The ADI goal represents the patient’s advance healthcare decision goals for the medical interventions that will be part of the clinician-authored care plan that will drive treatment. The patient’s documented goals of the medical care they will receive is based on the context or condition specified, and is intended to guide the provider-authored interventions that will be documented by the care team providing the treatment interventions that meet those documented patient goals. This allows a person-centered approach to care planning that reflects the specific goals, preferences, and priorities of that person which can then be merged with the clinical care plan so as to enable a jointly developed plan of care between the provider and person receiving care.

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

This structure is derived from USCoreGoalProfile

Name	Flags	Card.	Type	Description & Constraints
Goal	C	0..*	USCoreGoalProfile	This is an abstract profile. Child profiles: Goal, Goal, Goal Describes the intended objective(s) for a patient, group or organization goal-subject-expressedby: subject and expressedBy refer to the same patient
text	S	1..1	Narrative	Text summary of the resource, for human interpretation
category	S	0..*	CodeableConcept	E.g. Treatment, dietary, behavioral, etc.
text	S	0..1	string	Plain text representation of the concept
description
ContextualValueExtension		0..1	(Complex)	Contextual Value URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension
expressedBy	S	1..1	Reference(US Core Patient Profile)	Who's responsible for creating Goal?
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
goal-subject-expressedby	error	Goal	subject and expressedBy refer to the same patient : subject = expressedBy

Name	Flags	Card.	Type	Description & Constraints
Goal	C	0..*	USCoreGoalProfile	This is an abstract profile. Child profiles: Goal, Goal, Goal Describes the intended objective(s) for a patient, group or organization goal-subject-expressedby: subject and expressedBy refer to the same patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
text	S	1..1	Narrative	Text summary of the resource, for human interpretation
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
lifecycleStatus	?!SΣ	1..1	code	proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
category	SΣ	0..*	CodeableConcept	E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals.
text	SΣ	0..1	string	Plain text representation of the concept
description	SΣ	1..1	CodeableConcept	Code or text describing goal Binding: SNOMEDCTClinicalFindings (example): Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.
ContextualValueExtension		0..1	(Complex)	Contextual Value URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who this goal is intended for
target	SC	0..*	BackboneElement	Target outcome for the goal
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
due[x]	SΣ	0..1		Reach goal on or before
dueDate			date
expressedBy	SΣ	1..1	Reference(US Core Patient Profile)	Who's responsible for creating Goal?
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Goal.lifecycleStatus	required	GoalLifecycleStatus
Goal.category	example	GoalCategory
Goal.description	example	SNOMEDCTClinicalFindings

Constraints

Id	Grade	Path(s)	Details	Requirements
goal-subject-expressedby	error	Goal	subject and expressedBy refer to the same patient : subject = expressedBy

Name	Flags	Card.	Type	Description & Constraints
Goal	C	0..*	USCoreGoalProfile	This is an abstract profile. Child profiles: Goal, Goal, Goal Describes the intended objective(s) for a patient, group or organization goal-subject-expressedby: subject and expressedBy refer to the same patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text	S	1..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External Ids for this goal
lifecycleStatus	?!SΣ	1..1	code	proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
achievementStatus	Σ	0..1	CodeableConcept	in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable Binding: GoalAchievementStatus (preferred): Indicates the progression, or lack thereof, towards the goal against the target.
category	SΣ	0..*	CodeableConcept	E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
text	SΣ	0..1	string	Plain text representation of the concept
priority	Σ	0..1	CodeableConcept	high-priority | medium-priority | low-priority Binding: GoalPriority (preferred): The level of importance associated with a goal.
description	SΣ	1..1	CodeableConcept	Code or text describing goal Binding: SNOMEDCTClinicalFindings (example): Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ContextualValueExtension		0..1	(Complex)	Contextual Value URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who this goal is intended for
start[x]	Σ	0..1		When goal pursuit begins Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.
startDate			date
startCodeableConcept			CodeableConcept
target	SC	0..*	BackboneElement	Target outcome for the goal
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
measure	ΣC	0..1	CodeableConcept	The parameter whose value is being tracked Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.
detail[x]	ΣC	0..1		The target value to be achieved Binding: (unbound) (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.
detailQuantity			Quantity
detailRange			Range
detailCodeableConcept			CodeableConcept
detailString			string
detailBoolean			boolean
detailInteger			integer
detailRatio			Ratio
due[x]	SΣ	0..1		Reach goal on or before
dueDate			date S
dueDuration			Duration
statusDate	Σ	0..1	date	When goal status took effect
statusReason		0..1	string	Reason for current status
expressedBy	SΣ	1..1	Reference(US Core Patient Profile)	Who's responsible for creating Goal?
addresses		0..*	Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment)	Issues addressed by this goal
note		0..*	Annotation	Comments about the goal
outcomeCode		0..*	CodeableConcept	What result was achieved regarding the goal? Binding: SNOMEDCTClinicalFindings (example): The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months".
outcomeReference		0..*	Reference(Observation)	Observation that resulted from goal
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Goal.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Goal.lifecycleStatus	required	GoalLifecycleStatus
Goal.achievementStatus	preferred	GoalAchievementStatus
Goal.category	example	GoalCategory
Goal.priority	preferred	GoalPriority
Goal.description	example	SNOMEDCTClinicalFindings
Goal.start[x]	example	GoalStartEvent
Goal.target.measure	example	LOINCCodes (a valid code from LOINC)
Goal.target.detail[x]	example
Goal.outcomeCode	example	SNOMEDCTClinicalFindings

Differential View

This structure is derived from USCoreGoalProfile

Name	Flags	Card.	Type	Description & Constraints
Goal	C	0..*	USCoreGoalProfile	This is an abstract profile. Child profiles: Goal, Goal, Goal Describes the intended objective(s) for a patient, group or organization goal-subject-expressedby: subject and expressedBy refer to the same patient
text	S	1..1	Narrative	Text summary of the resource, for human interpretation
category	S	0..*	CodeableConcept	E.g. Treatment, dietary, behavioral, etc.
text	S	0..1	string	Plain text representation of the concept
description
ContextualValueExtension		0..1	(Complex)	Contextual Value URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension
expressedBy	S	1..1	Reference(US Core Patient Profile)	Who's responsible for creating Goal?
Documentation for this format

Constraints

Id	Grade	Path(s)	Details	Requirements
goal-subject-expressedby	error	Goal	subject and expressedBy refer to the same patient : subject = expressedBy

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Goal	C	0..*	USCoreGoalProfile	This is an abstract profile. Child profiles: Goal, Goal, Goal Describes the intended objective(s) for a patient, group or organization goal-subject-expressedby: subject and expressedBy refer to the same patient
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
text	S	1..1	Narrative	Text summary of the resource, for human interpretation
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
lifecycleStatus	?!SΣ	1..1	code	proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
category	SΣ	0..*	CodeableConcept	E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals.
text	SΣ	0..1	string	Plain text representation of the concept
description	SΣ	1..1	CodeableConcept	Code or text describing goal Binding: SNOMEDCTClinicalFindings (example): Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.
ContextualValueExtension		0..1	(Complex)	Contextual Value URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who this goal is intended for
target	SC	0..*	BackboneElement	Target outcome for the goal
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
due[x]	SΣ	0..1		Reach goal on or before
dueDate			date
expressedBy	SΣ	1..1	Reference(US Core Patient Profile)	Who's responsible for creating Goal?
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Goal.lifecycleStatus	required	GoalLifecycleStatus
Goal.category	example	GoalCategory
Goal.description	example	SNOMEDCTClinicalFindings

Constraints

Id	Grade	Path(s)	Details	Requirements
goal-subject-expressedby	error	Goal	subject and expressedBy refer to the same patient : subject = expressedBy

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Goal	C	0..*	USCoreGoalProfile	This is an abstract profile. Child profiles: Goal, Goal, Goal Describes the intended objective(s) for a patient, group or organization goal-subject-expressedby: subject and expressedBy refer to the same patient
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text	S	1..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier		0..*	Identifier	External Ids for this goal
lifecycleStatus	?!SΣ	1..1	code	proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected Binding: GoalLifecycleStatus (required)
achievementStatus	Σ	0..1	CodeableConcept	in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable Binding: GoalAchievementStatus (preferred): Indicates the progression, or lack thereof, towards the goal against the target.
category	SΣ	0..*	CodeableConcept	E.g. Treatment, dietary, behavioral, etc. Binding: GoalCategory (example): Codes for grouping and sorting goals.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	0..*	Coding	Code defined by a terminology system
text	SΣ	0..1	string	Plain text representation of the concept
priority	Σ	0..1	CodeableConcept	high-priority | medium-priority | low-priority Binding: GoalPriority (preferred): The level of importance associated with a goal.
description	SΣ	1..1	CodeableConcept	Code or text describing goal Binding: SNOMEDCTClinicalFindings (example): Codes providing the details of a particular goal. This will generally be system or implementation guide-specific. In many systems, only the text element will be used.
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
ContextualValueExtension		0..1	(Complex)	Contextual Value URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(US Core Patient Profile)	Who this goal is intended for
start[x]	Σ	0..1		When goal pursuit begins Binding: GoalStartEvent (example): Codes describing events that can trigger the initiation of a goal.
startDate			date
startCodeableConcept			CodeableConcept
target	SC	0..*	BackboneElement	Target outcome for the goal
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
measure	ΣC	0..1	CodeableConcept	The parameter whose value is being tracked Binding: LOINCCodes (example): Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level.
detail[x]	ΣC	0..1		The target value to be achieved Binding: (unbound) (example): Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal.
detailQuantity			Quantity
detailRange			Range
detailCodeableConcept			CodeableConcept
detailString			string
detailBoolean			boolean
detailInteger			integer
detailRatio			Ratio
due[x]	SΣ	0..1		Reach goal on or before
dueDate			date S
dueDuration			Duration
statusDate	Σ	0..1	date	When goal status took effect
statusReason		0..1	string	Reason for current status
expressedBy	SΣ	1..1	Reference(US Core Patient Profile)	Who's responsible for creating Goal?
addresses		0..*	Reference(Condition | Observation | MedicationStatement | NutritionOrder | ServiceRequest | RiskAssessment)	Issues addressed by this goal
note		0..*	Annotation	Comments about the goal
outcomeCode		0..*	CodeableConcept	What result was achieved regarding the goal? Binding: SNOMEDCTClinicalFindings (example): The result of the goal; e.g. "25% increase in shoulder mobility", "Anxiety reduced to moderate levels". "15 kg weight loss sustained over 6 months".
outcomeReference		0..*	Reference(Observation)	Observation that resulted from goal
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet
Goal.language	preferred	CommonLanguages Additional Bindings Purpose AllLanguages Max Binding
Goal.lifecycleStatus	required	GoalLifecycleStatus
Goal.achievementStatus	preferred	GoalAchievementStatus
Goal.category	example	GoalCategory
Goal.priority	preferred	GoalPriority
Goal.description	example	SNOMEDCTClinicalFindings
Goal.start[x]	example	GoalStartEvent
Goal.target.measure	example	LOINCCodes (a valid code from LOINC)
Goal.target.detail[x]	example
Goal.outcomeCode	example	SNOMEDCTClinicalFindings

This structure is derived from USCoreGoalProfile

Summary

Mandatory: 2 elements
Must-Support: 4 elements

Structures

This structure refers to these other structures:

• US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/pacio-adi/StructureDefinition/padi-contextualValue-extension