Physical Activity Implementation Guide
1.0.1 - STU Release 1 United States of America flag

Physical Activity Implementation Guide, published by HL7 International / Patient Care. This guide is not an authorized publication; it is the continuous build for version 1.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/physical-activity/ and changes regularly. See the Directory of published versions

Resource Profile: PACarePlan - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 2

Definitions for the pa-careplan resource profile.

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

0. CarePlan
Definition

A plan describing the plan to improve or maintain a patient's level of physical activity

2. CarePlan.implicitRules
Control0..0
4. CarePlan.text
6. CarePlan.text.div
Must Supporttrue
8. CarePlan.modifierExtension
Control0..0
10. CarePlan.status
Comments

In most instances, the 'status' of the CarePlan is expected to be 'active'. However, when the goals of the CarePlan are either achieved or no longer applicable, the status should be updated to 'completed' or 'revoked' respectively. While there are additional statuses available, they might not be universally used across all systems. Even though source systems are only expected to support 'active' and 'completed', receiving systems must handle the others if present, though they do not need to differentiate additional statues other than 'entered-in-error'.

12. CarePlan.intent
ShortPlan
Pattern Valueplan
14. CarePlan.category
Control2..?
16. CarePlan.category:PA
Slice NamePA
Control1..1
Must Supporttrue
Pattern Value{
  "coding" : [{
    "system" : "http://hl7.org/fhir/us/physical-activity/CodeSystem/pa-temporary-codes",
    "code" : "PhysicalActivity"
  }]
}
18. CarePlan.period
Must Supporttrue
20. CarePlan.period.start
Must Supporttrue
22. CarePlan.period.end
Must Supporttrue
24. CarePlan.note
Must Supporttrue
26. CarePlan.note.author[x]
Control1..?
TypeReference(Reference - RESTful or Logical)(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, PA Related Person)
[x] NoteSee Choice of Data Types for further information about how to use [x]
Must Supporttrue
Must Support TypesReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile)
28. CarePlan.note.time
Control1..?
Must Supporttrue
30. CarePlan.note.text
Must Supporttrue

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

0. CarePlan
Definition

A plan describing the plan to improve or maintain a patient's level of physical activity


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

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

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

ShortA set of rules under which this content was created
Comments

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

Control0..01
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. CarePlan.text
Definition

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

ShortText summary of the resource, for human interpretation
Comments

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

Control10..1
TypeNarrative
Is Modifierfalse
Must Supporttrue
Summaryfalse
Alternate Namesnarrative, html, xhtml, display
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
6. CarePlan.text.status
Definition

generated | additional.


The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

Shortgenerated | extensions | additional | empty
Control1..1
BindingThe codes SHALL be taken from US Core Narrative Statushttp://hl7.org/fhir/ValueSet/narrative-status|4.0.1
(required to http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status)

Constrained value set of narrative statuses.


The status of a resource narrative.

Typecode
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()))
8. CarePlan.text.div
Definition

The actual narrative content, a stripped down version of XHTML.

ShortLimited xhtml content
Comments

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

Control1..1
Typexhtml
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()))
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())
10. CarePlan.modifierExtension
Definition

An Extension


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).

ShortExtensionExtensions 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..0*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Summaryfalse
Requirements

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

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

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

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

In most instances, the 'status' of the CarePlan is expected to be 'active'. However, when the goals of the CarePlan are either achieved or no longer applicable, the status should be updated to 'completed' or 'revoked' respectively. While there are additional statuses available, they might not be universally used across all systems. Even though source systems are only expected to support 'active' and 'completed', receiving systems must handle the others if present, though they do not need to differentiate additional statues other than 'entered-in-error'.


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

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

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

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

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

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


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

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

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

ShortPlanproposal | plan | order | option
Comments

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

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

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


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

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

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

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

Type of plan.


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

ShortType of plan
Comments

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

Control20..*
BindingFor example codes, see CarePlanCategoryhttp://hl7.org/fhir/ValueSet/care-plan-category
(example to http://hl7.org/fhir/ValueSet/care-plan-category)

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

TypeCodeableConcept
Is Modifierfalse
Must Supporttrue
Summarytrue
Requirements

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


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

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

    Type of plan.


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

    ShortType of plan
    Comments

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

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

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

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

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


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

    Pattern Value{
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/core/CodeSystem/careplan-category",
        "code" : "assess-plan"
      }]
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. CarePlan.category:PA
    Slice NamePA
    Definition

    Type of plan.


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

    ShortType of plan
    Comments

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

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

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

    TypeCodeableConcept
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

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


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

    Pattern Value{
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/physical-activity/CodeSystem/pa-temporary-codes",
        "code" : "PhysicalActivity"
      }]
    }
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. CarePlan.subject
    Definition

    Who care plan is for.


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

    ShortWho the care plan is for
    Control1..1
    TypeReference(US Core Patient Profile, Patient, Group)
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

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

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

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

    ShortTime period plan covers
    Comments

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

    Control0..1
    TypePeriod
    Is Modifierfalse
    Must Supporttrue
    Summarytrue
    Requirements

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

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

    The start of the period. The boundary is inclusive.

    ShortStarting time with inclusive boundary
    Comments

    If the low element is missing, the meaning is that the low boundary is not known.

    Control0..1
    This element is affected by the following invariants: per-1
    TypedateTime
    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()))
    28. CarePlan.period.end
    Definition

    The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

    ShortEnd time with inclusive boundary, if not ongoing
    Comments

    The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

    Control0..1
    This element is affected by the following invariants: per-1
    TypedateTime
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supporttrue
    Summarytrue
    Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    30. CarePlan.note
    Definition

    General notes about the care plan not covered elsewhere.

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

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

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    32. CarePlan.note.author[x]
    Definition

    The individual responsible for making the annotation.

    ShortIndividual responsible for the annotation
    Comments

    Organization is used when there's no need for specific attribution as to who made the comment.

    Control10..1
    TypeReference(Reference - RESTful or Logical)(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, PA Related Person, Practitioner, Patient, RelatedPerson, Organization), string
    [x] NoteSee Choice of Data Types for further information about how to use [x]
    Is Modifierfalse
    Must Supporttrue
    Must Support TypesReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile)
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    34. CarePlan.note.time
    Definition

    Indicates when this particular annotation was made.

    ShortWhen the annotation was made
    Control10..1
    TypedateTime
    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()))
    36. CarePlan.note.text
    Definition

    The text of the annotation in markdown format.

    ShortThe annotation - text content (as markdown)
    Control1..1
    Typemarkdown
    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()))

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

    0. CarePlan
    Definition

    A plan describing the plan to improve or maintain a patient's level of physical activity

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

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

    ShortLogical id of this artifact
    Comments

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

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

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

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

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

    ShortA set of rules under which this content was created
    Comments

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

    Control0..0
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. CarePlan.language
    Definition

    The base language in which the resource is written.

    ShortLanguage of the resource content
    Comments

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

    Control0..1
    BindingThe codes SHOULD be taken from CommonLanguages
    (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. CarePlan.text
    Definition

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

    ShortText summary of the resource, for human interpretation
    Comments

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

    Control1..1
    TypeNarrative
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Alternate Namesnarrative, html, xhtml, display
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. CarePlan.text.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
    14. CarePlan.text.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())
    SlicingThis element introduces a set of slices on CarePlan.text.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 16. CarePlan.text.status
      Definition

      generated | additional.

      Shortgenerated | extensions | additional | empty
      Control1..1
      BindingThe codes SHALL be taken from US Core Narrative Status
      (required to http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status)

      Constrained value set of narrative statuses.

      Typecode
      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()))
      18. CarePlan.text.div
      Definition

      The actual narrative content, a stripped down version of XHTML.

      ShortLimited xhtml content
      Comments

      The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

      Control1..1
      Typexhtml
      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()))
      txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes (htmlChecks())
      txt-2: The narrative SHALL have some non-whitespace content (htmlChecks())
      20. CarePlan.contained
      Definition

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

      ShortContained, inline Resources
      Comments

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

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

      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.

      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())
      24. CarePlan.modifierExtension
      Definition

      An Extension

      ShortExtension
      Control0..0
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      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())
      26. CarePlan.identifier
      Definition

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

      ShortExternal Ids for this plan
      Comments

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

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

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

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

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

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

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

      ShortInstantiates external protocol or definition
      Comments

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

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

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

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

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

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

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

      ShortCarePlan replaced by this CarePlan
      Comments

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

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

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

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

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

      ShortPart of referenced CarePlan
      Comments

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

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

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

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

      In most instances, the 'status' of the CarePlan is expected to be 'active'. However, when the goals of the CarePlan are either achieved or no longer applicable, the status should be updated to 'completed' or 'revoked' respectively. While there are additional statuses available, they might not be universally used across all systems. Even though source systems are only expected to support 'active' and 'completed', receiving systems must handle the others if present, though they do not need to differentiate additional statues other than 'entered-in-error'.

      Control1..1
      BindingThe codes SHALL be taken from RequestStatus
      (required to http://hl7.org/fhir/ValueSet/request-status)

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

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

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

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

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

      ShortPlan
      Comments

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

      Control1..1
      BindingThe codes SHALL be taken from CarePlanIntent
      (required to http://hl7.org/fhir/ValueSet/care-plan-intent)

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

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

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

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

      Type of plan.

      ShortType of plan
      Comments

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

      Control2..*
      BindingFor example codes, see CarePlanCategory
      (example to http://hl7.org/fhir/ValueSet/care-plan-category)

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

      TypeCodeableConcept
      Is Modifierfalse
      Must Supporttrue
      Summarytrue
      Requirements

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

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

        Type of plan.

        ShortType of plan
        Comments

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

        Control1..1
        BindingFor example codes, see CarePlanCategory
        (example to http://hl7.org/fhir/ValueSet/care-plan-category)

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

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

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

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/core/CodeSystem/careplan-category",
            "code" : "assess-plan"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        46. CarePlan.category:PA
        Slice NamePA
        Definition

        Type of plan.

        ShortType of plan
        Comments

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

        Control1..1
        BindingFor example codes, see CarePlanCategory
        (example to http://hl7.org/fhir/ValueSet/care-plan-category)

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

        TypeCodeableConcept
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

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

        Pattern Value{
          "coding" : [{
            "system" : "http://hl7.org/fhir/us/physical-activity/CodeSystem/pa-temporary-codes",
            "code" : "PhysicalActivity"
          }]
        }
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        48. CarePlan.title
        Definition

        Human-friendly name for the care plan.

        ShortHuman-friendly name for the care plan
        Control0..1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        50. CarePlan.description
        Definition

        A description of the scope and nature of the plan.

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

        Provides more detail than conveyed by category.

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

        Who care plan is for.

        ShortWho the care plan is for
        Control1..1
        TypeReference(US Core Patient Profile)
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

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

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

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

        ShortEncounter created as part of
        Comments

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

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

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

        ShortTime period plan covers
        Comments

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

        Control0..1
        TypePeriod
        Is Modifierfalse
        Must Supporttrue
        Summarytrue
        Requirements

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

        Alternate Namestiming
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. CarePlan.period.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
        60. CarePlan.period.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())
        SlicingThis element introduces a set of slices on CarePlan.period.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 62. CarePlan.period.start
          Definition

          The start of the period. The boundary is inclusive.

          ShortStarting time with inclusive boundary
          Comments

          If the low element is missing, the meaning is that the low boundary is not known.

          Control0..1
          This element is affected by the following invariants: per-1
          TypedateTime
          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()))
          64. CarePlan.period.end
          Definition

          The end of the period. If the end of the period is missing, it means no end was known or planned at the time the instance was created. The start may be in the past, and the end date in the future, which means that period is expected/planned to end at that time.

          ShortEnd time with inclusive boundary, if not ongoing
          Comments

          The high value includes any matching date/time. i.e. 2012-02-03T10:00:00 is in a period that has an end value of 2012-02-03.

          Control0..1
          This element is affected by the following invariants: per-1
          TypedateTime
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supporttrue
          Summarytrue
          Meaning if MissingIf the end of the period is missing, it means that the period is ongoing
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          66. CarePlan.created
          Definition

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

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

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

          ShortWho is the designated responsible party
          Comments

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

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

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

          ShortWho provided the content of the care plan
          Comments

          Collaborative care plans may have multiple contributors.

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

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

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

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

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

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

          ShortHealth issues this plan addresses
          Comments

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

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

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

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

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

          ShortInformation considered as part of plan
          Comments

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

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

          Identifies barriers and other considerations associated with the care plan.

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

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

          ShortDesired outcome of plan
          Comments

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

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

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

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

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

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

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

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

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

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

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

          ShortAdditional content defined by implementations
          Comments

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

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

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

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

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

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

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

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

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

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

          ShortResults of the activity
          Comments

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

          Control0..*
          BindingFor example codes, see CarePlanActivityOutcome
          (example to http://hl7.org/fhir/ValueSet/care-plan-activity-outcome)

          Identifies the results of the activity.

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

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

          ShortAppointment, Encounter, Procedure, etc.
          Comments

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

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

          Links plan to resulting actions.

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

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

          ShortComments about the activity status/progress
          Comments

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

          Control0..*
          TypeAnnotation
          Is Modifierfalse
          Summaryfalse
          Requirements

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

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

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

          ShortActivity details defined in specific resource
          Comments

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

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

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

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

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

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

          Details in a simple form for generic care plan systems.

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

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

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

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

          ShortAdditional content defined by implementations
          Comments

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

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

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

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

          ShortExtensions that cannot be ignored even if unrecognized
          Comments

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

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

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

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

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

          ShortAppointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
          Control0..1
          BindingThe codes SHALL be taken from CarePlanActivityKind
          (required to http://hl7.org/fhir/ValueSet/care-plan-activity-kind|4.0.1)

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

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

          May determine what types of extensions are permitted.

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

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

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

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

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

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

          ShortInstantiates external protocol or definition
          Comments

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

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

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

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

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

          ShortDetail type of activity
          Comments

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

          Control0..1
          BindingFor example codes, see ProcedureCodes(SNOMEDCT)
          (example to http://hl7.org/fhir/ValueSet/procedure-code)

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

          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Requirements

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

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

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

          ShortWhy activity should be done or why activity was prohibited
          Comments

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

          Control0..*
          BindingFor example codes, see SNOMEDCTClinicalFindings
          (example to http://hl7.org/fhir/ValueSet/clinical-findings)

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

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

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

          ShortWhy activity is needed
          Comments

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

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

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

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

          So that participants know the link explicitly.

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

          Identifies what progress is being made for the specific activity.

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

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

          Control1..1
          BindingThe codes SHALL be taken from CarePlanActivityStatus
          (required to http://hl7.org/fhir/ValueSet/care-plan-activity-status|4.0.1)

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

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

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

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

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

          ShortReason for current status
          Comments

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

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

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

          ShortIf true, activity is prohibiting action
          Comments

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

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

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

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

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

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

          Allows prompting for activities and detection of missed planned activities.

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

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

          ShortWhere it should happen
          Comments

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

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

          Helps in planning of activity.

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

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

          ShortWho will be responsible?
          Comments

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

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

          Helps in planning of activity.

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

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

          ShortWhat is to be administered/supplied
          Control0..1
          BindingFor example codes, see SNOMEDCTMedicationCodes
          (example to http://hl7.org/fhir/ValueSet/medication-codes)

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

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

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

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

          Allows rough dose checking.

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

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

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

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

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

          General notes about the care plan not covered elsewhere.

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

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

          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          140. CarePlan.note.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
          142. CarePlan.note.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())
          SlicingThis element introduces a set of slices on CarePlan.note.extension. The slices are unordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 144. CarePlan.note.author[x]
            Definition

            The individual responsible for making the annotation.

            ShortIndividual responsible for the annotation
            Comments

            Organization is used when there's no need for specific attribution as to who made the comment.

            Control1..1
            TypeReference(Reference - RESTful or Logical)(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile, PA Related Person)
            [x] NoteSee Choice of Data Types for further information about how to use [x]
            Is Modifierfalse
            Must Supporttrue
            Must Support TypesReference(US Core Practitioner Profile, US Core Organization Profile, US Core Patient Profile)
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            146. CarePlan.note.time
            Definition

            Indicates when this particular annotation was made.

            ShortWhen the annotation was made
            Control1..1
            TypedateTime
            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()))
            148. CarePlan.note.text
            Definition

            The text of the annotation in markdown format.

            ShortThe annotation - text content (as markdown)
            Control1..1
            Typemarkdown
            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()))