PACIO Advance Directive Interoperability Implementation Guide
1.0.0 - STU 1 United States of America flag

PACIO Advance Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 1.0.0 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: ADIPreferenceCarePlan - Detailed Descriptions

Active as of 2024-01-11

Definitions for the ADI-PreferenceCarePlan resource profile.

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

0. CarePlan
Invariantsgoal-or-supportingInfo-required: Either goal or supportingInfo must exist, ie. goal and supportingInfo cannot both be blank, ie. if goal does not exist then supportingInfo must exist. (goal.empty() implies supportingInfo.exists())
2. CarePlan.text
Must Supporttrue
4. CarePlan.extension
SlicingThis element introduces a set of slices on CarePlan.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
6. CarePlan.extension:GoalOrderByDescendingPriority
Slice NameGoalOrderByDescendingPriority
Control0..1
TypeExtension(Goal Order by Descending Priority) (Extension Type: CodeableConcept)
8. CarePlan.status
Pattern Valueactive
10. CarePlan.intent
Pattern Valueproposal
12. CarePlan.category
Control1..?
SlicingThis element introduces a set of slices on CarePlan.category. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ $this
14. CarePlan.category:advance_care_planning
Slice Nameadvance_care_planning
Control1..1
Must Supporttrue
Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://snomed.info/sct&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;736366004&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Advance&nbsp;care&nbsp;plan&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
16. CarePlan.title
Control1..?
Must Supporttrue
18. CarePlan.subject
TypeReference(US Core Patient Profile)
Must Supporttrue
20. CarePlan.addresses
ShortHealth issues this plan addresses (use display only for potential conditions the patient does not currently have)
Comments

The conditions or circumstances in which the stated preferences and goals of the care plan apply. If there are no contained or referenceable resources (e.g. these are potential future conditions that do not represent a condition the patient currently has), the display should be in addresses.display. If no specific circumstances, then the display should indicate something like 'General' or 'All'

Control1..?
Must Supporttrue
22. CarePlan.supportingInfo
ShortObservations of a patient's preferences for the scope of this care plan.
TypeReference(Personal Intervention Preference, ADI Care Experience Preference)
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
24. CarePlan.goal
ShortPatient's goals for the scope of this care plan.
TypeReference(ADI Personal Goal)
Must Supporttrue

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

0. CarePlan
Definition

Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.

ShortHealthcare plan for patient or group
Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesCare Team
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
goal-or-supportingInfo-required: Either goal or supportingInfo must exist, ie. goal and supportingInfo cannot both be blank, ie. if goal does not exist then supportingInfo must exist. (goal.empty() implies supportingInfo.exists())
2. CarePlan.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. CarePlan.text
Definition

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

ShortText summary of the resource, for human interpretation
Comments

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

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

An Extension


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

ShortExtensionAdditional content defined by implementations
Comments

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

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

Indicates if the goals are ordered in descending priority (Y) or no specific order (N).

ShortGoal Order by Descending Priority
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Goal Order by Descending Priority) (Extension Type: CodeableConcept)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
10. CarePlan.modifierExtension
Definition

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

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

ShortExtensions that cannot be ignored
Comments

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

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

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

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

Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
Comments

The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid.

Control1..1
BindingThe codes SHALL be taken from RequestStatushttp://hl7.org/fhir/ValueSet/request-status|4.0.1

Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

Typecode
Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows clinicians to determine whether the plan is actionable or not.

Pattern Valueactive
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
14. CarePlan.intent
Definition

Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain.

Shortproposal | plan | order | option
Comments

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

Control1..1
BindingThe codes SHALL be taken from CarePlanIntenthttp://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1

Codes indicating the degree of authority/intentionality associated with a care plan.

Typecode
Is Modifiertrue because This element changes the interpretation of all descriptive attributes. For example &quot;the time the request is recommended to occur&quot; vs. &quot;the time the request is authorized to occur&quot; or &quot;who is recommended to perform the request&quot; vs. &quot;who is authorized to perform the request&quot;
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.

Pattern Valueproposal
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
16. CarePlan.category
Definition

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

ShortType of plan
Comments

There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

Control10..*
BindingFor example codes, see CarePlanCategoryhttp://hl7.org/fhir/ValueSet/care-plan-category

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Used for filtering what plan(s) are retrieved and displayed to different types of users.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on CarePlan.category. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ $this
18. CarePlan.category:advance_care_planning
Slice Nameadvance_care_planning
Definition

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

ShortType of plan
Comments

There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

Control10..1*
BindingFor example codes, see CarePlanCategoryhttp://hl7.org/fhir/ValueSet/care-plan-category

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

Used for filtering what plan(s) are retrieved and displayed to different types of users.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://snomed.info/sct&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;736366004&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Advance&nbsp;care&nbsp;plan&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
20. CarePlan.title
Definition

Human-friendly name for the care plan.

ShortHuman-friendly name for the care plan
Control10..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. CarePlan.subject
Definition

Identifies the patient or group whose intended care is described by the plan.

ShortWho the care plan is for
Control1..1
TypeReference(US Core Patient Profile, Patient, Group)
Is Modifierfalse
Must Supporttrue
Summarytrue
Alternate Namespatient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. CarePlan.addresses
Definition

Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.

ShortHealth issues this plan addresses (use display only for potential conditions the patient does not currently have)
Comments

The conditions or circumstances in which the stated preferences and goals of the care plan apply. If there are no contained or referenceable resources (e.g. these are potential future conditions that do not represent a condition the patient currently has), the display should be in addresses.display. If no specific circumstances, then the display should indicate something like 'General' or 'All'


When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance.

Control10..*
TypeReference(Condition)
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. CarePlan.supportingInfo
Definition

Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc.

ShortObservations of a patient's preferences for the scope of this care plan.Information considered as part of plan
Comments

Use "concern" to identify specific conditions addressed by the care plan.

Control0..*
TypeReference(Personal Intervention Preference, ADI Care Experience Preference, Resource)
Is Modifierfalse
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summaryfalse
Requirements

Identifies barriers and other considerations associated with the care plan.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. CarePlan.goal
Definition

Describes the intended objective(s) of carrying out the care plan.

ShortPatient's goals for the scope of this care plan.Desired outcome of plan
Comments

Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

Control0..*
TypeReference(ADI Personal Goal, Goal)
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.

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

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

0. CarePlan
Definition

Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions.

ShortHealthcare plan for patient or group
Control0..*
Is Modifierfalse
Summaryfalse
Alternate NamesCare Team
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
goal-or-supportingInfo-required: Either goal or supportingInfo must exist, ie. goal and supportingInfo cannot both be blank, ie. if goal does not exist then supportingInfo must exist. (goal.empty() implies supportingInfo.exists())
2. CarePlan.id
Definition

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

ShortLogical id of this artifact
Comments

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

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

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

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

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

ShortA set of rules under which this content was created
Comments

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

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. CarePlan.language
Definition

The base language in which the resource is written.

ShortLanguage of the resource content
Comments

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

Control0..1
BindingThe codes SHOULD be taken from CommonLanguages

A human language.

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

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

ShortText summary of the resource, for human interpretation
Comments

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

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

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

ShortContained, inline Resources
Comments

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

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

An Extension

ShortExtension
Control0..*
TypeExtension
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on CarePlan.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • value @ url
16. CarePlan.extension:GoalOrderByDescendingPriority
Slice NameGoalOrderByDescendingPriority
Definition

Indicates if the goals are ordered in descending priority (Y) or no specific order (N).

ShortGoal Order by Descending Priority
Control0..1
This element is affected by the following invariants: ele-1
TypeExtension(Goal Order by Descending Priority) (Extension Type: CodeableConcept)
Is Modifierfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
18. CarePlan.modifierExtension
Definition

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

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

ShortExtensions that cannot be ignored
Comments

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

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

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

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

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

ShortExternal Ids for this plan
Comments

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

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

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

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
22. CarePlan.instantiatesCanonical
Definition

The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.

ShortInstantiates FHIR protocol or definition
Control0..*
Typecanonical(PlanDefinition, Questionnaire, Measure, ActivityDefinition, OperationDefinition)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
24. CarePlan.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.

ShortInstantiates external protocol or definition
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

Control0..*
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. CarePlan.basedOn
Definition

A care plan that is fulfilled in whole or in part by this care plan.

ShortFulfills CarePlan
Control0..*
TypeReference(CarePlan)
Is Modifierfalse
Summarytrue
Requirements

Allows tracing of the care plan and tracking whether proposals/recommendations were acted upon.

Alternate Namesfulfills
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. CarePlan.replaces
Definition

Completed or terminated care plan whose function is taken by this new care plan.

ShortCarePlan replaced by this CarePlan
Comments

The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing.

Control0..*
TypeReference(CarePlan)
Is Modifierfalse
Summarytrue
Requirements

Allows tracing the continuation of a therapy or administrative process instantiated through multiple care plans.

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

A larger care plan of which this particular care plan is a component or step.

ShortPart of referenced CarePlan
Comments

Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed.

Control0..*
TypeReference(CarePlan)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. CarePlan.status
Definition

Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

Shortdraft | active | on-hold | revoked | completed | entered-in-error | unknown
Comments

The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan.

This element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid.

Control1..1
BindingThe codes SHALL be taken from RequestStatus

Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

Typecode
Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Allows clinicians to determine whether the plan is actionable or not.

Pattern Valueactive
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. CarePlan.intent
Definition

Indicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain.

Shortproposal | plan | order | option
Comments

This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.

Control1..1
BindingThe codes SHALL be taken from CarePlanIntent

Codes indicating the degree of authority/intentionality associated with a care plan.

Typecode
Is Modifiertrue because This element changes the interpretation of all descriptive attributes. For example &quot;the time the request is recommended to occur&quot; vs. &quot;the time the request is authorized to occur&quot; or &quot;who is recommended to perform the request&quot; vs. &quot;who is authorized to perform the request&quot;
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Requirements

Proposals/recommendations, plans and orders all use the same structure and can exist in the same fulfillment chain.

Pattern Valueproposal
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. CarePlan.category
Definition

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

ShortType of plan
Comments

There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

Control1..*
BindingFor example codes, see CarePlanCategory

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

TypeCodeableConcept
Is Modifierfalse
Summarytrue
Requirements

Used for filtering what plan(s) are retrieved and displayed to different types of users.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on CarePlan.category. The slices are unordered and Open, and can be differentiated using the following discriminators:
  • pattern @ $this
38. CarePlan.category:advance_care_planning
Slice Nameadvance_care_planning
Definition

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.

ShortType of plan
Comments

There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.

Control1..1
BindingFor example codes, see CarePlanCategory

Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

Used for filtering what plan(s) are retrieved and displayed to different types of users.

Pattern Value&lt;valueCodeableConcept&nbsp;xmlns=&quot;http://hl7.org/fhir&quot;&gt;<br/>&nbsp;&nbsp;&lt;coding&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;system&nbsp;value=&quot;http://snomed.info/sct&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;code&nbsp;value=&quot;736366004&quot;/&gt;<br/>&nbsp;&nbsp;&nbsp;&nbsp;&lt;display&nbsp;value=&quot;Advance&nbsp;care&nbsp;plan&quot;/&gt;<br/>&nbsp;&nbsp;&lt;/coding&gt;<br/>&lt;/valueCodeableConcept&gt;<br/>
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
40. CarePlan.title
Definition

Human-friendly name for the care plan.

ShortHuman-friendly name for the care plan
Control1..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supporttrue
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
42. CarePlan.description
Definition

A description of the scope and nature of the plan.

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

Provides more detail than conveyed by category.

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

Identifies the patient or group whose intended care is described by the plan.

ShortWho the care plan is for
Control1..1
TypeReference(US Core Patient Profile)
Is Modifierfalse
Must Supporttrue
Summarytrue
Alternate Namespatient
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
46. CarePlan.encounter
Definition

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

ShortEncounter created as part of
Comments

This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters.

Control0..1
TypeReference(Encounter)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
48. CarePlan.period
Definition

Indicates when the plan did (or is intended to) come into effect and end.

ShortTime period plan covers
Comments

Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition).

Control0..1
TypePeriod
Is Modifierfalse
Summarytrue
Requirements

Allows tracking what plan(s) are in effect at a particular time.

Alternate Namestiming
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
50. CarePlan.created
Definition

Represents when this particular CarePlan record was created in the system, which is often a system-generated date.

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

When populated, the author is responsible for the care plan. The care plan is attributed to the author.

ShortWho is the designated responsible party
Comments

The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor.

Control0..1
TypeReference(Patient, Practitioner, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
Is Modifierfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
54. CarePlan.contributor
Definition

Identifies the individual(s) or organization who provided the contents of the care plan.

ShortWho provided the content of the care plan
Comments

Collaborative care plans may have multiple contributors.

Control0..*
TypeReference(Patient, Practitioner, PractitionerRole, Device, RelatedPerson, Organization, CareTeam)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
56. CarePlan.careTeam
Definition

Identifies all people and organizations who are expected to be involved in the care envisioned by this plan.

ShortWho's involved in plan?
Control0..*
TypeReference(CareTeam)
Is Modifierfalse
Summaryfalse
Requirements

Allows representation of care teams, helps scope care plan. In some cases may be a determiner of access permissions.

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

Identifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.

ShortHealth issues this plan addresses (use display only for potential conditions the patient does not currently have)
Comments

The conditions or circumstances in which the stated preferences and goals of the care plan apply. If there are no contained or referenceable resources (e.g. these are potential future conditions that do not represent a condition the patient currently has), the display should be in addresses.display. If no specific circumstances, then the display should indicate something like 'General' or 'All'

Control1..*
TypeReference(Condition)
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

Links plan to the conditions it manages. The element can identify risks addressed by the plan as well as active conditions. (The Condition resource can include things like "at risk for hypertension" or "fall risk".) Also scopes plans - multiple plans may exist addressing different concerns.

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

Identifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc.

ShortObservations of a patient's preferences for the scope of this care plan.
Comments

Use "concern" to identify specific conditions addressed by the care plan.

Control0..*
TypeReference(Personal Intervention Preference, ADI Care Experience Preference)
Is Modifierfalse
Must Supporttrue
Must Support TypesNo must-support rules about the choice of types/profiles
Summaryfalse
Requirements

Identifies barriers and other considerations associated with the care plan.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
62. CarePlan.goal
Definition

Describes the intended objective(s) of carrying out the care plan.

ShortPatient's goals for the scope of this care plan.
Comments

Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.

Control0..*
TypeReference(ADI Personal Goal)
Is Modifierfalse
Must Supporttrue
Summaryfalse
Requirements

Provides context for plan. Allows plan effectiveness to be evaluated by clinicians.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
64. CarePlan.activity
Definition

Identifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc.

ShortAction to occur as part of plan
Control0..*
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Allows systems to prompt for performance of planned activities, and validate plans against best practice.

Invariantscpl-3: Provide a reference or detail, not both (detail.empty() or reference.empty())
ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
66. CarePlan.activity.id
Definition

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

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

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

ShortAdditional content defined by implementations
Comments

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

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

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

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

ShortExtensions that cannot be ignored even if unrecognized
Comments

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

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

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

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

Identifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not).

ShortResults of the activity
Comments

Note that this should not duplicate the activity status (e.g. completed or in progress).

Control0..*
BindingFor example codes, see CarePlanActivityOutcome

Identifies the results of the activity.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
74. CarePlan.activity.outcomeReference
Definition

Details of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource).

ShortAppointment, Encounter, Procedure, etc.
Comments

The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured.

Control0..*
TypeReference(Resource)
Is Modifierfalse
Summaryfalse
Requirements

Links plan to resulting actions.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
76. CarePlan.activity.progress
Definition

Notes about the adherence/status/progress of the activity.

ShortComments about the activity status/progress
Comments

This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description.

Control0..*
TypeAnnotation
Is Modifierfalse
Summaryfalse
Requirements

Can be used to capture information about adherence, progress, concerns, etc.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
78. CarePlan.activity.reference
Definition

The details of the proposed activity represented in a specific resource.

ShortActivity details defined in specific resource
Comments

Standard extension exists (resource-pertainsToGoal) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference.
The goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should not point to this CarePlan using the "basedOn" element. i.e. Requests that are part of a CarePlan are not "based on" the CarePlan.

Control0..1
This element is affected by the following invariants: cpl-3
TypeReference(Appointment, CommunicationRequest, DeviceRequest, MedicationRequest, NutritionOrder, Task, ServiceRequest, VisionPrescription, RequestGroup)
Is Modifierfalse
Summaryfalse
Requirements

Details in a form consistent with other applications and contexts of use.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
80. CarePlan.activity.detail
Definition

A simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc.

ShortIn-line definition of activity
Control0..1
This element is affected by the following invariants: cpl-3
TypeBackboneElement
Is Modifierfalse
Summaryfalse
Requirements

Details in a simple form for generic care plan systems.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
82. CarePlan.activity.detail.id
Definition

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

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

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

ShortAdditional content defined by implementations
Comments

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

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

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

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

ShortExtensions that cannot be ignored even if unrecognized
Comments

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

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

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

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

A description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.

ShortAppointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
Control0..1
BindingThe codes SHALL be taken from CarePlanActivityKind

Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.

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

May determine what types of extensions are permitted.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
90. CarePlan.activity.detail.instantiatesCanonical
Definition

The URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.

ShortInstantiates FHIR protocol or definition
Control0..*
Typecanonical(PlanDefinition, ActivityDefinition, Questionnaire, Measure, OperationDefinition)
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
92. CarePlan.activity.detail.instantiatesUri
Definition

The URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.

ShortInstantiates external protocol or definition
Comments

This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.

Control0..*
Typeuri
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Allows Questionnaires that the patient (or practitioner) should fill in to fulfill the care plan activity.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
94. CarePlan.activity.detail.code
Definition

Detailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter.

ShortDetail type of activity
Comments

Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead.

Control0..1
BindingFor example codes, see ProcedureCodes(SNOMEDCT)

Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Requirements

Allows matching performed to planned as well as validation against protocols.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
96. CarePlan.activity.detail.reasonCode
Definition

Provides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited.

ShortWhy activity should be done or why activity was prohibited
Comments

This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead.

Control0..*
BindingFor example codes, see SNOMEDCTClinicalFindings

Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc.

TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
98. CarePlan.activity.detail.reasonReference
Definition

Indicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan.

ShortWhy activity is needed
Comments

Conditions can be identified at the activity level that are not identified as reasons for the overall plan.

Control0..*
TypeReference(Condition, Observation, DiagnosticReport, DocumentReference)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
100. CarePlan.activity.detail.goal
Definition

Internal reference that identifies the goals that this activity is intended to contribute towards meeting.

ShortGoals this activity relates to
Control0..*
TypeReference(Goal)
Is Modifierfalse
Summaryfalse
Requirements

So that participants know the link explicitly.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
102. CarePlan.activity.detail.status
Definition

Identifies what progress is being made for the specific activity.

Shortnot-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
Comments

Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated.
The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the activity.

Control1..1
BindingThe codes SHALL be taken from CarePlanActivityStatus

Codes that reflect the current state of a care plan activity within its overall life cycle.

Typecode
Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the activity should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Indicates progress against the plan, whether the activity is still relevant for the plan.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
104. CarePlan.activity.detail.statusReason
Definition

Provides reason why the activity isn't yet started, is on hold, was cancelled, etc.

ShortReason for current status
Comments

Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed.

Control0..1
TypeCodeableConcept
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
106. CarePlan.activity.detail.doNotPerform
Definition

If true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan.

ShortIf true, activity is prohibiting action
Comments

This element is labeled as a modifier because it marks an activity as an activity that is not to be performed.

Control0..1
Typeboolean
Is Modifiertrue because If true this element negates the specified action. For example, instead of a request for a procedure, it is a request for the procedure to not occur.
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Captures intention to not do something that may have been previously typical.

Meaning if MissingIf missing indicates that the described activity is one that should be engaged in when following the plan.
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
108. CarePlan.activity.detail.scheduled[x]
Definition

The period, timing or frequency upon which the described activity is to occur.

ShortWhen activity is to occur
Control0..1
TypeChoice of: Timing, Period, string
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Requirements

Allows prompting for activities and detection of missed planned activities.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
110. CarePlan.activity.detail.location
Definition

Identifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc.

ShortWhere it should happen
Comments

May reference a specific clinical location or may identify a type of location.

Control0..1
TypeReference(Location)
Is Modifierfalse
Summaryfalse
Requirements

Helps in planning of activity.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
112. CarePlan.activity.detail.performer
Definition

Identifies who's expected to be involved in the activity.

ShortWho will be responsible?
Comments

A performer MAY also be a participant in the care plan.

Control0..*
TypeReference(Practitioner, PractitionerRole, Organization, RelatedPerson, Patient, CareTeam, HealthcareService, Device)
Is Modifierfalse
Summaryfalse
Requirements

Helps in planning of activity.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
114. CarePlan.activity.detail.product[x]
Definition

Identifies the food, drug or other product to be consumed or supplied in the activity.

ShortWhat is to be administered/supplied
Control0..1
BindingFor example codes, see SNOMEDCTMedicationCodes

A product supplied or administered as part of a care plan activity.

TypeChoice of: CodeableConcept, Reference(Medication, Substance)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
116. CarePlan.activity.detail.dailyAmount
Definition

Identifies the quantity expected to be consumed in a given day.

ShortHow to consume/day?
Control0..1
TypeQuantity(SimpleQuantity)
Is Modifierfalse
Summaryfalse
Requirements

Allows rough dose checking.

Alternate Namesdaily dose
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
118. CarePlan.activity.detail.quantity
Definition

Identifies the quantity expected to be supplied, administered or consumed by the subject.

ShortHow much to administer/supply/consume
Control0..1
TypeQuantity(SimpleQuantity)
Is Modifierfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
120. CarePlan.activity.detail.description
Definition

This provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc.

ShortExtra info describing activity to perform
Control0..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
122. CarePlan.note
Definition

General notes about the care plan not covered elsewhere.

ShortComments about the plan
Control0..*
TypeAnnotation
Is Modifierfalse
Summaryfalse
Requirements

Used to capture information that applies to the plan as a whole that doesn't fit into discrete elements.

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