/or what authored the composition
.... mode 1..1 code personal | professional | legal | official
Required Pattern: personal
.... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
... Slices for attester Content/Rules for all slices
.... attester:legal_attester 0..1 BackboneElement aka legal authenticator
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:professional_attester 0..* BackboneElement aka authenticator
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
... Slices for section 2..* BackboneElement Composition is broken into sections
Slice: Unordered, Open by pattern:code
.... section:healthcare_agent SC 1..1 BackboneElement Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations
Constraints: HCA-section-entries
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 81335-2
..... entry 0..* Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant) A reference to data that supports this section
..... emptyReason 0..1 CodeableConcept This is only MS (must support) if the document types are supported.
Binding: No Healthcare Agent Included Reason (required)
.... section:gpp_for_certain_health_condition 0..1 BackboneElement Preference care plans defined for specific situations and/or conditions
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 107905-2
..... entry 0..* Reference(ADI Preference Care Plan | ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Personal Goal) A reference to data that supports this section
.... section:gpp_personal_care_experience 0..1 BackboneElement Quality of Life related personal care experiences, personal goals, and priorities
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 81338-6
..... entry 0..* Reference(ADI Person-Authored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal) A reference to data that supports this section
.... section:gpp_upon_death 0..1 BackboneElement Goals, preferences, and priorities upon death
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 81337-8
..... entry 0..* Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences) A reference to data that supports this section
.... section:additional_documentation 0..1 BackboneElement Observations regarding the existence of other advance directive related information
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 77599-9
..... entry 0..* Reference(US Core Observation ADI Documentation Profile) A reference to data that supports this section
.... section:witness_and_notary 0..1 BackboneElement Witness and notary information. The first witness should be the author of the document
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 81339-4
..... entry 0..* Reference(ADI Witness | ADI Notary) A reference to data that supports this section
.... section:administrative_information 0..1 BackboneElement Administrative information associated with this personal advance care plan
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 107904-5

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Composition.type Base extensible Advance Directive Document Types . 📦20240712 VSAC v0.24
Composition.category Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.section:healthcare_agent.​emptyReason Base required No Healthcare Agent Included Reason 📦2.0.0-ballot This IG

Constraints

Id Grade Path(s) Description Expression
Composition-section-code-equals-type error Composition Composition section code must equal Composition type when section is portable_medical_orders section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type
HCA-section-cardinality error Composition If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required error Composition section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries error Composition.section:healthcare_agent If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Composition C 0..* ADICompositionHeader A set of resources composed into a single coherent clinical statement with clinical attestation
Constraints: clindoc-limit-participantType, HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
... 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
... text S 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:R5-Composition-version S 0..1 string Optional Extensions Element
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.version
.... extension:data-enterer S 0..1 (Complex) A Data Enterer represents the person who transferred the content, written or dictated, into the clinical document. To clarify, an author provides the content, subject to their own interpretation; a dataEnterer adds an author's information to the electronic system.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/data-enterer-extension
.... extension:informant S 0..* (Complex) An Informant is an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/informant-extension
.... extension:information-recipient S 0..* (Complex) An Information Recipient is the intended recipient of the information at the time the document was created.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/information-recipient-extension
.... extension:participant S 0..* (Complex) A Participant that is not a data-enter, information-recipient nor an informant
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension
.... extension:consent S 0..* Reference(Consent) consent
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/consent-extension
.... extension:basedOn S 0..* Reference(Resource) The clinical action, such as a plan, proposal or order that is fulfilled by or precipitated this FHIR Clinical Document, such as a radiologists report of an x-ray.
URL: http://hl7.org/fhir/StructureDefinition/event-basedOn
.... extension:change-made S 0..1 (Complex) Note of changes made, calculating changes maybe required for safety as this extension may not contain all changes. Experimental, may overlap with other elements such as FHIR R6 note.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
.... extension:ExpirationDateExtension 0..1 dateTime ADI Expiration Date
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
.... extension:Jurisdiction 0..* CodeableConcept US State or local jurisdiction
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction
Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
.... extension: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
.... 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
.... extension:ParticipantExtension 0..* Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) Participant
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
.... 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
.... extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
.... 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)
... Slices for modifierExtension ?! 0..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:R5-Composition-status ?!S 0..1 base64Binary, boolean, canonical(), code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference(), SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta This allows for additional status values found in R5. However, exercise caution as the R4 Composition.status is required.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.status
... 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 Directive Document Types . (extensible)
... Slices for category SΣ 2..* CodeableConcept Categorization of Composition
Slice: Unordered, Open by value:$this
Binding: Advance Healthcare Directive Categories LOINC . (extensible)
.... category:clinicalnotecategory SΣ 1..1 CodeableConcept Category for Clinical Note
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: 107903-7
...... display 1..1 string Representation defined by the system
Fixed Value: Clinical note
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... category:advanceDirectiveCategory SΣ 1..1 CodeableConcept Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC . (extensible)

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 healthcare 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 Patient Profile) Who and/or what authored the composition
... title SΣ 1..1 string Human Readable name/title
... Slices for attester S 1..* BackboneElement Attests to accuracy of composition
Slice: Unordered, Open by value:mode
.... attester:All Slices Content/Rules for all slices
..... 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 S 1..1 code personal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
Required Pattern: personal
..... time S 0..1 dateTime When the composition was attested
..... party S 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:legal_attester S 0..1 BackboneElement aka legal authenticator
..... 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.
Required Pattern: legal
..... time 0..1 dateTime When the composition was attested
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:professional_attester S 0..* BackboneElement aka authenticator
..... 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.
Required Pattern: professional
..... time 0..1 dateTime When the composition was attested
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
... custodian SΣ 1..1 Reference(US Core Organization Profile) Organization which maintains the composition
... Slices for relatesTo S 0..* BackboneElement Relationships to other compositions/documents
Slice: Unordered, Open by value:code, type:target
.... relatesTo:All Slices Content/Rules for all slices
..... 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.
..... Slices for target[x] 1..1 Target of the relationship
Slice: Unordered, Open by type:$this
...... targetIdentifier Identifier
...... targetReference Reference(Composition)
...... target[x]:targetIdentifier 0..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being appended, or to some other identifier of a non FHIR document
.... relatesTo:replaced_document S 0..* BackboneElement The document(s) being superceded
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... code 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
Required Pattern: replaces
..... Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this
...... target[x]:targetIdentifier 1..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being replaced, or to some other identifier of a non FHIR document
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
....... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
....... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
....... value Σ 1..1 string The value that is unique
Example General: 123456
....... period Σ 0..1 Period Time period when id is/was valid for use
....... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... relatesTo:appended_document S 0..* BackboneElement The document(s) being appended too
..... 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.
Required Pattern: appends
..... Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this
...... target[x]:targetIdentifier 1..1 Identifier Target of the relationship
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
....... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
....... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
....... value Σ 0..1 string The value that is unique
Example General: 123456
....... period Σ 0..1 Period Time period when id is/was valid for use
....... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... 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
... Slices for section SC 2..* BackboneElement Composition is broken into sections
Slice: Unordered, Open by pattern:code
Constraints: cmp-1, cmp-2
.... section:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 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
.... section:advance_directive_source_form SC 1..1 BackboneElement Advance directive source form
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: advance_directive_source_form
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Source Form) 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
.... section:healthcare_agent SC 1..1 BackboneElement Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations
Constraints: cmp-1, cmp-2, HCA-section-entries
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81335-2
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant) A reference to data that supports this section
..... emptyReason C 0..1 CodeableConcept This is only MS (must support) if the document types are supported.
Binding: No Healthcare Agent Included Reason (required)
..... section C 0..* See section (Composition) Nested Section
.... section:gpp_for_certain_health_condition SC 0..1 BackboneElement Preference care plans defined for specific situations and/or conditions
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 107905-2
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Preference Care Plan | ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Personal Goal) 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
.... section:gpp_personal_care_experience SC 0..1 BackboneElement Quality of Life related personal care experiences, personal goals, and priorities
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81338-6
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Person-Authored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal) 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
.... section:gpp_upon_death SC 0..1 BackboneElement Goals, preferences, and priorities upon death
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81337-8
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences) 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
.... section:additional_documentation SC 0..1 BackboneElement Observations regarding the existence of other advance directive related information
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 77599-9
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(US Core Observation ADI Documentation Profile) 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
.... section:witness_and_notary SC 0..1 BackboneElement Witness and notary information. The first witness should be the author of the document
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81339-4
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Witness | ADI Notary) 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
.... section:administrative_information SC 0..1 BackboneElement Administrative information associated with this personal advance care plan
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 107904-5
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Composition.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Composition.status Base required ADI Composition Status 📦2.0.0-ballot This IG
Composition.type Base extensible Advance Directive Document Types . 📦20240712 VSAC v0.24
Composition.category Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.category:clinicalnotecategory Base example Document Class Value Set 📍4.0.1 FHIR Std.
Composition.category:advanceDirectiveCategory Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.attester:legal_attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.attester:professional_attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.relatesTo.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​target[x]:targetIdentifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​target[x]:targetIdentifier.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​target[x]:targetIdentifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​target[x]:targetIdentifier.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Composition.event.code Base example v3 Code System ActCode 📦3.0.0 THO v7.1
Composition.section.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​emptyReason Base required No Healthcare Agent Included Reason 📦2.0.0-ballot This IG
Composition.section:gpp_for_certain_health_condition.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_for_certain_health_condition.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:gpp_for_certain_health_condition.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_for_certain_health_condition.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
Composition-section-code-equals-type error Composition Composition section code must equal Composition type when section is portable_medical_orders section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type
HCA-section-cardinality error Composition If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required error Composition section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries error Composition.section:healthcare_agent If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())
clindoc-limit-participantType error Composition The R4 FHIR Clinical Document Composition Profile contains specific extensions for data entry person, informant, information recipient, primary information recipient and tracker. So, they are not allowed in the participant extension in the R4 profile. In R6, the intention is to have dedicated-named slices of a backbone element. extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='ENT').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='INF').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='IRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='PRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='TRC').not()
cmp-1 error Composition.section, Composition.section:advance_directive_source_form, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information A section must contain at least one of text, entries, or sub-sections text.exists() or entry.exists() or section.exists()
cmp-2 error Composition.section, Composition.section:advance_directive_source_form, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information A section can only have an emptyReason if it is empty emptyReason.empty() or entry.empty()
dom-2 error Composition If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Composition If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Composition If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Composition If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Composition A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ADICompositionHeader

Summary

Mandatory: 3 elements(6 nested mandatory elements)
Must-Support: 1 element

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

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

Maturity: 2

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Composition C 0..* ADICompositionHeader A set of resources composed into a single coherent clinical statement with clinical attestation
Constraints: clindoc-limit-participantType, HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
... 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 BindingsPurpose
AllLanguages Max Binding
... text S 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... extension:R5-Composition-version S 0..1 string Optional Extensions Element
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.version
.... extension:data-enterer S 0..1 (Complex) A Data Enterer represents the person who transferred the content, written or dictated, into the clinical document. To clarify, an author provides the content, subject to their own interpretation; a dataEnterer adds an author's information to the electronic system.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/data-enterer-extension
.... extension:informant S 0..* (Complex) An Informant is an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/informant-extension
.... extension:information-recipient S 0..* (Complex) An Information Recipient is the intended recipient of the information at the time the document was created.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/information-recipient-extension
.... extension:participant S 0..* (Complex) A Participant that is not a data-enter, information-recipient nor an informant
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension
.... extension:consent S 0..* Reference(Consent) consent
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/consent-extension
.... extension:basedOn S 0..* Reference(Resource) The clinical action, such as a plan, proposal or order that is fulfilled by or precipitated this FHIR Clinical Document, such as a radiologists report of an x-ray.
URL: http://hl7.org/fhir/StructureDefinition/event-basedOn
.... extension:change-made S 0..1 (Complex) Note of changes made, calculating changes maybe required for safety as this extension may not contain all changes. Experimental, may overlap with other elements such as FHIR R6 note.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
.... extension:ExpirationDateExtension 0..1 dateTime ADI Expiration Date
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
.... extension:Jurisdiction 0..* CodeableConcept US State or local jurisdiction
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction
Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
.... extension: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
.... 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
.... extension:ParticipantExtension 0..* Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) Participant
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
.... 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
.... extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
.... 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)
... Slices for modifierExtension ?! 0..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:R5-Composition-status ?!S 0..1 base64Binary, boolean, canonical(), code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference(), SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta This allows for additional status values found in R5. However, exercise caution as the R4 Composition.status is required.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.status
... 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 Directive Document Types . (extensible)
... Slices for category SΣ 2..* CodeableConcept Categorization of Composition
Slice: Unordered, Open by value:$this
Binding: Advance Healthcare Directive Categories LOINC . (extensible)
.... category:clinicalnotecategory SΣ 1..1 CodeableConcept Category for Clinical Note
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: 107903-7
...... display 1..1 string Representation defined by the system
Fixed Value: Clinical note
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... category:advanceDirectiveCategory SΣ 1..1 CodeableConcept Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC . (extensible)

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 healthcare 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
... date SΣ 1..1 dateTime Composition editing time
... author SΣ 1..* Reference(US Core Patient Profile) Who and/or what authored the composition
... title SΣ 1..1 string Human Readable name/title
... Slices for attester S 1..* BackboneElement Attests to accuracy of composition
Slice: Unordered, Open by value:mode
.... attester:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... mode S 1..1 code personal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
Required Pattern: personal
..... time S 0..1 dateTime When the composition was attested
..... party S 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:legal_attester S 0..1 BackboneElement aka legal authenticator
..... 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.
Required Pattern: legal
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:professional_attester S 0..* BackboneElement aka authenticator
..... 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.
Required Pattern: professional
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
... custodian SΣ 1..1 Reference(US Core Organization Profile) Organization which maintains the composition
... Slices for relatesTo S 0..* BackboneElement Relationships to other compositions/documents
Slice: Unordered, Open by value:code, type:target
.... relatesTo:All Slices Content/Rules for all slices
..... 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.
..... Slices for target[x] 1..1 Target of the relationship
Slice: Unordered, Open by type:$this
...... targetIdentifier Identifier
...... targetReference Reference(Composition)
...... target[x]:targetIdentifier 0..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being appended, or to some other identifier of a non FHIR document
.... relatesTo:replaced_document S 0..* BackboneElement The document(s) being superceded
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... code 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
Required Pattern: replaces
..... Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this
...... target[x]:targetIdentifier 1..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being replaced, or to some other identifier of a non FHIR document
....... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
....... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
....... value Σ 1..1 string The value that is unique
Example General: 123456
.... relatesTo:appended_document S 0..* BackboneElement The document(s) being appended too
..... 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.
Required Pattern: appends
..... Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this
...... target[x]:targetIdentifier 1..1 Identifier Target of the relationship
....... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
... Slices for section SC 2..* BackboneElement Composition is broken into sections
Slice: Unordered, Open by pattern:code
Constraints: cmp-1, cmp-2
.... section:All Slices Content/Rules for all slices
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 0..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... section:advance_directive_source_form SC 1..1 BackboneElement Advance directive source form
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: advance_directive_source_form
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
.... section:healthcare_agent SC 1..1 BackboneElement Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations
Constraints: cmp-1, cmp-2, HCA-section-entries
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81335-2
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant) A reference to data that supports this section
..... emptyReason C 0..1 CodeableConcept This is only MS (must support) if the document types are supported.
Binding: No Healthcare Agent Included Reason (required)
.... section:gpp_for_certain_health_condition SC 0..1 BackboneElement Preference care plans defined for specific situations and/or conditions
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 107905-2
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Preference Care Plan | ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Personal Goal) A reference to data that supports this section
.... section:gpp_personal_care_experience SC 0..1 BackboneElement Quality of Life related personal care experiences, personal goals, and priorities
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81338-6
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Person-Authored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal) A reference to data that supports this section
.... section:gpp_upon_death SC 0..1 BackboneElement Goals, preferences, and priorities upon death
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81337-8
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences) A reference to data that supports this section
.... section:additional_documentation SC 0..1 BackboneElement Observations regarding the existence of other advance directive related information
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 77599-9
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(US Core Observation ADI Documentation Profile) A reference to data that supports this section
.... section:witness_and_notary SC 0..1 BackboneElement Witness and notary information. The first witness should be the author of the document
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81339-4
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... entry C 0..* Reference(ADI Witness | ADI Notary) A reference to data that supports this section
.... section:administrative_information SC 0..1 BackboneElement Administrative information associated with this personal advance care plan
Constraints: cmp-1, cmp-2
..... Slices for extension Content/Rules for all slices
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 107904-5
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... text SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Composition.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Composition.status Base required ADI Composition Status 📦2.0.0-ballot This IG
Composition.type Base extensible Advance Directive Document Types . 📦20240712 VSAC v0.24
Composition.category Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.category:clinicalnotecategory Base example Document Class Value Set 📍4.0.1 FHIR Std.
Composition.category:advanceDirectiveCategory Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.attester:legal_attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.attester:professional_attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.relatesTo.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​target[x]:targetIdentifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​target[x]:targetIdentifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Composition.section.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​emptyReason Base required No Healthcare Agent Included Reason 📦2.0.0-ballot This IG
Composition.section:gpp_for_certain_health_condition.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​code Base example Document Section Codes 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
Composition-section-code-equals-type error Composition Composition section code must equal Composition type when section is portable_medical_orders section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type
HCA-section-cardinality error Composition If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required error Composition section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries error Composition.section:healthcare_agent If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())
clindoc-limit-participantType error Composition The R4 FHIR Clinical Document Composition Profile contains specific extensions for data entry person, informant, information recipient, primary information recipient and tracker. So, they are not allowed in the participant extension in the R4 profile. In R6, the intention is to have dedicated-named slices of a backbone element. extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='ENT').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='INF').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='IRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='PRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='TRC').not()
cmp-1 error Composition.section, Composition.section:advance_directive_source_form, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information A section must contain at least one of text, entries, or sub-sections text.exists() or entry.exists() or section.exists()
cmp-2 error Composition.section, Composition.section:advance_directive_source_form, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information A section can only have an emptyReason if it is empty emptyReason.empty() or entry.empty()
dom-2 error Composition If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Composition If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Composition If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Composition If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Composition A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

Differential View

This structure is derived from ADICompositionHeader

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Composition C 0..* ADICompositionHeader A set of resources composed into a single coherent clinical statement with clinical attestation
Constraints: HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
... type 1..1 CodeableConcept Kind of composition (LOINC if possible)
Binding: Advance Directive Document Types . (extensible)
... category 2..* CodeableConcept Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC . (extensible)
... author 1..* Reference(US Core Patient Profile) Who and/or what authored the composition
.... mode 1..1 code personal | professional | legal | official
Required Pattern: personal
.... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
... Slices for attester Content/Rules for all slices
.... attester:legal_attester 0..1 BackboneElement aka legal authenticator
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:professional_attester 0..* BackboneElement aka authenticator
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
... Slices for section 2..* BackboneElement Composition is broken into sections
Slice: Unordered, Open by pattern:code
.... section:healthcare_agent SC 1..1 BackboneElement Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations
Constraints: HCA-section-entries
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 81335-2
..... entry 0..* Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant) A reference to data that supports this section
..... emptyReason 0..1 CodeableConcept This is only MS (must support) if the document types are supported.
Binding: No Healthcare Agent Included Reason (required)
.... section:gpp_for_certain_health_condition 0..1 BackboneElement Preference care plans defined for specific situations and/or conditions
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 107905-2
..... entry 0..* Reference(ADI Preference Care Plan | ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Personal Goal) A reference to data that supports this section
.... section:gpp_personal_care_experience 0..1 BackboneElement Quality of Life related personal care experiences, personal goals, and priorities
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 81338-6
..... entry 0..* Reference(ADI Person-Authored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal) A reference to data that supports this section
.... section:gpp_upon_death 0..1 BackboneElement Goals, preferences, and priorities upon death
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 81337-8
..... entry 0..* Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences) A reference to data that supports this section
.... section:additional_documentation 0..1 BackboneElement Observations regarding the existence of other advance directive related information
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 77599-9
..... entry 0..* Reference(US Core Observation ADI Documentation Profile) A reference to data that supports this section
.... section:witness_and_notary 0..1 BackboneElement Witness and notary information. The first witness should be the author of the document
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 81339-4
..... entry 0..* Reference(ADI Witness | ADI Notary) A reference to data that supports this section
.... section:administrative_information 0..1 BackboneElement Administrative information associated with this personal advance care plan
..... code 1..1 CodeableConcept Classification of section (recommended)
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: 107904-5

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
Composition.type Base extensible Advance Directive Document Types . 📦20240712 VSAC v0.24
Composition.category Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.section:healthcare_agent.​emptyReason Base required No Healthcare Agent Included Reason 📦2.0.0-ballot This IG

Constraints

Id Grade Path(s) Description Expression
Composition-section-code-equals-type error Composition Composition section code must equal Composition type when section is portable_medical_orders section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type
HCA-section-cardinality error Composition If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required error Composition section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries error Composition.section:healthcare_agent If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())

Snapshot View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. Composition C 0..* ADICompositionHeader A set of resources composed into a single coherent clinical statement with clinical attestation
Constraints: clindoc-limit-participantType, HCA-section-cardinality, HCA-section-emptyReason-required, Composition-section-code-equals-type
... 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
... text S 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
.... extension:R5-Composition-version S 0..1 string Optional Extensions Element
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.version
.... extension:data-enterer S 0..1 (Complex) A Data Enterer represents the person who transferred the content, written or dictated, into the clinical document. To clarify, an author provides the content, subject to their own interpretation; a dataEnterer adds an author's information to the electronic system.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/data-enterer-extension
.... extension:informant S 0..* (Complex) An Informant is an information source for any content within the clinical document. This informant is constrained for use when the source of information is an assigned health care provider for the patient.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/informant-extension
.... extension:information-recipient S 0..* (Complex) An Information Recipient is the intended recipient of the information at the time the document was created.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/information-recipient-extension
.... extension:participant S 0..* (Complex) A Participant that is not a data-enter, information-recipient nor an informant
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension
.... extension:consent S 0..* Reference(Consent) consent
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/consent-extension
.... extension:basedOn S 0..* Reference(Resource) The clinical action, such as a plan, proposal or order that is fulfilled by or precipitated this FHIR Clinical Document, such as a radiologists report of an x-ray.
URL: http://hl7.org/fhir/StructureDefinition/event-basedOn
.... extension:change-made S 0..1 (Complex) Note of changes made, calculating changes maybe required for safety as this extension may not contain all changes. Experimental, may overlap with other elements such as FHIR R6 note.
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
.... extension:ExpirationDateExtension 0..1 dateTime ADI Expiration Date
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
.... extension:Jurisdiction 0..* CodeableConcept US State or local jurisdiction
URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction
Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
.... extension: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
.... 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
.... extension:ParticipantExtension 0..* Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) Participant
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
.... 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
.... extension:ClauseExtension 0..* (Complex) Clause
URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
.... 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)
... Slices for modifierExtension ?! 0..* Extension Extension
Slice: Unordered, Open by value:url
.... modifierExtension:R5-Composition-status ?!S 0..1 base64Binary, boolean, canonical(), code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference(), SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta This allows for additional status values found in R5. However, exercise caution as the R4 Composition.status is required.
URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.status
... 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 Directive Document Types . (extensible)
... Slices for category SΣ 2..* CodeableConcept Categorization of Composition
Slice: Unordered, Open by value:$this
Binding: Advance Healthcare Directive Categories LOINC . (extensible)
.... category:clinicalnotecategory SΣ 1..1 CodeableConcept Category for Clinical Note
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: 107903-7
...... display 1..1 string Representation defined by the system
Fixed Value: Clinical note
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
.... category:advanceDirectiveCategory SΣ 1..1 CodeableConcept Categorization of Composition
Binding: Advance Healthcare Directive Categories LOINC . (extensible)

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 healthcare 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 Patient Profile) Who and/or what authored the composition
... title SΣ 1..1 string Human Readable name/title
... Slices for attester S 1..* BackboneElement Attests to accuracy of composition
Slice: Unordered, Open by value:mode
.... attester:All Slices Content/Rules for all slices
..... 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 S 1..1 code personal | professional | legal | official
Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
Required Pattern: personal
..... time S 0..1 dateTime When the composition was attested
..... party S 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:legal_attester S 0..1 BackboneElement aka legal authenticator
..... 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.
Required Pattern: legal
..... time 0..1 dateTime When the composition was attested
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
.... attester:professional_attester S 0..* BackboneElement aka authenticator
..... 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.
Required Pattern: professional
..... time 0..1 dateTime When the composition was attested
..... party 0..1 Reference(US Core Patient Profile | RelatedPerson | ADI Witness | ADI Notary | ADI Practitioner Role) Who attested the composition
... custodian SΣ 1..1 Reference(US Core Organization Profile) Organization which maintains the composition
... Slices for relatesTo S 0..* BackboneElement Relationships to other compositions/documents
Slice: Unordered, Open by value:code, type:target
.... relatesTo:All Slices Content/Rules for all slices
..... 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.
..... Slices for target[x] 1..1 Target of the relationship
Slice: Unordered, Open by type:$this
...... targetIdentifier Identifier
...... targetReference Reference(Composition)
...... target[x]:targetIdentifier 0..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being appended, or to some other identifier of a non FHIR document
.... relatesTo:replaced_document S 0..* BackboneElement The document(s) being superceded
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... code 1..1 code replaces | transforms | signs | appends
Binding: DocumentRelationshipType (required): The type of relationship between documents.
Required Pattern: replaces
..... Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this
...... target[x]:targetIdentifier 1..1 Identifier Reference to the Bundle.identifier of the FHIR Clinical Document being replaced, or to some other identifier of a non FHIR document
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... use ?!Σ 0..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
....... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
....... system Σ 1..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
....... value Σ 1..1 string The value that is unique
Example General: 123456
....... period Σ 0..1 Period Time period when id is/was valid for use
....... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
.... relatesTo:appended_document S 0..* BackboneElement The document(s) being appended too
..... 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.
Required Pattern: appends
..... Slices for target[x] 1..1 Identifier Target of the relationship
Slice: Unordered, Closed by type:$this
...... target[x]:targetIdentifier 1..1 Identifier Target of the relationship
....... id 0..1 string Unique id for inter-element referencing
....... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
....... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
....... type Σ 0..1 CodeableConcept Description of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
....... system Σ 0..1 uri The namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
....... value Σ 0..1 string The value that is unique
Example General: 123456
....... period Σ 0..1 Period Time period when id is/was valid for use
....... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
... 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
... Slices for section SC 2..* BackboneElement Composition is broken into sections
Slice: Unordered, Open by pattern:code
Constraints: cmp-1, cmp-2
.... section:All Slices Content/Rules for all slices
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 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
.... section:advance_directive_source_form SC 1..1 BackboneElement Advance directive source form
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: advance_directive_source_form
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Source Form) 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
.... section:healthcare_agent SC 1..1 BackboneElement Healthcare agents, healthcare agent advisors, and consent regarding their roles, powers, and limitations
Constraints: cmp-1, cmp-2, HCA-section-entries
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81335-2
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Healthcare Agent Consent | ADI Healthcare Agent Participant) A reference to data that supports this section
..... emptyReason C 0..1 CodeableConcept This is only MS (must support) if the document types are supported.
Binding: No Healthcare Agent Included Reason (required)
..... section C 0..* See section (Composition) Nested Section
.... section:gpp_for_certain_health_condition SC 0..1 BackboneElement Preference care plans defined for specific situations and/or conditions
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 107905-2
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Preference Care Plan | ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Personal Goal) 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
.... section:gpp_personal_care_experience SC 0..1 BackboneElement Quality of Life related personal care experiences, personal goals, and priorities
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81338-6
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Person-Authored Care Experience Preference | ADI Personal Priorities Organizer | ADI Personal Goal) 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
.... section:gpp_upon_death SC 0..1 BackboneElement Goals, preferences, and priorities upon death
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81337-8
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Person Authored Personal Intervention Preference | ADI Personal Priorities Organizer | ADI Autopsy Observation | ADI Organ Donation Observation | ADI Personal Goal | ADI Upon Death Preferences) 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
.... section:additional_documentation SC 0..1 BackboneElement Observations regarding the existence of other advance directive related information
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 77599-9
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(US Core Observation ADI Documentation Profile) 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
.... section:witness_and_notary SC 0..1 BackboneElement Witness and notary information. The first witness should be the author of the document
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 81339-4
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 0..* Reference(ADI Witness | ADI Notary) 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
.... section:administrative_information SC 0..1 BackboneElement Administrative information associated with this personal advance care plan
Constraints: cmp-1, cmp-2
..... id 0..1 string Unique id for inter-element referencing
..... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
...... extension:change-made S 0..1 (Complex) Change Made
URL: http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ChangeMade
...... extension: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 S 1..1 string Label for section (e.g. for ToC)
..... code S 1..1 CodeableConcept Classification of section (recommended)
Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
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: 107904-5
....... display 0..1 string Representation defined by the system
....... userSelected 0..1 boolean If this coding was chosen directly by the user
...... text 0..1 string Plain text representation of the concept
..... 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 SC 1..1 Narrative Text summary of the section, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
..... mode 0..1 code working | snapshot | changes
Binding: ListMode (required): The processing mode that applies to this section.
..... orderedBy 0..1 CodeableConcept Order of section entries
Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
..... entry C 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

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
Composition.language Base preferred Common Languages 📍4.0.1 FHIR Std.
Composition.status Base required ADI Composition Status 📦2.0.0-ballot This IG
Composition.type Base extensible Advance Directive Document Types . 📦20240712 VSAC v0.24
Composition.category Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.category:clinicalnotecategory Base example Document Class Value Set 📍4.0.1 FHIR Std.
Composition.category:advanceDirectiveCategory Base extensible Advance Healthcare Directive Categories LOINC . 📦20250402 VSAC v0.24
Composition.attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.attester:legal_attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.attester:professional_attester.​mode Base required CompositionAttestationMode 📍4.0.1 FHIR Std.
Composition.relatesTo.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​target[x]:targetIdentifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Composition.relatesTo:replaced_document.​target[x]:targetIdentifier.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​code Base required DocumentRelationshipType 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​target[x]:targetIdentifier.​use Base required IdentifierUse 📍4.0.1 FHIR Std.
Composition.relatesTo:appended_document.​target[x]:targetIdentifier.​type Base extensible IdentifierType 📍4.0.1 FHIR Std.
Composition.event.code Base example v3 Code System ActCode 📦3.0.0 THO v7.1
Composition.section.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:advance_directive_source_form.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:healthcare_agent.​emptyReason Base required No Healthcare Agent Included Reason 📦2.0.0-ballot This IG
Composition.section:gpp_for_certain_health_condition.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_for_certain_health_condition.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:gpp_for_certain_health_condition.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_for_certain_health_condition.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_personal_care_experience.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:gpp_upon_death.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:additional_documentation.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:witness_and_notary.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​code Base example Document Section Codes 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​mode Base required ListMode 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​orderedBy Base preferred List Order Codes 📍4.0.1 FHIR Std.
Composition.section:administrative_information.​emptyReason Base preferred List Empty Reasons 📍4.0.1 FHIR Std.

Constraints

Id Grade Path(s) Description Expression
Composition-section-code-equals-type error Composition Composition section code must equal Composition type when section is portable_medical_orders section.where(code.coding.code = 'portable_medical_orders').exists() implies section.where(code.coding.code = 'portable_medical_orders').code = type
HCA-section-cardinality error Composition If the PACP Composition document type is equal to Power of attorney (64298-3), Patient Personal advance care plan (81334-5), or Power of attorney and Living will (92664-2), then the PACP Composition requires one and only one healthcare agent section slice with code = 81335-2 (Patient Healthcare agent) (type.coding.where(code = '64298-3').exists().not() and type.coding.where(code = '81334-5').exists().not() and type.coding.where(code = '92664-2').exists().not()) or section.where(code.coding.where(code = '81335-2').exists()).count() = 1
HCA-section-emptyReason-required error Composition section[healthcare_agent].emptyReason is required if section[healthcare_agent] is present and there are no entries. section.where(code.coding.where(code = '81335-2').exists()).exists().not() or section.where(code.coding.where(code = '81335-2').exists()).entry.count() > 0 or section.where(code.coding.where(code = '81335-2').exists()).emptyReason.exists()
HCA-section-entries error Composition.section:healthcare_agent If healthcare agent section entry exists, then the HCA consent entry and HCA RelatedPerson entry must exist entry.exists().not() or (entry.where($this.resolve() is Consent).exists() and entry.where($this.resolve() is RelatedPerson).exists())
clindoc-limit-participantType error Composition The R4 FHIR Clinical Document Composition Profile contains specific extensions for data entry person, informant, information recipient, primary information recipient and tracker. So, they are not allowed in the participant extension in the R4 profile. In R6, the intention is to have dedicated-named slices of a backbone element. extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='ENT').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='INF').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='IRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='PRCP').not() and extension.where(url='http://hl7.org/fhir/uv/fhir-clinical-document/StructureDefinition/ParticipantExtension').extension.where(url='type').value.coding.exists(system='http://terminology.hl7.org/CodeSystem/v3-ParticipationType' and code='TRC').not()
cmp-1 error Composition.section, Composition.section:advance_directive_source_form, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information A section must contain at least one of text, entries, or sub-sections text.exists() or entry.exists() or section.exists()
cmp-2 error Composition.section, Composition.section:advance_directive_source_form, Composition.section:healthcare_agent, Composition.section:gpp_for_certain_health_condition, Composition.section:gpp_personal_care_experience, Composition.section:gpp_upon_death, Composition.section:additional_documentation, Composition.section:witness_and_notary, Composition.section:administrative_information A section can only have an emptyReason if it is empty emptyReason.empty() or entry.empty()
dom-2 error Composition If the resource is contained in another resource, it SHALL NOT contain nested Resources contained.contained.empty()
dom-3 error Composition If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4 error Composition If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5 error Composition If a resource is contained in another resource, it SHALL NOT have a security label contained.meta.security.empty()
dom-6 best practice Composition A resource should have narrative for robust management text.`div`.exists()
ele-1 error **ALL** elements All FHIR elements must have a @value or children hasValue() or (children().count() > id.count())
ext-1 error **ALL** extensions Must have either extensions or value[x], not both extension.exists() != value.exists()

This structure is derived from ADICompositionHeader

Summary

Mandatory: 3 elements(6 nested mandatory elements)
Must-Support: 1 element

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

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

Maturity: 2

 

Other representations of profile: CSV, Excel, Schematron