ACT-NOW Implementation Guide
0.4.0 - ci-build New Zealand flag

ACT-NOW Implementation Guide, published by Te aho o te kahu - Cancer Control Agency. This guide is not an authorized publication; it is the continuous build for version 0.4.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/davidhay25/actnow/ and changes regularly. See the Directory of published versions

Resource Profile: CareplanCycle - Detailed Descriptions

Draft as of 2024-06-24

Definitions for the an-careplan-cycle resource profile.

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

0. CarePlan
Invariantsan-cycleCP-1: If the CarePlan was cancelled, then there must be the cancellation reason extension present (CarePlan.status = 'completed' implies extension('http://canshare.co.nz/fhir/StructureDefinition/an-last-admin-date').exists())
2. CarePlan.extension
Control2..?
SlicingThis element introduces a set of slices on CarePlan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 4. CarePlan.extension:cycle-planned-length
    Slice Namecycle-planned-length
    Control1..1
    TypeExtension(CyclePlannedLength) (Extension Type: integer)
    6. CarePlan.extension:cycle-number
    Slice Namecycle-number
    Control1..1
    TypeExtension(CycleNumber) (Extension Type: integer)
    8. CarePlan.extension:last-admin-date
    Slice Namelast-admin-date
    Control0..1
    TypeExtension(LastAdminDate) (Extension Type: dateTime)
    10. CarePlan.identifier
    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control1..?
    12. CarePlan.partOf
    Control1..1
    TypeReference(Regimen Careplan)
    14. CarePlan.intent
    Pattern Valueplan
    16. CarePlan.category
    Control1..?
    18. CarePlan.category.coding
    Control1..?
    SlicingThis element introduces a set of slices on CarePlan.category.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • pattern @ code
    • 20. CarePlan.category.coding:cyclecode
      Slice Namecyclecode
      Definition

      Code identifying this carePlan as being at the cycle level

      ShortCycle level carePlan
      Control1..1
      Must Supporttrue
      22. CarePlan.category.coding:cyclecode.system
      Pattern Valuehttp://snomed.info/sct
      24. CarePlan.category.coding:cyclecode.code
      Control1..?
      Pattern Value261761000210103
      26. CarePlan.title
      Control1..?
      28. CarePlan.period
      Control1..?

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

      0. CarePlan
      Definition

      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
      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())
      an-cycleCP-1: If the CarePlan was cancelled, then there must be the cancellation reason extension present (CarePlan.status = 'completed' implies extension('http://canshare.co.nz/fhir/StructureDefinition/an-last-admin-date').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..1
      Typeuri
      Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      4. CarePlan.extension
      Definition

      An Extension


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

      ShortExtensionAdditional content defined by implementations
      Comments

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

      Control20..*
      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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ url
      • 6. CarePlan.extension:cycle-planned-length
        Slice Namecycle-planned-length
        Definition

        The number of cycles that administered for a regimen

        ShortExtension
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(CyclePlannedLength) (Extension Type: integer)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        8. CarePlan.extension:cycle-number
        Slice Namecycle-number
        Definition

        The cycle number of the regimen that this CP represents

        ShortExtension
        Control1..1
        This element is affected by the following invariants: ele-1
        TypeExtension(CycleNumber) (Extension Type: integer)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        10. CarePlan.extension:last-admin-date
        Slice Namelast-admin-date
        Definition

        The last date that a medication administration was made for this cycle

        ShortExtension
        Control0..1
        This element is affected by the following invariants: ele-1
        TypeExtension(LastAdminDate) (Extension Type: dateTime)
        Is Modifierfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        12. CarePlan.modifierExtension
        Definition

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

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

        ShortExtensions that cannot be ignored
        Comments

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

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

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

        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
        14. 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)
        Control10..*
        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()))
        16. 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.

        Control10..1*
        TypeReference(Regimen Careplan, CarePlan)
        Is Modifierfalse
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        18. 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

        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|4.0.1)

        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
        Summarytrue
        Requirements

        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()))
        20. CarePlan.intent
        Definition

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

        Shortproposal | 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|4.0.1)

        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
        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()))
        22. CarePlan.category
        Definition

        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..*
        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
        Summarytrue
        Requirements

        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()))
        24. CarePlan.category.coding
        Definition

        A reference to a code defined by a terminology system.

        ShortCode defined by a terminology system
        Comments

        Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

        Control10..*
        TypeCoding
        Is Modifierfalse
        Summarytrue
        Requirements

        Allows for alternative encodings within a code system, and translations to other code systems.

        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.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • pattern @ code
        • 26. CarePlan.category.coding:cyclecode
          Slice Namecyclecode
          Definition

          Code identifying this carePlan as being at the cycle level


          A reference to a code defined by a terminology system.

          ShortCycle level carePlanCode defined by a terminology system
          Comments

          Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

          Control10..1*
          TypeCoding
          Is Modifierfalse
          Must Supporttrue
          Summarytrue
          Requirements

          Allows for alternative encodings within a code system, and translations to other code systems.

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

          The identification of the code system that defines the meaning of the symbol in the code.

          ShortIdentity of the terminology system
          Comments

          The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

          Control0..1
          Typeuri
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to be unambiguous about the source of the definition of the symbol.

          Pattern Valuehttp://snomed.info/sct
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          30. CarePlan.category.coding:cyclecode.code
          Definition

          A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

          ShortSymbol in syntax defined by the system
          Control10..1
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Requirements

          Need to refer to a particular code in the system.

          Pattern Value261761000210103
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          32. CarePlan.title
          Definition

          Human-friendly name for the care plan.

          ShortHuman-friendly name for the care plan
          Control10..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()))
          34. CarePlan.subject
          Definition

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

          ShortWho the care plan is for
          Control1..1
          TypeReference(Patient, Group)
          Is Modifierfalse
          Summarytrue
          Alternate Namespatient
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          36. 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).

          Control10..1
          TypePeriod
          Is Modifierfalse
          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()))

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

          0. CarePlan
          Definition

          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
          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())
          an-cycleCP-1: If the CarePlan was cancelled, then there must be the cancellation reason extension present (CarePlan.status = 'completed' implies extension('http://canshare.co.nz/fhir/StructureDefinition/an-last-admin-date').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..1
          Typeuri
          Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          8. 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.

          Control0..1
          TypeNarrative
          Is Modifierfalse
          Summaryfalse
          Alternate Namesnarrative, html, xhtml, display
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          12. 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
          14. CarePlan.extension
          Definition

          An Extension

          ShortExtension
          Control2..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
          SlicingThis element introduces a set of slices on CarePlan.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 16. CarePlan.extension:cycle-planned-length
            Slice Namecycle-planned-length
            Definition

            The number of cycles that administered for a regimen

            ShortExtension
            Control1..1
            This element is affected by the following invariants: ele-1
            TypeExtension(CyclePlannedLength) (Extension Type: integer)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            18. CarePlan.extension:cycle-number
            Slice Namecycle-number
            Definition

            The cycle number of the regimen that this CP represents

            ShortExtension
            Control1..1
            This element is affected by the following invariants: ele-1
            TypeExtension(CycleNumber) (Extension Type: integer)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            20. CarePlan.extension:last-admin-date
            Slice Namelast-admin-date
            Definition

            The last date that a medication administration was made for this cycle

            ShortExtension
            Control0..1
            This element is affected by the following invariants: ele-1
            TypeExtension(LastAdminDate) (Extension Type: dateTime)
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            22. CarePlan.modifierExtension
            Definition

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

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

            ShortExtensions that cannot be ignored
            Comments

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

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

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

            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
            24. 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)
            Control1..*
            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()))
            26. 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()))
            28. 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()))
            30. 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()))
            32. 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()))
            34. 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.

            Control1..1
            TypeReference(Regimen Careplan)
            Is Modifierfalse
            Summarytrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            36. 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

            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 RequestStatus
            (required to http://hl7.org/fhir/ValueSet/request-status|4.0.1)

            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
            Summarytrue
            Requirements

            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()))
            38. CarePlan.intent
            Definition

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

            Shortproposal | 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 CarePlanIntent
            (required to http://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1)

            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
            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()))
            40. CarePlan.category
            Definition

            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.

            Control1..*
            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
            Summarytrue
            Requirements

            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()))
            42. CarePlan.category.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
            44. CarePlan.category.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.category.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 46. CarePlan.category.coding
              Definition

              A reference to a code defined by a terminology system.

              ShortCode defined by a terminology system
              Comments

              Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

              Control1..*
              TypeCoding
              Is Modifierfalse
              Summarytrue
              Requirements

              Allows for alternative encodings within a code system, and translations to other code systems.

              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.coding. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • pattern @ code
              • 48. CarePlan.category.coding:cyclecode
                Slice Namecyclecode
                Definition

                Code identifying this carePlan as being at the cycle level

                ShortCycle level carePlan
                Comments

                Codes may be defined very casually in enumerations, or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Ordering of codings is undefined and SHALL NOT be used to infer meaning. Generally, at most only one of the coding values will be labeled as UserSelected = true.

                Control1..1
                TypeCoding
                Is Modifierfalse
                Must Supporttrue
                Summarytrue
                Requirements

                Allows for alternative encodings within a code system, and translations to other code systems.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                50. CarePlan.category.coding:cyclecode.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
                52. CarePlan.category.coding:cyclecode.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.category.coding.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 54. CarePlan.category.coding:cyclecode.system
                  Definition

                  The identification of the code system that defines the meaning of the symbol in the code.

                  ShortIdentity of the terminology system
                  Comments

                  The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should reference to some definition that establishes the system clearly and unambiguously.

                  Control0..1
                  Typeuri
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to be unambiguous about the source of the definition of the symbol.

                  Pattern Valuehttp://snomed.info/sct
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  56. CarePlan.category.coding:cyclecode.version
                  Definition

                  The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

                  ShortVersion of the system - if relevant
                  Comments

                  Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

                  NoteThis is a business version Id, not a resource version Id (see discussion)
                  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()))
                  58. CarePlan.category.coding:cyclecode.code
                  Definition

                  A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).

                  ShortSymbol in syntax defined by the system
                  Control1..1
                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to refer to a particular code in the system.

                  Pattern Value261761000210103
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  60. CarePlan.category.coding:cyclecode.display
                  Definition

                  A representation of the meaning of the code in the system, following the rules of the system.

                  ShortRepresentation defined by the system
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  Need to be able to carry a human-readable meaning of the code for readers that do not know the system.

                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  62. CarePlan.category.coding:cyclecode.userSelected
                  Definition

                  Indicates that this coding was chosen by a user directly - e.g. off a pick list of available items (codes or displays).

                  ShortIf this coding was chosen directly by the user
                  Comments

                  Amongst a set of alternatives, a directly chosen code is the most appropriate starting point for new translations. There is some ambiguity about what exactly 'directly chosen' implies, and trading partner agreement may be needed to clarify the use of this element and its consequences more completely.

                  Control0..1
                  Typeboolean
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summarytrue
                  Requirements

                  This has been identified as a clinical safety criterium - that this exact system/code pair was chosen explicitly, rather than inferred by the system based on some rules or language processing.

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

                  A human language representation of the concept as seen/selected/uttered by the user who entered the data and/or which represents the intended meaning of the user.

                  ShortPlain text representation of the concept
                  Comments

                  Very often the text is the same as a displayName of one of the codings.

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

                  The codes from the terminologies do not always capture the correct meaning with all the nuances of the human using them, or sometimes there is no appropriate code at all. In these cases, the text is used to capture the full meaning of the source.

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

                  Human-friendly name for the care plan.

                  ShortHuman-friendly name for the care plan
                  Control1..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()))
                  68. 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()))
                  70. CarePlan.subject
                  Definition

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

                  ShortWho the care plan is for
                  Control1..1
                  TypeReference(Patient, Group)
                  Is Modifierfalse
                  Summarytrue
                  Alternate Namespatient
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  72. 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()))
                  74. 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).

                  Control1..1
                  TypePeriod
                  Is Modifierfalse
                  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()))
                  76. 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()))
                  78. 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()))
                  80. 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()))
                  82. 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()))
                  84. 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()))
                  86. 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()))
                  88. 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()))
                  90. 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()))
                  92. 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
                  94. 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())
                  96. 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())
                  98. 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()))
                  100. 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()))
                  102. 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()))
                  104. 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()))
                  106. 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()))
                  108. 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
                  110. 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())
                  112. 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())
                  114. 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()))
                  116. 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()))
                  118. 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()))
                  120. 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()))
                  122. 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()))
                  124. 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()))
                  126. 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()))
                  128. 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()))
                  130. 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()))
                  132. 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()))
                  134. 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] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  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()))
                  136. 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()))
                  138. 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()))
                  140. 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] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  142. 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()))
                  144. 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()))
                  146. 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()))
                  148. CarePlan.note
                  Definition

                  General notes about the care plan not covered elsewhere.

                  ShortComments about the plan
                  Control0..*
                  TypeAnnotation
                  Is Modifierfalse
                  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()))