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

PACIO Advance Healthcare Directive Interoperability Implementation Guide, published by HL7 International / Patient Empowerment. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/pacio-adi/ and changes regularly. See the Directory of published versions

## Resource Profile: ADI Composition Header ( Abstract )

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

This abstract profile defines constraints that represent common administrative and demographic concepts for advance directives information used in US Realm clinical documents.

This profile, largely based on the CCDA on FHIR US Realm Header profile, defines requirements that address specific exchange requirements for a composition containing a person's advance care plan information.

Conformance:

In the cases where the patient is not able to "write" the PACP contents due to literacy constraints or physical disability, e.g. hemiplegia, the patient/subject is still considered author of the content, and a data enterer will fill the role of physically creating the document by entering the author’s requested information into the system used to create the document.

Advance Directive Information versionNumber represents a numeric value used to version successive replacement documents. Best practice for systems that support distributed document creation and updating is to populate the versionNumber with the timestamp created from the date/time when the version of the document is created in the system. Note: this may or may not be equivalent to the timestamp integer for Composition.date. the versionNumber timestamp always will be equivalent to the Bundle.timestamp for the document.

To better align with CDA, versionNumber should be a string label generated by converting the ClinicalDocument.effectiveTime (or Composition.date) to UTC time (-0000) and then using the YYYYMMDDhhmmss as the version.

For documents created within a system will follow the pattern that the timestamp-label versionNumber will be equivalent to the timestamp of the Composition.date and the Bundle.timestamp. However, for unstructured historical documents uploaded into a system, the timestamp-label versionNumber will be equivalent to the timestamp of the the Bundle.timestamp, but the Composition.date will reflect the creation date of the original document.

Usages:

- Derived from this Profile: ADI PtAuthored Composition and ADI PMO Composition
- CapabilityStatements using this Profile: ADI CapabilityStatement

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | Clinical Document | This is an abstract profile. Child profiles: ADIPACPComposition, ADIPMOComposition A set of resources composed into a single coherent clinical statement with clinical attestation
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language | S | 1..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Slices for extension |  |  |  | Content/Rules for all slices
extension:versionNumber |  | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:ExpirationDateExtension |  | 0..1 | dateTime | ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction |  | 0..* | CodeableConcept | US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension |  | 0..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) | Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
extension:PerformerExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 1..1 | Identifier | Version-independent identifier for the Composition
status | ?!Σ | 1..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S Σ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: Advance Healthcare Directive Categories LOINC (extensible)
category | S Σ | 0..1 | CodeableConcept | Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 42348-3
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance healthcare directives
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter | Σ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S Σ | 1..1 | dateTime | Composition editing time
author | S Σ | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) | Who and/or what authored the composition
title | S Σ | 1..1 | string | Human Readable name/title
custodian | S Σ | 1..1 | Reference(US Core Organization Profile) | Organization which maintains the composition
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Composition.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Composition.status | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
Composition.type | extensible | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov
Composition.category | example | Pattern Value: LOINC Code 42348-3("Advance healthcare directives") `http://hl7.org/fhir/ValueSet/document-classcodes` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Composition | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Composition | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |

This structure is derived from Clinical Document

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  |  | Clinical Document | This is an abstract profile. Child profiles: ADIPACPComposition, ADIPMOComposition
language | S | 1..1 | code | Language of the resource content
Slices for extension |  |  |  | Content/Rules for all slices
extension:ExpirationDateExtension |  | 0..1 | dateTime | ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction |  | 0..* | CodeableConcept | US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension |  | 0..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) | Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
extension:PerformerExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
identifier | S | 1..1 | Identifier | Version-independent identifier for the Composition
status |  | 1..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: Advance Healthcare Directive Categories LOINC (extensible)
category | S | 0..1 | CodeableConcept | Categorization of Composition Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 42348-3
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance healthcare directives
subject | S | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter |  | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S | 1..1 | dateTime | Composition editing time
author | S | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) | Who and/or what authored the composition
title | S | 1..1 | string | Human Readable name/title
confidentiality |  | 0..0 |  |
custodian | S | 1..1 | Reference(US Core Organization Profile) | Organization which maintains the composition
event |  |  |  |
code |  | 0..* | CodeableConcept | Code(s) that apply to the event being documented Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: acp-services
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance care planning services
Slices for detail |  | 0..* | Reference(Resource) | The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator |  | 0..1 | Reference(ADI Facilitator) | ADI Facilitator
section |  |  |  |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
Composition.status | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
Composition.type | extensible | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | Clinical Document | This is an abstract profile. Child profiles: ADIPACPComposition, ADIPMOComposition A set of resources composed into a single coherent clinical statement with clinical attestation
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language | S | 1..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:versionNumber |  | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:ExpirationDateExtension |  | 0..1 | dateTime | ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction |  | 0..* | CodeableConcept | US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension |  | 0..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) | Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
extension:PerformerExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 1..1 | Identifier | Version-independent identifier for the Composition
status | ?!Σ | 1..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S Σ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: Advance Healthcare Directive Categories LOINC (extensible)
category | S Σ | 0..1 | CodeableConcept | Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 42348-3
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance healthcare directives
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter | Σ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S Σ | 1..1 | dateTime | Composition editing time
author | S Σ | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) | Who and/or what authored the composition
title | S Σ | 1..1 | string | Human Readable name/title
attester |  | 0..* | BackboneElement | Attests to accuracy of composition
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
mode |  | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time |  | 0..1 | dateTime | When the composition was attested
party |  | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the composition
custodian | S Σ | 1..1 | Reference(US Core Organization Profile) | Organization which maintains the composition
relatesTo |  | 0..* | BackboneElement | Relationships to other compositions/documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x] |  | 1..1 |  | Target of the relationship
targetIdentifier |  |  | Identifier |
targetReference |  |  | Reference(Composition) |
event | Σ | 0..* | BackboneElement | The clinical service(s) being documented
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 0..* | CodeableConcept | Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: acp-services
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance care planning services
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
period | Σ | 0..1 | Period | The period covered by the documentation
Slices for detail | Σ | 0..* | Reference(Resource) | The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator | Σ | 0..1 | Reference(ADI Facilitator) | ADI Facilitator
section | C | 0..* | BackboneElement | Composition is broken into sections Constraints: cmp-1, cmp-2
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
title |  | 0..1 | string | Label for section (e.g. for ToC)
code |  | 0..1 | CodeableConcept | Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author |  | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the section
focus |  | 0..1 | Reference(Resource) | Who/what the section is about, when it is not about the subject of composition
text | C | 0..1 | Narrative | Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode |  | 0..1 | code | working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy |  | 0..1 | CodeableConcept | Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry | C | 0..* | Reference(Resource) | A reference to data that supports this section
emptyReason | C | 0..1 | CodeableConcept | Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section | C | 0..* | See section (Composition) | Nested Section
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Composition.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Composition.status | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
Composition.type | extensible | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov
Composition.category | example | Pattern Value: LOINC Code 42348-3("Advance healthcare directives") `http://hl7.org/fhir/ValueSet/document-classcodes` From the FHIR Standard
Composition.attester.mode | required | CompositionAttestationMode `http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1` From the FHIR Standard
Composition.relatesTo.code | required | DocumentRelationshipType `http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1` From the FHIR Standard
Composition.event.code | example | Pattern Value: acp-services("Advance care planning services") `http://terminology.hl7.org/ValueSet/v3-ActCode`
Composition.section.code | example | DocumentSectionCodes `http://hl7.org/fhir/ValueSet/doc-section-codes` From the FHIR Standard
Composition.section.mode | required | ListMode `http://hl7.org/fhir/ValueSet/list-mode|4.0.1` From the FHIR Standard
Composition.section.orderedBy | preferred | ListOrderCodes `http://hl7.org/fhir/ValueSet/list-order` From the FHIR Standard
Composition.section.emptyReason | preferred | ListEmptyReasons `http://hl7.org/fhir/ValueSet/list-empty-reason` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
cmp-1 | error | Composition.section | A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists() |
cmp-2 | error | Composition.section | A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty() |
dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Composition | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Composition | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |

This structure is derived from Clinical Document

Summary

Mandatory: 4 elements
Must-Support: 10 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- ADI Facilitator (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Facilitator)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
- http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Composition.event.detail

Maturity: 2

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | Clinical Document | This is an abstract profile. Child profiles: ADIPACPComposition, ADIPMOComposition A set of resources composed into a single coherent clinical statement with clinical attestation
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language | S | 1..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
Slices for extension |  |  |  | Content/Rules for all slices
extension:versionNumber |  | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:ExpirationDateExtension |  | 0..1 | dateTime | ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction |  | 0..* | CodeableConcept | US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension |  | 0..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) | Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
extension:PerformerExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 1..1 | Identifier | Version-independent identifier for the Composition
status | ?!Σ | 1..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S Σ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: Advance Healthcare Directive Categories LOINC (extensible)
category | S Σ | 0..1 | CodeableConcept | Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 42348-3
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance healthcare directives
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter | Σ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S Σ | 1..1 | dateTime | Composition editing time
author | S Σ | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) | Who and/or what authored the composition
title | S Σ | 1..1 | string | Human Readable name/title
custodian | S Σ | 1..1 | Reference(US Core Organization Profile) | Organization which maintains the composition
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Composition.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Composition.status | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
Composition.type | extensible | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov
Composition.category | example | Pattern Value: LOINC Code 42348-3("Advance healthcare directives") `http://hl7.org/fhir/ValueSet/document-classcodes` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Composition | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Composition | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |

Differential View

This structure is derived from Clinical Document

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  |  | Clinical Document | This is an abstract profile. Child profiles: ADIPACPComposition, ADIPMOComposition
language | S | 1..1 | code | Language of the resource content
Slices for extension |  |  |  | Content/Rules for all slices
extension:ExpirationDateExtension |  | 0..1 | dateTime | ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction |  | 0..* | CodeableConcept | US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension |  | 0..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) | Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
extension:PerformerExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
identifier | S | 1..1 | Identifier | Version-independent identifier for the Composition
status |  | 1..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: Advance Healthcare Directive Categories LOINC (extensible)
category | S | 0..1 | CodeableConcept | Categorization of Composition Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 42348-3
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance healthcare directives
subject | S | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter |  | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S | 1..1 | dateTime | Composition editing time
author | S | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) | Who and/or what authored the composition
title | S | 1..1 | string | Human Readable name/title
confidentiality |  | 0..0 |  |
custodian | S | 1..1 | Reference(US Core Organization Profile) | Organization which maintains the composition
event |  |  |  |
code |  | 0..* | CodeableConcept | Code(s) that apply to the event being documented Required Pattern: At least the following
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: acp-services
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance care planning services
Slices for detail |  | 0..* | Reference(Resource) | The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator |  | 0..1 | Reference(ADI Facilitator) | ADI Facilitator
section |  |  |  |
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
Documentation for this format

#### Terminology Bindings (Differential)

Path | Conformance | ValueSet | URI
Composition.status | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
Composition.type | extensible | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | Clinical Document | This is an abstract profile. Child profiles: ADIPACPComposition, ADIPMOComposition A set of resources composed into a single coherent clinical statement with clinical attestation
id | Σ | 0..1 | id | Logical id of this artifact
meta | Σ | 0..1 | Meta | Metadata about the resource
implicitRules | ?!Σ | 0..1 | uri | A set of rules under which this content was created
language | S | 1..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
Additional Bindings | Purpose
AllLanguages | Max Binding
text |  | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:versionNumber |  | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:ExpirationDateExtension |  | 0..1 | dateTime | ADI Expiration Date URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
extension:Jurisdiction |  | 0..* | CodeableConcept | US State or local jurisdiction URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction Binding: USPS Two Letter Alphabetic Codes (extensible): Target US State or local jurisdiction.
extension:DataEntererExtension |  | 0..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Data Enterer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
extension:InformantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson) | Informant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
extension:ParticipantExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | RelatedPerson) | Participant URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
extension:PerformerExtension |  | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | Performer URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
extension:DocumentRevokeStatus | S | 0..1 | code | Revoke Status URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status Binding: ADI Document Revoke Status (required)
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
identifier | S Σ | 1..1 | Identifier | Version-independent identifier for the Composition
status | ?!Σ | 1..1 | code | preliminary | final | amended | entered-in-error Binding: ADI Composition Status (required)
type | S Σ | 1..1 | CodeableConcept | Kind of composition (LOINC if possible) Binding: Advance Healthcare Directive Categories LOINC (extensible)
category | S Σ | 0..1 | CodeableConcept | Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://loinc.org
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: 42348-3
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance healthcare directives
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
subject | S Σ | 1..1 | Reference(US Core Patient Profile) | Who and/or what the composition is about
encounter | Σ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S Σ | 1..1 | dateTime | Composition editing time
author | S Σ | 1..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson) | Who and/or what authored the composition
title | S Σ | 1..1 | string | Human Readable name/title
attester |  | 0..* | BackboneElement | Attests to accuracy of composition
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
mode |  | 1..1 | code | personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time |  | 0..1 | dateTime | When the composition was attested
party |  | 0..1 | Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization) | Who attested the composition
custodian | S Σ | 1..1 | Reference(US Core Organization Profile) | Organization which maintains the composition
relatesTo |  | 0..* | BackboneElement | Relationships to other compositions/documents
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code |  | 1..1 | code | replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x] |  | 1..1 |  | Target of the relationship
targetIdentifier |  |  | Identifier |
targetReference |  |  | Reference(Composition) |
event | Σ | 0..* | BackboneElement | The clinical service(s) being documented
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
code | Σ | 0..* | CodeableConcept | Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented. Required Pattern: At least the following
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
coding |  | 1..* | Coding | Code defined by a terminology system Fixed Value: (Complex)
id |  | 0..1 | string | Unique id for inter-element referencing
extension |  | 0..* | Extension | Additional content defined by implementations
system |  | 1..1 | uri | Identity of the terminology system Fixed Value: http://hl7.org/fhir/us/pacio-adi/CodeSystem/adi-temp-cs
version |  | 0..1 | string | Version of the system - if relevant
code |  | 1..1 | code | Symbol in syntax defined by the system Fixed Value: acp-services
display |  | 1..1 | string | Representation defined by the system Fixed Value: Advance care planning services
userSelected |  | 0..1 | boolean | If this coding was chosen directly by the user
text |  | 0..1 | string | Plain text representation of the concept
period | Σ | 0..1 | Period | The period covered by the documentation
Slices for detail | Σ | 0..* | Reference(Resource) | The event(s) being documented Slice: Unordered, Open by profile:resolve()
detail:adiFacilitator | Σ | 0..1 | Reference(ADI Facilitator) | ADI Facilitator
section | C | 0..* | BackboneElement | Composition is broken into sections Constraints: cmp-1, cmp-2
id |  | 0..1 | string | Unique id for inter-element referencing
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:ClauseExtension |  | 0..* | (Complex) | Clause URL: http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
title |  | 0..1 | string | Label for section (e.g. for ToC)
code |  | 0..1 | CodeableConcept | Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author |  | 0..* | Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization) | Who and/or what authored the section
focus |  | 0..1 | Reference(Resource) | Who/what the section is about, when it is not about the subject of composition
text | C | 0..1 | Narrative | Text summary of the section, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
mode |  | 0..1 | code | working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy |  | 0..1 | CodeableConcept | Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry | C | 0..* | Reference(Resource) | A reference to data that supports this section
emptyReason | C | 0..1 | CodeableConcept | Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section | C | 0..* | See section (Composition) | Nested Section
Documentation for this format

#### Terminology Bindings

Path | Conformance | ValueSet / Code | URI
Composition.language | preferred | CommonLanguages `http://hl7.org/fhir/ValueSet/languages` From the FHIR Standard
Additional Bindings | Purpose
AllLanguages | Max Binding
Composition.status | required | ADICompositionStatusVS `http://hl7.org/fhir/us/pacio-adi/ValueSet/ADICompositionStatusVS` From this IG
Composition.type | extensible | AdvanceHealthcareDirectiveCategoriesLOINC `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.11.20.9.69.4` From https://vsac.nlm.nih.gov
Composition.category | example | Pattern Value: LOINC Code 42348-3("Advance healthcare directives") `http://hl7.org/fhir/ValueSet/document-classcodes` From the FHIR Standard
Composition.attester.mode | required | CompositionAttestationMode `http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1` From the FHIR Standard
Composition.relatesTo.code | required | DocumentRelationshipType `http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1` From the FHIR Standard
Composition.event.code | example | Pattern Value: acp-services("Advance care planning services") `http://terminology.hl7.org/ValueSet/v3-ActCode`
Composition.section.code | example | DocumentSectionCodes `http://hl7.org/fhir/ValueSet/doc-section-codes` From the FHIR Standard
Composition.section.mode | required | ListMode `http://hl7.org/fhir/ValueSet/list-mode|4.0.1` From the FHIR Standard
Composition.section.orderedBy | preferred | ListOrderCodes `http://hl7.org/fhir/ValueSet/list-order` From the FHIR Standard
Composition.section.emptyReason | preferred | ListEmptyReasons `http://hl7.org/fhir/ValueSet/list-empty-reason` From the FHIR Standard

#### Constraints

Id | Grade | Path(s) | Details | Requirements
cmp-1 | error | Composition.section | A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists() |
cmp-2 | error | Composition.section | A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty() |
dom-2 | error | Composition | If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty() |
dom-3 | error | Composition | If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty() |
dom-4 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty() |
dom-5 | error | Composition | If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty() |
dom-6 | best practice | Composition | A resource should have narrative for robust management : text.`div`.exists() |
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count()) |
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both : extension.exists() != value.exists() |

This structure is derived from Clinical Document

Summary

Mandatory: 4 elements
Must-Support: 10 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Encounter Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-encounter)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core PractitionerRole Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitionerrole)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- ADI Facilitator (http://hl7.org/fhir/us/pacio-adi/StructureDefinition/ADI-Facilitator)

Extensions

This structure refers to these extensions:

- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-expiration-date-extension
- http://hl7.org/fhir/us/core/StructureDefinition/us-core-jurisdiction
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-dataEnterer-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-informant-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-healthcareAgentParticipant-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-performer-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-clause-extension
- http://hl7.org/fhir/us/pacio-adi/StructureDefinition/adi-document-revoke-status

Slices

This structure defines the following Slices:

- The element 1 is sliced based on the value of Composition.event.detail

Maturity: 2

Other representations of profile: CSV, Excel, Schematron