SDOH Clinical Care
2.2.0 - STU 2.2 United States of America flag

SDOH Clinical Care, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 2.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-sdoh-clinicalcare/ and changes regularly. See the Directory of published versions

Resource Profile: SDOHCCCondition - Detailed Descriptions

Page standards status: Trial-use

Definitions for the SDOHCC-Condition resource profile.

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

0. Condition
Definition

For representation of SDOH conditions.

ShortDetailed information about SDOH conditions, problems or diagnoses
Comments

Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths (e.g., to arrive at SDOH Conditions) are also possible.

One specific use for this profile is to represent a Health Concern that is either; 1) directly asserted based on the patient’s answer to a specific question from an SDOH screening questionnaire or 2) computed/generated based on the patient’s answers to multiple questions. The questions and answers from the screening questionnaire are also represented using SDC Questionnaire, SDC QuestionnaireResponse and SDOHCC Screening Response Observation.

InvariantsSDOH-Con-1: Can only have a max of one asserter. (extension('http://hl7.org/fhir/us/sdoh-clinicalcare/extension-Condition.asserter').count()+asserter.count()<=1)
2. Condition.extension
SlicingThis element introduces a set of slices on Condition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Condition.extension:asserterDevice
    Slice NameasserterDevice
    Control0..1
    This element is affected by the following invariants: SDOH-Con-1
    TypeExtension(SDOHCC Extension Condition Asserter) (Extension Type: Reference)
    Must Supporttrue
    6. Condition.extension:asserterDevice.value[x]
    TypeReference(Device)
    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
    8. Condition.verificationStatus
    Comments

    verificationStatus is not required. For example, when a patient complains of stress during a provider encounter, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

    For SDOH conditions that are autogenerated based on a questionnaire response, the Condition.asserter is a “Device” AND Condition.Category should be "health-concern". In that case, Condition.verificationStatus should be "unconfirmed" and should be changed to “confirmed” only after review and concurrence by the provider and patient.

    10. Condition.category
    Requirements

    For a condition that is autogenerated based only on an individual's responses to an SDOH questionnaire, category should be "health-concern".

    SlicingThis element introduces a set of slices on Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ $this
    • 12. Condition.category:SDOH
      Slice NameSDOH
      Definition

      An SDOH category assigned to the condition.

      Shorte.g., food-insecurity | transportation-insecurity
      Control0..*
      BindingThe codes SHALL be taken from SDOHCC ValueSet SDOH Category
      (required to http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory)

      Codes for high-level SDOH categories.

      Requirements

      Codes from this value set can be used to assign one or more SDOH categories (e.g., food-insecurity, transportation-insecurity, etc.) to a condition. It is recommended that SDOH category codes be used to facilitate searching for SDOH conditions.

      14. Condition.code
      BindingThe codes SHALL be taken from US Core Condition Code
      (required to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code)

      Valueset to describe the actual problem experienced by the patient

      Additional BindingsPurposeUsage
      Digital Access Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): digital-access
      Digital Literacy Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): digital-literacy
      Less Than High School Education Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): educational-attainment
      Elder Abuse Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): elder-abuse
      Unemployment Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): employment-status
      Financial Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): financial-insecurity
      Food Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): food-insecurity
      Health Insurance Coverage Status Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): health-insurance-coverage-status
      Homelessness Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): homelessness
      Housing Instability Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): housing-instability
      Inadequate Housing Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): inadequate-housing
      Intimate Partner Violence Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): intimate-partner-violence
      Material Hardship Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): material-hardship
      Medical Cost Burden Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): medical-cost-burden
      Health Literacy Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): personal-health-literacy
      Social Connection Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): social-connection
      Stress Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): stress
      Transportation Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): transportation-insecurity
      Utility Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): utility-insecurity
      Veteran Status Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): veteran-status
      US Core Condition CodeRequiredCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): sdoh-category-unspecified
      Requirements

      Code is required and must be selected from the bound value set.

      16. Condition.bodySite
      Control0..0
      18. Condition.subject
      Definition

      Indicates the patient who the condition record is associated with.

      Requirements

      US Core Condition Profile restricts subject to patient.

      20. Condition.onset[x]
      Definition

      Estimated or actual dateTime or Period the condition began.

      ShortEstimated dateTime or Period
      Comments

      For SDOH conditions that have their onset over an extended (or fuzzy) period (e.g., the past month), Condition.onset may use a lower precision representation (e.g., month/year or year) as opposed to a higher precision representation (e.g., year/month/date/hour/min).

      TypeChoice of: dateTime, Period, string, Range, Age
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      22. Condition.abatement[x]
      Definition

      The estimated or actual dateTime or Period that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution".

      Comments

      There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

      For SDOH Conditions that have a fuzzy abatement period, a lower precision representation (e.g., month/year or year) may be used. However, for SDOH Conditions that end at a specific point in time (e.g., food insecurity may abate upon acquiring a new job or gaining eligibility to a food program) a higher precision representation (e.g., year/month/date) may also be used.

      TypeChoice of: dateTime, Period, string, Range, Age
      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      24. Condition.recorder
      TypeReference(Practitioner, PractitionerRole)
      26. Condition.asserter
      Definition

      The individual or device making the condition statement.

      ShortPerson or device that asserts this condition
      Comments

      References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

      For a condition that is autogenerated based on the patient directly answering a specific question from an SDOH screening questionnaire, the Condition.asserter should be the patient. For a condition that is autogenerated based on a computation that uses the patient’s answers to multiple questions, Condition.asserter should reference “Device” (using the using AsserterDevice extension) to specify the device used to compute the condition.

      TypeReference(RelatedPerson, US Core Patient Profile, US Core Practitioner Profile, US Core PractitionerRole Profile)
      Must Supporttrue
      Must Support TypesNo must-support rules about the choice of types/profiles
      28. Condition.stage
      Control0..0
      30. Condition.evidence
      Must Supporttrue
      32. Condition.evidence.code
      Comments

      Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

      Information represented by Condition.evidence.code may overlap significantly with information represented by Condition.evidence.detail. Multiple approaches to representing the same information may negatively impact interoperability. Therefore, where similar infomation could be provided by either Condition.evidence.code or Condition.evidence.detail, it is recommended that Condition.evidence.detail should be used as supporting evidence for the condition.

      34. Condition.evidence.detail
      Comments

      References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

      Additionally, see Comment for Condition.evidence.code.

      SlicingThis element introduces a set of slices on Condition.evidence.detail. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • profile @ resolve()
      • 36. Condition.evidence.detail:SupportedDetail
        Slice NameSupportedDetail
        Definition

        Links to other relevant information.

        Control0..*
        TypeReference(SDOHCC Observation Screening Response, SDOHCC Condition, SDOHCC Observation Assessment, SDC Questionnaire Response)
        Must Supporttrue
        Must Support TypesNo must-support rules about the choice of types/profiles
        Requirements

        When a condition is based on one or more SDOH observations that were generated from questionnaire responses, Condition.evidence.detail should reference instances that comply with the SDOHCC Observation Screening Response or SDC Questionnaire Response. However, references to other instance types are also possible.

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

        0. Condition
        Definition

        For representation of SDOH conditions.


        A clinical condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern.

        ShortDetailed information about SDOH conditions, problems or diagnosesDetailed information about conditions, problems or diagnoses
        Comments

        Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths (e.g., to arrive at SDOH Conditions) are also possible.

        One specific use for this profile is to represent a Health Concern that is either; 1) directly asserted based on the patient’s answer to a specific question from an SDOH screening questionnaire or 2) computed/generated based on the patient’s answers to multiple questions. The questions and answers from the screening questionnaire are also represented using SDC Questionnaire, SDC QuestionnaireResponse and SDOHCC Screening Response Observation.

        Control0..*
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
        con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
        con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
        dom-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())
        us-core-1: A code in Condition.category SHOULD be from US Core Condition Category Codes value set. (where(category.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-condition-category')).exists())
        SDOH-Con-1: Can only have a max of one asserter. (extension('http://hl7.org/fhir/us/sdoh-clinicalcare/extension-Condition.asserter').count()+asserter.count()<=1)
        con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
        con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
        con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
        2. Condition.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. Condition.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 Condition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 6. Condition.extension:asserterDevice
          Slice NameasserterDevice
          Definition

          Optional Extension Element - found in all resources.

          ShortOptional Extensions Element
          Control0..1
          This element is affected by the following invariants: ele-1, SDOH-Con-1
          TypeExtension(SDOHCC Extension Condition Asserter) (Extension Type: Reference)
          Is Modifierfalse
          Must Supporttrue
          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())
          8. Condition.extension:asserterDevice.extension
          Definition

          An Extension


          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.

          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..0*
          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 Condition.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 10. Condition.extension:asserterDevice.url
            Definition

            Source of the definition for the extension code - a logical name or a URL.

            Shortidentifies the meaning of the extension
            Comments

            The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

            Control1..1
            Typeuri
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            Fixed Valuehttp://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ExtensionConditionAsserter
            12. Condition.extension:asserterDevice.value[x]
            Definition

            Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

            ShortValue of extension
            Control0..1
            TypeReference(Device), date, Meta, Address, Attachment, integer, Count, DataRequirement, Dosage, uuid, Identifier, Coding, SampledData, id, positiveInt, Distance, Period, Duration, canonical, Range, RelatedArtifact, base64Binary, UsageContext, Timing, decimal, CodeableConcept, ParameterDefinition, dateTime, code, string, Contributor, oid, instant, ContactPoint, HumanName, Money, markdown, Ratio, Age, TriggerDefinition, Quantity, uri, url, Annotation, ContactDetail, boolean, Expression, Signature, unsignedInt, time
            [x] NoteSeeChoice of Data Typesfor 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()))
            14. Condition.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())
            16. Condition.clinicalStatus
            Definition

            The clinical status of the condition.

            Shortactive | recurrence | relapse | inactive | remission | resolved
            Comments

            The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

            Control0..1
            This element is affected by the following invariants: con-3, con-4, con-5
            BindingThe codes SHALL be taken from ConditionClinicalStatusCodeshttp://hl7.org/fhir/ValueSet/condition-clinical|4.0.1
            (required to http://hl7.org/fhir/ValueSet/condition-clinical)
            TypeCodeableConcept
            Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            18. Condition.verificationStatus
            Definition

            The verification status to support the clinical status of the condition.

            Shortunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
            Comments

            verificationStatus is not required. For example, when a patient complains of stress during a provider encounter, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

            For SDOH conditions that are autogenerated based on a questionnaire response, the Condition.asserter is a “Device” AND Condition.Category should be "health-concern". In that case, Condition.verificationStatus should be "unconfirmed" and should be changed to “confirmed” only after review and concurrence by the provider and patient.


            verificationStatus is not required. For example, when a patient has abdominal pain in the ED, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

            Control0..1
            This element is affected by the following invariants: con-3, con-5
            BindingThe codes SHALL be taken from ConditionVerificationStatushttp://hl7.org/fhir/ValueSet/condition-ver-status|4.0.1
            (required to http://hl7.org/fhir/ValueSet/condition-ver-status)
            TypeCodeableConcept
            Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
            Must Supporttrue
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            20. Condition.category
            Definition

            A category assigned to the condition.

            Shortproblem-list-item | encounter-diagnosis | health-concern
            Comments

            The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

            Control10..*
            This element is affected by the following invariants: us-core-1
            BindingUnless not suitable, these codes SHALL be taken from US Core Condition Category Codeshttp://hl7.org/fhir/ValueSet/condition-category
            (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-category)
            TypeCodeableConcept
            Is Modifierfalse
            Must Supporttrue
            Summaryfalse
            Requirements

            For a condition that is autogenerated based only on an individual's responses to an SDOH questionnaire, category should be "health-concern".

            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 Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ $this
            • 22. Condition.category:SDOH
              Slice NameSDOH
              Definition

              An SDOH category assigned to the condition.


              A category assigned to the condition.

              Shorte.g., food-insecurity | transportation-insecurityproblem-list-item | encounter-diagnosis
              Comments

              The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

              Control0..*
              This element is affected by the following invariants: us-core-1
              BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from SDOHCC ValueSet SDOH Categoryhttp://hl7.org/fhir/ValueSet/condition-category
              (required to http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory)

              Codes for high-level SDOH categories.


              A category assigned to the condition.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Requirements

              Codes from this value set can be used to assign one or more SDOH categories (e.g., food-insecurity, transportation-insecurity, etc.) to a condition. It is recommended that SDOH category codes be used to facilitate searching for SDOH conditions.

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

              Identification of the condition, problem or diagnosis.

              ShortIdentification of the condition, problem or diagnosis
              Control10..1
              BindingThe codes SHALL be taken from For example codes, see US Core Condition Codehttp://hl7.org/fhir/ValueSet/condition-code
              (required to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code)

              Valueset to describe the actual problem experienced by the patient


              Identification of the condition or diagnosis.

              Additional BindingsPurposeUsage
              Digital Access Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): digital-access
              Digital Literacy Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): digital-literacy
              Less Than High School Education Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): educational-attainment
              Elder Abuse Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): elder-abuse
              Unemployment Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): employment-status
              Financial Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): financial-insecurity
              Food Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): food-insecurity
              Health Insurance Coverage Status Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): health-insurance-coverage-status
              Homelessness Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): homelessness
              Housing Instability Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): housing-instability
              Inadequate Housing Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): inadequate-housing
              Intimate Partner Violence Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): intimate-partner-violence
              Material Hardship Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): material-hardship
              Medical Cost Burden Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): medical-cost-burden
              Health Literacy Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): personal-health-literacy
              Social Connection Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): social-connection
              Stress Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): stress
              Transportation Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): transportation-insecurity
              Utility Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): utility-insecurity
              Veteran Status Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): veteran-status
              US Core Condition CodeRequiredCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): sdoh-category-unspecified
              TypeCodeableConcept
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              Code is required and must be selected from the bound value set.


              0..1 to account for primarily narrative only resources.

              Alternate Namestype
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              26. Condition.bodySite
              Definition

              The anatomical location where this condition manifests itself.

              ShortAnatomical location, if relevant
              Comments

              Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

              Control0..0*
              BindingFor example codes, see SNOMEDCTBodyStructureshttp://hl7.org/fhir/ValueSet/body-site
              (example to http://hl7.org/fhir/ValueSet/body-site)

              Codes describing anatomical locations. May include laterality.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              28. Condition.subject
              Definition

              Indicates the patient who the condition record is associated with.


              Indicates the patient or group who the condition record is associated with.

              ShortWho has the condition?
              Control1..1
              TypeReference(US Core Patient Profile, Patient, Group)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

              US Core Condition Profile restricts subject to patient.


              Group is typically used for veterinary or public health use cases.

              Alternate Namespatient
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. Condition.onset[x]
              Definition

              Estimated or actual dateTime or Period the condition began.


              Estimated or actual date or date-time the condition began, in the opinion of the clinician.

              ShortEstimated dateTime or PeriodEstimated or actual date, date-time, or age
              Comments

              For SDOH conditions that have their onset over an extended (or fuzzy) period (e.g., the past month), Condition.onset may use a lower precision representation (e.g., month/year or year) as opposed to a higher precision representation (e.g., year/month/date/hour/min).


              Age is generally used when the patient reports an age at which the Condition began to occur.

              Control0..1
              TypeChoice of: dateTime, Period, string, Range, Age
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              32. Condition.abatement[x]
              Definition

              The estimated or actual dateTime or Period that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution".


              The date or estimated date that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution" - Conditions are never really resolved, but they can abate.

              ShortWhen in resolution/remission
              Comments

              There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

              For SDOH Conditions that have a fuzzy abatement period, a lower precision representation (e.g., month/year or year) may be used. However, for SDOH Conditions that end at a specific point in time (e.g., food insecurity may abate upon acquiring a new job or gaining eligibility to a food program) a higher precision representation (e.g., year/month/date) may also be used.


              There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. Age is generally used when the patient reports an age at which the Condition abated. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

              Control0..1
              This element is affected by the following invariants: con-4
              TypeChoice of: dateTime, Period, string, Range, Age
              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. Condition.recorder
              Definition

              Individual who recorded the record and takes responsibility for its content.

              ShortWho recorded the condition
              Control0..1
              TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson)
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              36. Condition.asserter
              Definition

              The individual or device making the condition statement.


              Individual who is making the condition statement.

              ShortPerson or device that asserts this conditionPerson who asserts this condition
              Comments

              References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

              For a condition that is autogenerated based on the patient directly answering a specific question from an SDOH screening questionnaire, the Condition.asserter should be the patient. For a condition that is autogenerated based on a computation that uses the patient’s answers to multiple questions, Condition.asserter should reference “Device” (using the using AsserterDevice extension) to specify the device used to compute the condition.

              Control0..1
              This element is affected by the following invariants: SDOH-Con-1
              TypeReference(RelatedPerson, US Core Patient Profile, US Core Practitioner Profile, US Core PractitionerRole Profile, Practitioner, PractitionerRole, Patient)
              Is Modifierfalse
              Must Supporttrue
              Must Support TypesNo must-support rules about the choice of types/profiles
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. Condition.stage
              Definition

              Clinical stage or grade of a condition. May include formal severity assessments.

              ShortStage/grade, usually assessed formally
              Control0..0*
              TypeBackboneElement
              Is Modifierfalse
              Summaryfalse
              Invariantscon-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
              ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              con-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
              41. Condition.evidence
              Definition

              Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

              ShortSupporting evidence
              Comments

              The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

              Control0..*
              TypeBackboneElement
              Is Modifierfalse
              Must Supporttrue
              Summaryfalse
              Invariantscon-2: evidence SHALL have code or details (code.exists() or detail.exists())
              ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              con-2: evidence SHALL have code or details (code.exists() or detail.exists())
              43. Condition.evidence.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())
              45. Condition.evidence.code
              Definition

              A manifestation or symptom that led to the recording of this condition.

              ShortManifestation/symptom
              Comments

              Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

              Information represented by Condition.evidence.code may overlap significantly with information represented by Condition.evidence.detail. Multiple approaches to representing the same information may negatively impact interoperability. Therefore, where similar infomation could be provided by either Condition.evidence.code or Condition.evidence.detail, it is recommended that Condition.evidence.detail should be used as supporting evidence for the condition.

              Control0..*
              This element is affected by the following invariants: con-2
              BindingFor example codes, see ManifestationAndSymptomCodeshttp://hl7.org/fhir/ValueSet/manifestation-or-symptom
              (example to http://hl7.org/fhir/ValueSet/manifestation-or-symptom)

              Codes that describe the manifestation or symptoms of a condition.

              TypeCodeableConcept
              Is Modifierfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              47. Condition.evidence.detail
              Definition

              Links to other relevant information, including pathology reports.

              ShortSupporting information found elsewhere
              Comments

              References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

              Additionally, see Comment for Condition.evidence.code.

              Control0..*
              This element is affected by the following invariants: con-2
              TypeReference(Resource)
              Is Modifierfalse
              Summarytrue
              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 Condition.evidence.detail. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • profile @ resolve()
              • 49. Condition.evidence.detail:SupportedDetail
                Slice NameSupportedDetail
                Definition

                Links to other relevant information.


                Links to other relevant information, including pathology reports.

                ShortSupporting information found elsewhere
                Control0..*
                This element is affected by the following invariants: con-2
                TypeReference(SDOHCC Observation Screening Response, SDOHCC Condition, SDOHCC Observation Assessment, SDC Questionnaire Response, Resource)
                Is Modifierfalse
                Must Supporttrue
                Must Support TypesNo must-support rules about the choice of types/profiles
                Summarytrue
                Requirements

                When a condition is based on one or more SDOH observations that were generated from questionnaire responses, Condition.evidence.detail should reference instances that comply with the SDOHCC Observation Screening Response or SDC Questionnaire Response. However, references to other instance types are also possible.

                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. Condition
                Definition

                For representation of SDOH conditions.

                ShortDetailed information about SDOH conditions, problems or diagnoses
                Comments

                Many of the SDOHCC profiles reference one another. One flow supported by this IG is that QuestionnaireResponses result in Observations that can be used as evidence for Conditions that can lead to Goals, ServiceRequests and Procedures. However, alternatives paths (e.g., to arrive at SDOH Conditions) are also possible.

                One specific use for this profile is to represent a Health Concern that is either; 1) directly asserted based on the patient’s answer to a specific question from an SDOH screening questionnaire or 2) computed/generated based on the patient’s answers to multiple questions. The questions and answers from the screening questionnaire are also represented using SDC Questionnaire, SDC QuestionnaireResponse and SDOHCC Screening Response Observation.

                Control0..*
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
                con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
                con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
                dom-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())
                us-core-1: A code in Condition.category SHOULD be from US Core Condition Category Codes value set. (where(category.memberOf('http://hl7.org/fhir/us/core/ValueSet/us-core-condition-category')).exists())
                SDOH-Con-1: Can only have a max of one asserter. (extension('http://hl7.org/fhir/us/sdoh-clinicalcare/extension-Condition.asserter').count()+asserter.count()<=1)
                2. Condition.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. Condition.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. Condition.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. Condition.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
                (preferred to http://hl7.org/fhir/ValueSet/languages)

                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. Condition.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
                Summaryfalse
                Alternate Namesnarrative, html, xhtml, display
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                12. Condition.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. Condition.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 Condition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 16. Condition.extension:asserterDevice
                  Slice NameasserterDevice
                  Definition

                  Optional Extension Element - found in all resources.

                  ShortOptional Extensions Element
                  Control0..1
                  This element is affected by the following invariants: ele-1, SDOH-Con-1
                  TypeExtension(SDOHCC Extension Condition Asserter) (Extension Type: Reference)
                  Is Modifierfalse
                  Must Supporttrue
                  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. Condition.extension:asserterDevice.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
                  20. Condition.extension:asserterDevice.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..0
                  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 Condition.extension.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 22. Condition.extension:asserterDevice.url
                    Definition

                    Source of the definition for the extension code - a logical name or a URL.

                    Shortidentifies the meaning of the extension
                    Comments

                    The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

                    Control1..1
                    Typeuri
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    Fixed Valuehttp://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ExtensionConditionAsserter
                    24. Condition.extension:asserterDevice.value[x]
                    Definition

                    Value of extension - must be one of a constrained set of the data types (see Extensibility for a list).

                    ShortValue of extension
                    Control0..1
                    TypeReference(Device)
                    [x] NoteSeeChoice of Data Typesfor 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()))
                    26. Condition.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())
                    28. Condition.identifier
                    Definition

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

                    ShortExternal Ids for this condition
                    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 condition 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()))
                    30. Condition.clinicalStatus
                    Definition

                    The clinical status of the condition.

                    Shortactive | recurrence | relapse | inactive | remission | resolved
                    Comments

                    The data type is CodeableConcept because clinicalStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

                    Control0..1
                    This element is affected by the following invariants: con-3, con-4, con-5
                    BindingThe codes SHALL be taken from ConditionClinicalStatusCodes
                    (required to http://hl7.org/fhir/ValueSet/condition-clinical)
                    TypeCodeableConcept
                    Is Modifiertrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
                    Must Supporttrue
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    32. Condition.verificationStatus
                    Definition

                    The verification status to support the clinical status of the condition.

                    Shortunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
                    Comments

                    verificationStatus is not required. For example, when a patient complains of stress during a provider encounter, there is not likely going to be a verification status. The data type is CodeableConcept because verificationStatus has some clinical judgment involved, such that there might need to be more specificity than the required FHIR value set allows. For example, a SNOMED coding might allow for additional specificity.

                    For SDOH conditions that are autogenerated based on a questionnaire response, the Condition.asserter is a “Device” AND Condition.Category should be "health-concern". In that case, Condition.verificationStatus should be "unconfirmed" and should be changed to “confirmed” only after review and concurrence by the provider and patient.

                    Control0..1
                    This element is affected by the following invariants: con-3, con-5
                    BindingThe codes SHALL be taken from ConditionVerificationStatus
                    (required to http://hl7.org/fhir/ValueSet/condition-ver-status)
                    TypeCodeableConcept
                    Is Modifiertrue because This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.
                    Must Supporttrue
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    34. Condition.category
                    Definition

                    A category assigned to the condition.

                    Shortproblem-list-item | encounter-diagnosis | health-concern
                    Comments

                    The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

                    Control1..*
                    This element is affected by the following invariants: us-core-1
                    BindingUnless not suitable, these codes SHALL be taken from US Core Condition Category Codes
                    (extensible to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-category)
                    TypeCodeableConcept
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Requirements

                    For a condition that is autogenerated based only on an individual's responses to an SDOH questionnaire, category should be "health-concern".

                    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 Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ $this
                    • 36. Condition.category:SDOH
                      Slice NameSDOH
                      Definition

                      An SDOH category assigned to the condition.

                      Shorte.g., food-insecurity | transportation-insecurity
                      Comments

                      The categorization is often highly contextual and may appear poorly differentiated or not very useful in other contexts.

                      Control0..*
                      This element is affected by the following invariants: us-core-1
                      BindingThe codes SHALL be taken from SDOHCC ValueSet SDOH Category
                      (required to http://hl7.org/fhir/us/sdoh-clinicalcare/ValueSet/SDOHCC-ValueSetSDOHCategory)

                      Codes for high-level SDOH categories.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Requirements

                      Codes from this value set can be used to assign one or more SDOH categories (e.g., food-insecurity, transportation-insecurity, etc.) to a condition. It is recommended that SDOH category codes be used to facilitate searching for SDOH conditions.

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

                      A subjective assessment of the severity of the condition as evaluated by the clinician.

                      ShortSubjective severity of condition
                      Comments

                      Coding of the severity with a terminology is preferred, where possible.

                      Control0..1
                      BindingThe codes SHOULD be taken from Condition/DiagnosisSeverity
                      (preferred to http://hl7.org/fhir/ValueSet/condition-severity)

                      A subjective assessment of the severity of the condition as evaluated by the clinician.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      40. Condition.code
                      Definition

                      Identification of the condition, problem or diagnosis.

                      ShortIdentification of the condition, problem or diagnosis
                      Control1..1
                      BindingThe codes SHALL be taken from US Core Condition Code
                      (required to http://hl7.org/fhir/us/core/ValueSet/us-core-condition-code)

                      Valueset to describe the actual problem experienced by the patient

                      Additional BindingsPurposeUsage
                      Digital Access Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): digital-access
                      Digital Literacy Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): digital-literacy
                      Less Than High School Education Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): educational-attainment
                      Elder Abuse Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): elder-abuse
                      Unemployment Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): employment-status
                      Financial Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): financial-insecurity
                      Food Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): food-insecurity
                      Health Insurance Coverage Status Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): health-insurance-coverage-status
                      Homelessness Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): homelessness
                      Housing Instability Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): housing-instability
                      Inadequate Housing Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): inadequate-housing
                      Intimate Partner Violence Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): intimate-partner-violence
                      Material Hardship Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): material-hardship
                      Medical Cost Burden Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): medical-cost-burden
                      Health Literacy Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): personal-health-literacy
                      Social Connection Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): social-connection
                      Stress Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): stress
                      Transportation Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): transportation-insecurity
                      Utility Insecurity Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): utility-insecurity
                      Veteran Status Diagnoses .ExtensibleCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): veteran-status
                      US Core Condition CodeRequiredCondition.category (Details: SDOHCC-Condition code Condition.category = ' Condition.category ', stated as ' null '): sdoh-category-unspecified
                      TypeCodeableConcept
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      Code is required and must be selected from the bound value set.

                      Alternate Namestype
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      42. Condition.bodySite
                      Definition

                      The anatomical location where this condition manifests itself.

                      ShortAnatomical location, if relevant
                      Comments

                      Only used if not implicit in code found in Condition.code. If the use case requires attributes from the BodySite resource (e.g. to identify and track separately) then use the standard extension bodySite. May be a summary code, or a reference to a very precise definition of the location, or both.

                      Control0..0
                      BindingFor example codes, see SNOMEDCTBodyStructures
                      (example to http://hl7.org/fhir/ValueSet/body-site)

                      Codes describing anatomical locations. May include laterality.

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

                      Indicates the patient who the condition record is associated with.

                      ShortWho has the condition?
                      Control1..1
                      TypeReference(US Core Patient Profile)
                      Is Modifierfalse
                      Must Supporttrue
                      Summarytrue
                      Requirements

                      US Core Condition Profile restricts subject to patient.

                      Alternate Namespatient
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      46. Condition.encounter
                      Definition

                      The Encounter during which this Condition 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. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

                      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. Condition.onset[x]
                      Definition

                      Estimated or actual dateTime or Period the condition began.

                      ShortEstimated dateTime or Period
                      Comments

                      For SDOH conditions that have their onset over an extended (or fuzzy) period (e.g., the past month), Condition.onset may use a lower precision representation (e.g., month/year or year) as opposed to a higher precision representation (e.g., year/month/date/hour/min).

                      Control0..1
                      TypeChoice of: dateTime, Period
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Must Support TypesNo must-support rules about the choice of types/profiles
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      50. Condition.abatement[x]
                      Definition

                      The estimated or actual dateTime or Period that the condition resolved or went into remission. This is called "abatement" because of the many overloaded connotations associated with "remission" or "resolution".

                      ShortWhen in resolution/remission
                      Comments

                      There is no explicit distinction between resolution and remission because in many cases the distinction is not clear. If there is no abatement element, it is unknown whether the condition has resolved or entered remission; applications and users should generally assume that the condition is still valid. When abatementString exists, it implies the condition is abated.

                      For SDOH Conditions that have a fuzzy abatement period, a lower precision representation (e.g., month/year or year) may be used. However, for SDOH Conditions that end at a specific point in time (e.g., food insecurity may abate upon acquiring a new job or gaining eligibility to a food program) a higher precision representation (e.g., year/month/date) may also be used.

                      Control0..1
                      This element is affected by the following invariants: con-4
                      TypeChoice of: dateTime, Period
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Must Supporttrue
                      Must Support TypesNo must-support rules about the choice of types/profiles
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      52. Condition.recordedDate
                      Definition

                      The recordedDate represents when this particular Condition 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
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      54. Condition.recorder
                      Definition

                      Individual who recorded the record and takes responsibility for its content.

                      ShortWho recorded the condition
                      Control0..1
                      TypeReference(Practitioner, PractitionerRole)
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      56. Condition.asserter
                      Definition

                      The individual or device making the condition statement.

                      ShortPerson or device that asserts this condition
                      Comments

                      References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

                      For a condition that is autogenerated based on the patient directly answering a specific question from an SDOH screening questionnaire, the Condition.asserter should be the patient. For a condition that is autogenerated based on a computation that uses the patient’s answers to multiple questions, Condition.asserter should reference “Device” (using the using AsserterDevice extension) to specify the device used to compute the condition.

                      Control0..1
                      This element is affected by the following invariants: SDOH-Con-1
                      TypeReference(RelatedPerson, US Core Patient Profile, US Core Practitioner Profile, US Core PractitionerRole Profile)
                      Is Modifierfalse
                      Must Supporttrue
                      Must Support TypesNo must-support rules about the choice of types/profiles
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      58. Condition.stage
                      Definition

                      Clinical stage or grade of a condition. May include formal severity assessments.

                      ShortStage/grade, usually assessed formally
                      Control0..0
                      TypeBackboneElement
                      Is Modifierfalse
                      Summaryfalse
                      Invariantscon-1: Stage SHALL have summary or assessment (summary.exists() or assessment.exists())
                      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      66. Condition.evidence
                      Definition

                      Supporting evidence / manifestations that are the basis of the Condition's verification status, such as evidence that confirmed or refuted the condition.

                      ShortSupporting evidence
                      Comments

                      The evidence may be a simple list of coded symptoms/manifestations, or references to observations or formal assessments, or both.

                      Control0..*
                      TypeBackboneElement
                      Is Modifierfalse
                      Must Supporttrue
                      Summaryfalse
                      Invariantscon-2: evidence SHALL have code or details (code.exists() or detail.exists())
                      ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      68. Condition.evidence.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
                      70. Condition.evidence.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())
                      72. Condition.evidence.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())
                      74. Condition.evidence.code
                      Definition

                      A manifestation or symptom that led to the recording of this condition.

                      ShortManifestation/symptom
                      Comments

                      Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.

                      Information represented by Condition.evidence.code may overlap significantly with information represented by Condition.evidence.detail. Multiple approaches to representing the same information may negatively impact interoperability. Therefore, where similar infomation could be provided by either Condition.evidence.code or Condition.evidence.detail, it is recommended that Condition.evidence.detail should be used as supporting evidence for the condition.

                      Control0..*
                      This element is affected by the following invariants: con-2
                      BindingFor example codes, see ManifestationAndSymptomCodes
                      (example to http://hl7.org/fhir/ValueSet/manifestation-or-symptom)

                      Codes that describe the manifestation or symptoms of a condition.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      76. Condition.evidence.detail
                      Definition

                      Links to other relevant information, including pathology reports.

                      ShortSupporting information found elsewhere
                      Comments

                      References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository.

                      Additionally, see Comment for Condition.evidence.code.

                      Control0..*
                      This element is affected by the following invariants: con-2
                      TypeReference(Resource)
                      Is Modifierfalse
                      Summarytrue
                      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 Condition.evidence.detail. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • profile @ resolve()
                      • 78. Condition.evidence.detail:SupportedDetail
                        Slice NameSupportedDetail
                        Definition

                        Links to other relevant information.

                        ShortSupporting information found elsewhere
                        Control0..*
                        This element is affected by the following invariants: con-2
                        TypeReference(SDOHCC Observation Screening Response, SDOHCC Condition, SDOHCC Observation Assessment, SDC Questionnaire Response)
                        Is Modifierfalse
                        Must Supporttrue
                        Must Support TypesNo must-support rules about the choice of types/profiles
                        Summarytrue
                        Requirements

                        When a condition is based on one or more SDOH observations that were generated from questionnaire responses, Condition.evidence.detail should reference instances that comply with the SDOHCC Observation Screening Response or SDC Questionnaire Response. However, references to other instance types are also possible.

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

                        Additional information about the Condition. This is a general notes/comments entry for description of the Condition, its diagnosis and prognosis.

                        ShortAdditional information about the Condition
                        Control0..*
                        TypeAnnotation
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))