National Directory of Healthcare Providers & Services (NDH) Implementation Guide
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National Directory of Healthcare Providers & Services (NDH) Implementation Guide, published by HL7 International / Patient Administration. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/fhir-us-ndh/ and changes regularly. See the Directory of published versions

Resource Profile: NdhRestriction - Detailed Descriptions

Active as of 2023-01-22

Definitions for the ndh-Restriction resource profile.

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

0. Consent
2. Consent.extension
SlicingThis element introduces a set of slices on Consent.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. Consent.extension:restrictFhirPath
    Slice NamerestrictFhirPath
    Control0..*
    TypeExtension(NDH usage restriction fhir path) (Extension Type: Expression)
    6. Consent.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control0..0
    8. Consent.status
    ShortIndicates the current state of this restriction
    Comments

    This element is labeled as a modifier because the status contains the codes rejected and entered-in-error that mark the restriction as not currently valid.

    Must Supporttrue
    10. Consent.scope
    BindingUnless not suitable, these codes SHALL be taken from NDH Consent Scope Value Set
    (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentScopeNdhVS)
    Must Supporttrue
    12. Consent.category
    Shortdescribes the type of restriction (e.g. the data may be further disclosed by the downstream workflow environment per the terms of a Data Use Agreement)
    BindingUnless not suitable, these codes SHALL be taken from NDH Consent Category Value Set
    (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentCategoryNdhVS)
    Must Supporttrue
    14. Consent.patient
    Control0..0
    16. Consent.dateTime
    Shortindicates when the restriction was last updated
    Must Supporttrue
    Labellast updated
    18. Consent.performer
    Control0..0
    20. Consent.organization
    Control0..0
    22. Consent.source[x]
    Control0..0
    24. Consent.policy
    Must Supporttrue
    26. Consent.policy.authority
    Control0..0
    28. Consent.policy.uri
    ShortSpecific policy covered by this restriction
    Must Supporttrue
    30. Consent.policyRule
    BindingUnless not suitable, these codes SHALL be taken from Consent Policy Rules Value Set
    (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentPolicyRulesVS)
    Must Supporttrue
    32. Consent.verification
    Control0..0
    37. Consent.provision
    Shortdefines access rights for restricted content
    Must Supporttrue
    39. Consent.provision.type
    Must Supporttrue
    41. Consent.provision.period
    Control0..0
    43. Consent.provision.actor
    Control1..?
    Must Supporttrue
    45. Consent.provision.actor.role
    Must Supporttrue
    47. Consent.provision.actor.reference
    ShortdefinedUserOrGroup
    TypeReference(NDH Base CareTeam Profile, NDH Base Organization Profile, NDH Base Practitioner Profile, NDH Base PractitionerRole)
    Must Supporttrue
    Must Support TypesNo must-support rules about the choice of types/profiles
    49. Consent.provision.action
    Definition

    Describes how the reference is related to the restriction (contributes to; reason for; existance of; specific value)

    ShortreasonType
    Control0..1
    BindingUnless not suitable, these codes SHALL be taken from ConsentActionCodes
    (extensible to http://hl7.org/fhir/ValueSet/consent-action)
    Must Supporttrue
    51. Consent.provision.securityLabel
    ShortuserType
    Must Supporttrue
    53. Consent.provision.purpose
    Definition

    Name assigned to the restriction condition

    ShortreasonName
    Must Supporttrue
    55. Consent.provision.class
    Control0..0
    57. Consent.provision.code
    Control0..0
    59. Consent.provision.dataPeriod
    Control0..0
    61. Consent.provision.data
    Control0..0
    Must Supporttrue
    65. Consent.provision.provision
    Control0..0

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

    0. Consent
    Definition

    A record of a healthcare consumer’s choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.

    ShortA healthcare consumer's choices to permit or deny recipients or roles to perform actions for specific purposes and periods of time
    Comments

    Broadly, there are 3 key areas of consent for patients: Consent around sharing information (aka Privacy Consent Directive - Authorization to Collect, Use, or Disclose information), consent for specific treatment, or kinds of treatment, and general advance care directives.

    Control0..*
    Is Modifierfalse
    Summaryfalse
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
    ppc-2: IF Scope=privacy, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not())
    ppc-3: IF Scope=research, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='research').exists().not())
    ppc-4: IF Scope=adr, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='adr').exists().not())
    ppc-5: IF Scope=treatment, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not())
    ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
    ppc-2: IF Scope=privacy, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not())
    ppc-3: IF Scope=research, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='research').exists().not())
    ppc-4: IF Scope=adr, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='adr').exists().not())
    ppc-5: IF Scope=treatment, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not())
    2. Consent.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. Consent.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 Consent.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 6. Consent.extension:restrictFhirPath
      Slice NamerestrictFhirPath
      Definition

      NDH usage restriction to resource element level

      ShortNDH usage restriction fhir path
      Control0..*
      This element is affected by the following invariants: ele-1
      TypeExtension(NDH usage restriction fhir path) (Extension Type: Expression)
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      8. Consent.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())
      10. Consent.identifier
      Definition

      Unique identifier for this copy of the Consent Statement.

      ShortIdentifier for this record (external references)
      Comments

      This identifier identifies this copy of the consent. Where this identifier is also used elsewhere as the identifier for a consent record (e.g. a CDA consent document) then the consent details are expected to be the same.

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..0*
      TypeIdentifier
      Is Modifierfalse
      Summarytrue
      Example<br/><b>General</b>:{ "system" : "http://acme.org/identifier/local/eCMS", "value" : "Local eCMS identifier" }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      12. Consent.status
      Definition

      Indicates the current state of this consent.

      ShortIndicates the current state of this restrictiondraft | proposed | active | rejected | inactive | entered-in-error
      Comments

      This element is labeled as a modifier because the status contains the codes rejected and entered-in-error that mark the restriction as not currently valid.


      This element is labeled as a modifier because the status contains the codes rejected and entered-in-error that mark the Consent as not currently valid.

      Control1..1
      BindingThe codes SHALL be taken from ConsentStatehttp://hl7.org/fhir/ValueSet/consent-state-codes|4.0.1
      (required to http://hl7.org/fhir/ValueSet/consent-state-codes|4.0.1)

      Indicates the state of the consent.

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

      The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.

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

      A selector of the type of consent being presented: ADR, Privacy, Treatment, Research. This list is now extensible.

      ShortWhich of the four areas this resource covers (extensible)
      Control1..1
      BindingUnless not suitable, these codes SHALL be taken from NDH Consent Scope Value Sethttp://hl7.org/fhir/ValueSet/consent-scope
      (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentScopeNdhVS)
      TypeCodeableConcept
      Is Modifiertrue because Allows changes to codes based on scope selection
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. Consent.category
      Definition

      A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.

      Shortdescribes the type of restriction (e.g. the data may be further disclosed by the downstream workflow environment per the terms of a Data Use Agreement)Classification of the consent statement - for indexing/retrieval
      Control1..*
      BindingUnless not suitable, these codes SHALL be taken from NDH Consent Category Value Sethttp://hl7.org/fhir/ValueSet/consent-category
      (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentCategoryNdhVS)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. Consent.patient
      Definition

      The patient/healthcare consumer to whom this consent applies.

      ShortWho the consent applies to
      Comments

      Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.

      Control0..01
      TypeReference(Patient)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Consent.dateTime
      Definition

      When this Consent was issued / created / indexed.

      Shortindicates when the restriction was last updatedWhen this Consent was created or indexed
      Comments

      This is not the time of the original consent, but the time that this statement was made or derived.

      Control0..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Labellast updated
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Consent.performer
      Definition

      Either the Grantor, which is the entity responsible for granting the rights listed in a Consent Directive or the Grantee, which is the entity responsible for complying with the Consent Directive, including any obligations or limitations on authorizations and enforcement of prohibitions.

      ShortWho is agreeing to the policy and rules
      Comments

      Commonly, the patient the consent pertains to is the consentor, but particularly for young and old people, it may be some other person - e.g. a legal guardian.

      Control0..0*
      TypeReference(Organization, Patient, Practitioner, RelatedPerson, PractitionerRole)
      Is Modifierfalse
      Summarytrue
      Alternate Namesconsentor
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      24. Consent.organization
      Definition

      The organization that manages the consent, and the framework within which it is executed.

      ShortCustodian of the consent
      Control0..0*
      TypeReference(Organization)
      Is Modifierfalse
      Summarytrue
      Alternate Namescustodian
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Consent.source[x]
      Definition

      The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.

      ShortSource from which this consent is taken
      Comments

      The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.

      Control0..01
      TypeChoice of: Attachment, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse)
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      28. Consent.policy
      Definition

      The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.

      ShortPolicies covered by this consent
      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      30. Consent.policy.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())
      32. Consent.policy.authority
      Definition

      Entity or Organization having regulatory jurisdiction or accountability for enforcing policies pertaining to Consent Directives.

      ShortEnforcement source for policy
      Control0..01
      This element is affected by the following invariants: ppc-1
      Typeuri
      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()))
      34. Consent.policy.uri
      Definition

      The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.

      ShortSpecific policy covered by this restrictionSpecific policy covered by this consent
      Comments

      This element is for discoverability / documentation and does not modify or qualify the policy rules.

      Control0..1
      This element is affected by the following invariants: ppc-1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. Consent.policyRule
      Definition

      A reference to the specific base computable regulation or policy.

      ShortRegulation that this consents to
      Comments

      If the policyRule is absent, computable consent would need to be constructed from the elements of the Consent resource.

      Control0..1
      This element is affected by the following invariants: ppc-1
      BindingUnless not suitable, these codes SHALL be taken from Consent Policy Rules Value Sethttp://hl7.org/fhir/ValueSet/consent-policy
      (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentPolicyRulesVS)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

      Might be a unique identifier of a policy set in XACML, or other rules engine.

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

      Whether a treatment instruction (e.g. artificial respiration yes or no) was verified with the patient, his/her family or another authorized person.

      ShortConsent Verified by patient or family
      Control0..0*
      TypeBackboneElement
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. Consent.provision
      Definition

      An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.

      Shortdefines access rights for restricted contentConstraints to the base Consent.policyRule
      Control0..1
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. Consent.provision.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())
      48. Consent.provision.type
      Definition

      Action to take - permit or deny - when the rule conditions are met. Not permitted in root rule, required in all nested rules.

      Shortdeny | permit
      Control0..1
      BindingThe codes SHALL be taken from ConsentProvisionTypehttp://hl7.org/fhir/ValueSet/consent-provision-type|4.0.1
      (required to http://hl7.org/fhir/ValueSet/consent-provision-type|4.0.1)

      How a rule statement is applied, such as adding additional consent or removing consent.

      Typecode
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. Consent.provision.period
      Definition

      The timeframe in this rule is valid.

      ShortTimeframe for this rule
      Control0..01
      TypePeriod
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. Consent.provision.actor
      Definition

      Who or what is controlled by this rule. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').

      ShortWho|what controlled by this rule (or group, by role)
      Control10..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Meaning if MissingThere is no specific actor associated with the exception
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      54. Consent.provision.actor.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())
      56. Consent.provision.actor.role
      Definition

      How the individual is involved in the resources content that is described in the exception.

      ShortHow the actor is involved
      Control1..1
      BindingUnless not suitable, these codes SHALL be taken from SecurityRoleTypehttp://hl7.org/fhir/ValueSet/security-role-type
      (extensible to http://hl7.org/fhir/ValueSet/security-role-type)

      How an actor is involved in the consent considerations.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. Consent.provision.actor.reference
      Definition

      The resource that identifies the actor. To identify actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').

      ShortdefinedUserOrGroupResource for the actor (or group, by role)
      Control1..1
      TypeReference(NDH Base CareTeam Profile, NDH Base Organization Profile, NDH Base Practitioner Profile, NDH Base PractitionerRole, Device, Group, CareTeam, Organization, Patient, Practitioner, RelatedPerson, PractitionerRole)
      Is Modifierfalse
      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()))
      60. Consent.provision.action
      Definition

      Describes how the reference is related to the restriction (contributes to; reason for; existance of; specific value)


      Actions controlled by this Rule.

      ShortreasonTypeActions controlled by this rule
      Comments

      Note that this is the direct action (not the grounds for the action covered in the purpose element). At present, the only action in the understood and tested scope of this resource is 'read'.

      Control0..1*
      BindingUnless not suitable, these codes SHALL be taken from For example codes, see ConsentActionCodeshttp://hl7.org/fhir/ValueSet/consent-action
      (extensible to http://hl7.org/fhir/ValueSet/consent-action)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Meaning if Missingall actions
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      62. Consent.provision.securityLabel
      Definition

      A security label, comprised of 0..* security label fields (Privacy tags), which define which resources are controlled by this exception.

      ShortuserTypeSecurity Labels that define affected resources
      Comments

      If the consent specifies a security label of "R" then it applies to all resources that are labeled "R" or lower. E.g. for Confidentiality, it's a high water mark. For other kinds of security labels, subsumption logic applies. When the purpose of use tag is on the data, access request purpose of use shall not conflict.

      Control0..*
      BindingUnless not suitable, these codes SHALL be taken from All Security Labelshttp://hl7.org/fhir/ValueSet/security-labels
      (extensible to http://hl7.org/fhir/ValueSet/security-labels)

      Security Labels from the Healthcare Privacy and Security Classification System.

      TypeCoding
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      64. Consent.provision.purpose
      Definition

      Name assigned to the restriction condition


      The context of the activities a user is taking - why the user is accessing the data - that are controlled by this rule.

      ShortreasonNameContext of activities covered by this rule
      Comments

      When the purpose of use tag is on the data, access request purpose of use shall not conflict.

      Control0..*
      BindingUnless not suitable, these codes SHALL be taken from PurposeOfUsehttp://terminology.hl7.org/ValueSet/v3-PurposeOfUse
      (extensible to http://terminology.hl7.org/ValueSet/v3-PurposeOfUse)

      What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels.

      TypeCoding
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. Consent.provision.class
      Definition

      The class of information covered by this rule. The type can be a FHIR resource type, a profile on a type, or a CDA document, or some other type that indicates what sort of information the consent relates to.

      Shorte.g. Resource Type, Profile, CDA, etc.
      Comments

      Multiple types are or'ed together. The intention of the contentType element is that the codes refer to profiles or document types defined in a standard or an implementation guide somewhere.

      Control0..0*
      BindingUnless not suitable, these codes SHALL be taken from ConsentContentClasshttp://hl7.org/fhir/ValueSet/consent-content-class
      (extensible to http://hl7.org/fhir/ValueSet/consent-content-class)

      The class (type) of information a consent rule covers.

      TypeCoding
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      68. Consent.provision.code
      Definition

      If this code is found in an instance, then the rule applies.

      Shorte.g. LOINC or SNOMED CT code, etc. in the content
      Comments

      Typical use of this is a Document code with class = CDA.

      Control0..0*
      BindingFor example codes, see ConsentContentCodeshttp://hl7.org/fhir/ValueSet/consent-content-code
      (example to http://hl7.org/fhir/ValueSet/consent-content-code)

      If this code is found in an instance, then the exception applies.

      TypeCodeableConcept
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      70. Consent.provision.dataPeriod
      Definition

      Clinical or Operational Relevant period of time that bounds the data controlled by this rule.

      ShortTimeframe for data controlled by this rule
      Comments

      This has a different sense to the Consent.period - that is when the consent agreement holds. This is the time period of the data that is controlled by the agreement.

      Control0..01
      TypePeriod
      Is Modifierfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      72. Consent.provision.data
      Definition

      The resources controlled by this rule if specific resources are referenced.

      ShortData controlled by this rule
      Control0..0*
      TypeBackboneElement
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Meaning if Missingall data
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      77. Consent.provision.provision
      Definition

      Rules which provide exceptions to the base rule or subrules.

      ShortNested Exception Rules
      Control0..0*
      TypeSeettp://hl7.org/fhir/StructureDefinition/Consent#Consent.provision
      Is Modifierfalse
      Summaryfalse
      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. Consent
      Definition

      A record of a healthcare consumer’s choices, which permits or denies identified recipient(s) or recipient role(s) to perform one or more actions within a given policy context, for specific purposes and periods of time.

      ShortA healthcare consumer's choices to permit or deny recipients or roles to perform actions for specific purposes and periods of time
      Comments

      Broadly, there are 3 key areas of consent for patients: Consent around sharing information (aka Privacy Consent Directive - Authorization to Collect, Use, or Disclose information), consent for specific treatment, or kinds of treatment, and general advance care directives.

      Control0..*
      Is Modifierfalse
      Summaryfalse
      Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
      dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
      dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
      dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
      dom-6: A resource should have narrative for robust management (text.`div`.exists())
      ppc-1: Either a Policy or PolicyRule (policy.exists() or policyRule.exists())
      ppc-2: IF Scope=privacy, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='patient-privacy').exists().not())
      ppc-3: IF Scope=research, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='research').exists().not())
      ppc-4: IF Scope=adr, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='adr').exists().not())
      ppc-5: IF Scope=treatment, there must be a patient (patient.exists() or scope.coding.where(system='something' and code='treatment').exists().not())
      2. Consent.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. Consent.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. Consent.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. Consent.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. Consent.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. Consent.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. Consent.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 Consent.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 16. Consent.extension:restrictFhirPath
        Slice NamerestrictFhirPath
        Definition

        NDH usage restriction to resource element level

        ShortNDH usage restriction fhir path
        Control0..*
        This element is affected by the following invariants: ele-1
        TypeExtension(NDH usage restriction fhir path) (Extension Type: Expression)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        18. Consent.modifierExtension
        Definition

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

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

        ShortExtensions that cannot be ignored
        Comments

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

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

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

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

        Unique identifier for this copy of the Consent Statement.

        ShortIdentifier for this record (external references)
        Comments

        This identifier identifies this copy of the consent. Where this identifier is also used elsewhere as the identifier for a consent record (e.g. a CDA consent document) then the consent details are expected to be the same.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control0..0
        TypeIdentifier
        Is Modifierfalse
        Summarytrue
        Example<br/><b>General</b>:{ "system" : "http://acme.org/identifier/local/eCMS", "value" : "Local eCMS identifier" }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        22. Consent.status
        Definition

        Indicates the current state of this consent.

        ShortIndicates the current state of this restriction
        Comments

        This element is labeled as a modifier because the status contains the codes rejected and entered-in-error that mark the restriction as not currently valid.

        Control1..1
        BindingThe codes SHALL be taken from ConsentState
        (required to http://hl7.org/fhir/ValueSet/consent-state-codes|4.0.1)

        Indicates the state of the consent.

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

        The Consent Directive that is pointed to might be in various lifecycle states, e.g., a revoked Consent Directive.

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

        A selector of the type of consent being presented: ADR, Privacy, Treatment, Research. This list is now extensible.

        ShortWhich of the four areas this resource covers (extensible)
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from NDH Consent Scope Value Set
        (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentScopeNdhVS)
        TypeCodeableConcept
        Is Modifiertrue because Allows changes to codes based on scope selection
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. Consent.category
        Definition

        A classification of the type of consents found in the statement. This element supports indexing and retrieval of consent statements.

        Shortdescribes the type of restriction (e.g. the data may be further disclosed by the downstream workflow environment per the terms of a Data Use Agreement)
        Control1..*
        BindingUnless not suitable, these codes SHALL be taken from NDH Consent Category Value Set
        (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentCategoryNdhVS)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        28. Consent.patient
        Definition

        The patient/healthcare consumer to whom this consent applies.

        ShortWho the consent applies to
        Comments

        Commonly, the patient the consent pertains to is the author, but for young and old people, it may be some other person.

        Control0..0
        TypeReference(Patient)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        30. Consent.dateTime
        Definition

        When this Consent was issued / created / indexed.

        Shortindicates when the restriction was last updated
        Comments

        This is not the time of the original consent, but the time that this statement was made or derived.

        Control0..1
        TypedateTime
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Labellast updated
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        32. Consent.performer
        Definition

        Either the Grantor, which is the entity responsible for granting the rights listed in a Consent Directive or the Grantee, which is the entity responsible for complying with the Consent Directive, including any obligations or limitations on authorizations and enforcement of prohibitions.

        ShortWho is agreeing to the policy and rules
        Comments

        Commonly, the patient the consent pertains to is the consentor, but particularly for young and old people, it may be some other person - e.g. a legal guardian.

        Control0..0
        TypeReference(Organization, Patient, Practitioner, RelatedPerson, PractitionerRole)
        Is Modifierfalse
        Summarytrue
        Alternate Namesconsentor
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        34. Consent.organization
        Definition

        The organization that manages the consent, and the framework within which it is executed.

        ShortCustodian of the consent
        Control0..0
        TypeReference(Organization)
        Is Modifierfalse
        Summarytrue
        Alternate Namescustodian
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        36. Consent.source[x]
        Definition

        The source on which this consent statement is based. The source might be a scanned original paper form, or a reference to a consent that links back to such a source, a reference to a document repository (e.g. XDS) that stores the original consent document.

        ShortSource from which this consent is taken
        Comments

        The source can be contained inline (Attachment), referenced directly (Consent), referenced in a consent repository (DocumentReference), or simply by an identifier (Identifier), e.g. a CDA document id.

        Control0..0
        TypeChoice of: Attachment, Reference(Consent, DocumentReference, Contract, QuestionnaireResponse)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        38. Consent.policy
        Definition

        The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.

        ShortPolicies covered by this consent
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        40. Consent.policy.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
        42. Consent.policy.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())
        44. Consent.policy.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())
        46. Consent.policy.authority
        Definition

        Entity or Organization having regulatory jurisdiction or accountability for enforcing policies pertaining to Consent Directives.

        ShortEnforcement source for policy
        Control0..0
        This element is affected by the following invariants: ppc-1
        Typeuri
        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()))
        48. Consent.policy.uri
        Definition

        The references to the policies that are included in this consent scope. Policies may be organizational, but are often defined jurisdictionally, or in law.

        ShortSpecific policy covered by this restriction
        Comments

        This element is for discoverability / documentation and does not modify or qualify the policy rules.

        Control0..1
        This element is affected by the following invariants: ppc-1
        Typeuri
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. Consent.policyRule
        Definition

        A reference to the specific base computable regulation or policy.

        ShortRegulation that this consents to
        Comments

        If the policyRule is absent, computable consent would need to be constructed from the elements of the Consent resource.

        Control0..1
        This element is affected by the following invariants: ppc-1
        BindingUnless not suitable, these codes SHALL be taken from Consent Policy Rules Value Set
        (extensible to http://hl7.org/fhir/us/ndh/ValueSet/ConsentPolicyRulesVS)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

        Might be a unique identifier of a policy set in XACML, or other rules engine.

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

        Whether a treatment instruction (e.g. artificial respiration yes or no) was verified with the patient, his/her family or another authorized person.

        ShortConsent Verified by patient or family
        Control0..0
        TypeBackboneElement
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        60. Consent.provision
        Definition

        An exception to the base policy of this consent. An exception can be an addition or removal of access permissions.

        Shortdefines access rights for restricted content
        Control0..1
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        62. Consent.provision.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
        64. Consent.provision.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())
        66. Consent.provision.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())
        68. Consent.provision.type
        Definition

        Action to take - permit or deny - when the rule conditions are met. Not permitted in root rule, required in all nested rules.

        Shortdeny | permit
        Control0..1
        BindingThe codes SHALL be taken from ConsentProvisionType
        (required to http://hl7.org/fhir/ValueSet/consent-provision-type|4.0.1)

        How a rule statement is applied, such as adding additional consent or removing consent.

        Typecode
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        70. Consent.provision.period
        Definition

        The timeframe in this rule is valid.

        ShortTimeframe for this rule
        Control0..0
        TypePeriod
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        72. Consent.provision.actor
        Definition

        Who or what is controlled by this rule. Use group to identify a set of actors by some property they share (e.g. 'admitting officers').

        ShortWho|what controlled by this rule (or group, by role)
        Control1..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Meaning if MissingThere is no specific actor associated with the exception
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        74. Consent.provision.actor.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
        76. Consent.provision.actor.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())
        78. Consent.provision.actor.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())
        80. Consent.provision.actor.role
        Definition

        How the individual is involved in the resources content that is described in the exception.

        ShortHow the actor is involved
        Control1..1
        BindingUnless not suitable, these codes SHALL be taken from SecurityRoleType
        (extensible to http://hl7.org/fhir/ValueSet/security-role-type)

        How an actor is involved in the consent considerations.

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        82. Consent.provision.actor.reference
        Definition

        The resource that identifies the actor. To identify actors by type, use group to identify a set of actors by some property they share (e.g. 'admitting officers').

        ShortdefinedUserOrGroup
        Control1..1
        TypeReference(NDH Base CareTeam Profile, NDH Base Organization Profile, NDH Base Practitioner Profile, NDH Base PractitionerRole)
        Is Modifierfalse
        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()))
        84. Consent.provision.action
        Definition

        Describes how the reference is related to the restriction (contributes to; reason for; existance of; specific value)

        ShortreasonType
        Comments

        Note that this is the direct action (not the grounds for the action covered in the purpose element). At present, the only action in the understood and tested scope of this resource is 'read'.

        Control0..1
        BindingUnless not suitable, these codes SHALL be taken from ConsentActionCodes
        (extensible to http://hl7.org/fhir/ValueSet/consent-action)
        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Meaning if Missingall actions
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        86. Consent.provision.securityLabel
        Definition

        A security label, comprised of 0..* security label fields (Privacy tags), which define which resources are controlled by this exception.

        ShortuserType
        Comments

        If the consent specifies a security label of "R" then it applies to all resources that are labeled "R" or lower. E.g. for Confidentiality, it's a high water mark. For other kinds of security labels, subsumption logic applies. When the purpose of use tag is on the data, access request purpose of use shall not conflict.

        Control0..*
        BindingUnless not suitable, these codes SHALL be taken from All Security Labels
        (extensible to http://hl7.org/fhir/ValueSet/security-labels)

        Security Labels from the Healthcare Privacy and Security Classification System.

        TypeCoding
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        88. Consent.provision.purpose
        Definition

        Name assigned to the restriction condition

        ShortreasonName
        Comments

        When the purpose of use tag is on the data, access request purpose of use shall not conflict.

        Control0..*
        BindingUnless not suitable, these codes SHALL be taken from PurposeOfUse
        (extensible to http://terminology.hl7.org/ValueSet/v3-PurposeOfUse)

        What purposes of use are controlled by this exception. If more than one label is specified, operations must have all the specified labels.

        TypeCoding
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        90. Consent.provision.class
        Definition

        The class of information covered by this rule. The type can be a FHIR resource type, a profile on a type, or a CDA document, or some other type that indicates what sort of information the consent relates to.

        Shorte.g. Resource Type, Profile, CDA, etc.
        Comments

        Multiple types are or'ed together. The intention of the contentType element is that the codes refer to profiles or document types defined in a standard or an implementation guide somewhere.

        Control0..0
        BindingUnless not suitable, these codes SHALL be taken from ConsentContentClass
        (extensible to http://hl7.org/fhir/ValueSet/consent-content-class)

        The class (type) of information a consent rule covers.

        TypeCoding
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        92. Consent.provision.code
        Definition

        If this code is found in an instance, then the rule applies.

        Shorte.g. LOINC or SNOMED CT code, etc. in the content
        Comments

        Typical use of this is a Document code with class = CDA.

        Control0..0
        BindingFor example codes, see ConsentContentCodes
        (example to http://hl7.org/fhir/ValueSet/consent-content-code)

        If this code is found in an instance, then the exception applies.

        TypeCodeableConcept
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        94. Consent.provision.dataPeriod
        Definition

        Clinical or Operational Relevant period of time that bounds the data controlled by this rule.

        ShortTimeframe for data controlled by this rule
        Comments

        This has a different sense to the Consent.period - that is when the consent agreement holds. This is the time period of the data that is controlled by the agreement.

        Control0..0
        TypePeriod
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        96. Consent.provision.data
        Definition

        The resources controlled by this rule if specific resources are referenced.

        ShortData controlled by this rule
        Control0..0
        TypeBackboneElement
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Meaning if Missingall data
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        103. Consent.provision.provision
        Definition

        Rules which provide exceptions to the base rule or subrules.

        ShortNested Exception Rules
        Control0..0
        TypeSeettp://hl7.org/fhir/StructureDefinition/Consent#Consent.provision
        Is Modifierfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))