XpanDH Hospital Discharge Report
0.1.0 - ci-build 150

XpanDH Hospital Discharge Report, published by XpanDH Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/xpandh-hdr/ and changes regularly. See the Directory of published versions

Resource Profile: ConditionEncounterHdrXpandh - Detailed Descriptions

Draft as of 2024-06-19

Definitions for the condition-encounter-hdr-xpandh resource profile.

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

0. Condition
2. Condition.category
Definition

Slices per type of classificaton

Shortcategory codes
Control3..?
SlicingThis element introduces a set of slices on Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ $this
  • 4. Condition.category:hdr-core
    Slice Namehdr-core
    Shortencounter-diagnosis
    Control1..1
    Pattern Value{
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
        "code" : "encounter-diagnosis"
      }]
    }
    6. Condition.category:poa
    Slice Namepoa
    Definition

    Present on admission, Hospital acquired condition, Not applicable or unknown

    ShortPOA, HAC, NA
    Control1..1
    BindingThe codes SHALL be taken from Condition Present on Admission (POA) Value Set
    (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/hdr-poa-indicator-xpandh-vs)
    8. Condition.category:treated
    Slice Nametreated
    Definition

    Class of the problem (treated, other) in relation to the hospital encounter. Treated problems were treated or affected provisioning of care (diagnostics, therapy, nursing, monitoring) during the hospital encounter. At least one problem should be marked as Treated. Other problems are recorded only if they are important for continuity of care (after discharge).

    ShortTreated or untreated
    Control1..1
    BindingThe codes SHALL be taken from Treatment Class Value Set
    (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/hdr-treated-xpandh-vs)

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

    0. Condition
    Definition

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

    ShortDocumentation of a health problem of the patientDetailed information about conditions, problems or diagnoses
    Control0..*
    Is Modifierfalse
    Summaryfalse
    Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
    con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
    con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
    dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
    dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    con-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
    con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
    con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
    2. Condition.implicitRules
    Definition

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

    ShortA set of rules under which this content was created
    Comments

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

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

    Human readable specification of the problem. This is a general notes/comments entry for description of the problem, its diagnosis and prognosis.


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

    ShortText summary of the resource, for human interpretation
    Comments

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

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

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

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

    ShortExtensions that cannot be ignored
    Comments

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

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

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

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

    The problem status describes the condition of the problem:

    1. Active problems are problems of which the patient experiences symptoms or for which evidence exists.

    2. If condition is abated, then clinicalStatus must be either inactive, resolved, or remission.

    3. Problems with the status 'Inactive' refer to problems that don't affect the patient anymore or that of which there is no evidence of existence anymore.


    The clinical status of the condition.

    ShortConcept - reference to a terminology or just textactive | recurrence | relapse | inactive | remission | resolved
    Comments

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


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

    Control10..1
    This element is affected by the following invariants: ele-1, con-3, con-4, con-5
    BindingThe codes SHALL be taken from ConditionClinicalStatusCodeshttp://hl7.org/fhir/ValueSet/condition-clinical|4.0.1
    (required to http://hl7.org/fhir/ValueSet/condition-clinical)
    TypeCodeableConcept(Codeable Concept (IPS))
    Is Modifierfalsetrue because This element is labeled as a modifier because the status contains codes that mark the condition as no longer active.
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. Condition.verificationStatus
    Definition

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

    ShortConcept - reference to a terminology or just textunconfirmed | provisional | differential | confirmed | refuted | entered-in-error
    Comments

    This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.


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

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

    Slices per type of classificaton


    A category assigned to the condition.

    Shortcategory codesproblem-list-item | encounter-diagnosis
    Comments

    In this profile, Condition represents a health problem of the patient. Therefore one of the category value(s) must be problem-list-item.


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

    Control30..*
    This element is affected by the following invariants: ele-1
    BindingThe codes SHOULD be taken from Unless not suitable, these codes SHALL be taken from Problem Type - IPShttp://hl7.org/fhir/ValueSet/condition-category
    (preferred to http://hl7.org/fhir/uv/ips/ValueSet/problem-type-uv-ips)
    Additional BindingsPurposeDocumentation
    Problem Type (LOINC)candidate

    An alternative additional binding to the LOINC "Problem" code - retained for backward compatibility.

    TypeCodeableConcept(Codeable Concept (IPS))
    Is Modifierfalse
    Must Supporttrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ $this
    • 14. Condition.category:hdr-core
      Slice Namehdr-core
      Definition

      A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.


      A category assigned to the condition.

      Shortencounter-diagnosisproblem-list-item | encounter-diagnosis
      Comments

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


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

      Control10..1*
      This element is affected by the following invariants: ele-1
      BindingThe codes SHOULD be taken from Unless not suitable, these codes SHALL be taken from Problem Type - IPShttp://hl7.org/fhir/ValueSet/condition-category
      (preferred to http://hl7.org/fhir/uv/ips/ValueSet/problem-type-uv-ips)
      Additional BindingsPurposeDocumentation
      Problem Type (LOINC)candidate

      An alternative additional binding to the LOINC "Problem" code - retained for backward compatibility.

      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifierfalse
      Must Supporttrue
      Pattern Value{
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
          "code" : "encounter-diagnosis"
        }]
      }
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      16. Condition.category:poa
      Slice Namepoa
      Definition

      Present on admission, Hospital acquired condition, Not applicable or unknown


      A category assigned to the condition.

      ShortPOA, HAC, NAproblem-list-item | encounter-diagnosis
      Comments

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


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

      Control10..1*
      This element is affected by the following invariants: ele-1
      BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from Condition Present on Admission (POA) Value Sethttp://hl7.org/fhir/ValueSet/condition-category
      (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/hdr-poa-indicator-xpandh-vs)
      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      18. Condition.category:treated
      Slice Nametreated
      Definition

      Class of the problem (treated, other) in relation to the hospital encounter. Treated problems were treated or affected provisioning of care (diagnostics, therapy, nursing, monitoring) during the hospital encounter. At least one problem should be marked as Treated. Other problems are recorded only if they are important for continuity of care (after discharge).


      A category assigned to the condition.

      ShortTreated or untreatedproblem-list-item | encounter-diagnosis
      Comments

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


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

      Control10..1*
      This element is affected by the following invariants: ele-1
      BindingThe codes SHALL be taken from Unless not suitable, these codes SHALL be taken from Treatment Class Value Sethttp://hl7.org/fhir/ValueSet/condition-category
      (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/hdr-treated-xpandh-vs)
      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      20. Condition.severity
      Definition

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

      ShortConcept - reference to a terminology or just textSubjective severity of condition
      Comments

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


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

      Control0..1
      This element is affected by the following invariants: ele-1
      BindingThe codes SHOULD be taken from Condition/DiagnosisSeverityhttp://hl7.org/fhir/ValueSet/condition-severity
      (preferred to http://hl7.org/fhir/ValueSet/condition-severity)
      Additional BindingsPurposeDocumentation
      Problem Severity - IPScandidate

      An alternative additional binding to LOINC answer codes for condition/problem severity

      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifierfalse
      Must Supporttrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      22. Condition.code
      Definition

      The problem code specifies the problem. Depending on the setting, different code systems can be used. The ProblemCodelist provides an overview of the possible code systems.


      Identification of the condition, problem or diagnosis.

      ShortConcept - reference to a terminology or just textIdentification of the condition, problem or diagnosis
      Comments

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

      Control10..1
      This element is affected by the following invariants: ele-1
      BindingThe codes SHALL be taken from For example codes, see Condition Value Sethttp://hl7.org/fhir/ValueSet/condition-code
      (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/hdr-condition-xpandh-vs)

      Valueset to describe the actual problem experienced by the patient


      Identification of the condition or diagnosis.

      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifierfalse
      Must Supporttrue
      Requirements

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

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

      Anatomical location which is the focus of the problem.


      The anatomical location where this condition manifests itself.

      ShortConcept - reference to a terminology or just textAnatomical location, if relevant
      Comments

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


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

      Control0..*
      This element is affected by the following invariants: ele-1
      BindingFor example codes, see SNOMEDCTBodyStructureshttp://hl7.org/fhir/ValueSet/body-site
      (example to http://hl7.org/fhir/ValueSet/body-site)
      TypeCodeableConcept(Codeable Concept (IPS))
      Is Modifierfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      26. Condition.bodySite.extension:laterality
      Slice Namelaterality
      Definition

      Qualifier to specify laterality.

      ShortLaterality Qualifier Extension
      Control0..1
      TypeExtension(Laterality Qualifier Extension) (Extension Type: CodeableConcept)
      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())
      28. Condition.bodySite.coding
      Definition

      A reference to a code defined by a terminology system.

      ShortA reference to a code defined by a terminology systemCode 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.


      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.

      Control0..*
      This element is affected by the following invariants: ele-1
      TypeCoding(Coding with translations)
      Is Modifierfalse
      Must Supporttrue
      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()))
      30. Condition.bodySite.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
      Must Supporttrue
      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()))
      32. Condition.subject
      Definition

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

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

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

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

      A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

      ShortLiteral reference, Relative, internal or absolute URL
      Comments

      Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

      Control10..1
      This element is affected by the following invariants: ref-1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supporttrue
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. Condition.onset[x]
      Definition

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

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

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

      Control0..1
      TypeChoice of: dateTime, Age, Period, Range, 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
      Must Supporttrue
      Must Support TypesdateTime
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Condition.onset[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • type @ $this
      • 38. Condition.onset[x]:onsetDateTime
        Slice NameonsetDateTime
        Definition

        Onset of the symptom, complaint, functional limitation, complication or date of diagnosis. A ‘vague’ date, such as only the year or the month and the year, is permitted.


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

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

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

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

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

        ShortWhen in resolution/remission
        Comments

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

        Control0..1
        This element is affected by the following invariants: con-4
        TypeChoice of: dateTime, Age, Period, Range, 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
        Must Supporttrue
        Must Support TypesdateTime
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Condition.abatement[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • type @ $this
        • 42. Condition.abatement[x]:abatementDateTime
          Slice NameabatementDateTime
          Definition

          The date or estimated date that the condition resolved or went into remission. A ‘vague’ date, such as only the year or the month and the year, is permitted


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

          ShortWhen in resolution/remission
          Comments

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

          Control0..1
          This element is affected by the following invariants: con-4
          TypedateTime, string, Period, Range, Age
          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          44. Condition.recordedDate
          Definition

          Date (and time) when this problem was recorded into information system.


          The recordedDate represents when this particular Condition record was created in the system, which is often a system-generated date.

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

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

          0. Condition
          Definition

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

          ShortDocumentation of a health problem of the patient
          Control0..*
          Is Modifierfalse
          Summaryfalse
          Invariantscon-3: Condition.clinicalStatus SHALL be present if verificationStatus is not entered-in-error and category is problem-list-item (clinicalStatus.exists() or verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code = 'entered-in-error').exists() or category.select($this='problem-list-item').empty())
          con-4: If condition is abated, then clinicalStatus must be either inactive, resolved, or remission (abatement.empty() or clinicalStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-clinical' and (code='resolved' or code='remission' or code='inactive')).exists())
          con-5: Condition.clinicalStatus SHALL NOT be present if verification Status is entered-in-error (verificationStatus.coding.where(system='http://terminology.hl7.org/CodeSystem/condition-ver-status' and code='entered-in-error').empty() or clinicalStatus.empty())
          dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
          dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
          dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
          dom-6: A resource should have narrative for robust management (text.`div`.exists())
          2. Condition.id
          Definition

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

          ShortLogical id of this artifact
          Comments

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

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

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

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

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

          ShortA set of rules under which this content was created
          Comments

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

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

          The base language in which the resource is written.

          ShortLanguage of the resource content
          Comments

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

          Control0..1
          BindingThe codes SHOULD be taken from CommonLanguages
          (preferred to http://hl7.org/fhir/ValueSet/languages)

          A human language.

          Additional BindingsPurpose
          AllLanguagesMax Binding
          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          10. Condition.text
          Definition

          Human readable specification of the problem. This is a general notes/comments entry for description of the problem, its diagnosis and prognosis.

          ShortText summary of the resource, for human interpretation
          Comments

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

          Control1..1
          TypeNarrative
          Is Modifierfalse
          Summaryfalse
          Alternate Namesnarrative, html, xhtml, display
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          12. Condition.contained
          Definition

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

          ShortContained, inline Resources
          Comments

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

          Control0..*
          TypeResource
          Is Modifierfalse
          Summaryfalse
          Alternate Namesinline resources, anonymous resources, contained resources
          14. Condition.extension
          Definition

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

          ShortAdditional content defined by implementations
          Comments

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

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

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

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

          ShortExtensions that cannot be ignored
          Comments

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

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

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

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

          Globally unique identifier of this problem which remain constant as the resource is updated and propagates from server to server.

          ShortExternal Ids for this condition
          Comments

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

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

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

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

          The problem status describes the condition of the problem:

          1. Active problems are problems of which the patient experiences symptoms or for which evidence exists.

          2. If condition is abated, then clinicalStatus must be either inactive, resolved, or remission.

          3. Problems with the status 'Inactive' refer to problems that don't affect the patient anymore or that of which there is no evidence of existence anymore.

          ShortConcept - reference to a terminology or just text
          Comments

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

          Control1..1
          This element is affected by the following invariants: ele-1
          BindingThe codes SHALL be taken from ConditionClinicalStatusCodes
          (required to http://hl7.org/fhir/ValueSet/condition-clinical)
          TypeCodeableConcept(Codeable Concept (IPS))
          Is Modifierfalse
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          22. Condition.verificationStatus
          Definition

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

          ShortConcept - reference to a terminology or just text
          Comments

          This element is labeled as a modifier because the status contains the code refuted and entered-in-error that mark the Condition as not currently valid.

          Control0..1
          This element is affected by the following invariants: ele-1
          BindingThe codes SHALL be taken from ConditionVerificationStatus
          (required to http://hl7.org/fhir/ValueSet/condition-ver-status)
          TypeCodeableConcept(Codeable Concept (IPS))
          Is Modifierfalse
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          24. Condition.category
          Definition

          Slices per type of classificaton

          Shortcategory codes
          Comments

          In this profile, Condition represents a health problem of the patient. Therefore one of the category value(s) must be problem-list-item.

          Control3..*
          This element is affected by the following invariants: ele-1
          BindingThe codes SHOULD be taken from Problem Type - IPS
          (preferred to http://hl7.org/fhir/uv/ips/ValueSet/problem-type-uv-ips)
          Additional BindingsPurposeDocumentation
          Problem Type (LOINC)candidate

          An alternative additional binding to the LOINC "Problem" code - retained for backward compatibility.

          TypeCodeableConcept(Codeable Concept (IPS))
          Is Modifierfalse
          Must Supporttrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Condition.category. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ $this
          • 26. Condition.category:hdr-core
            Slice Namehdr-core
            Definition

            A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.

            Shortencounter-diagnosis
            Comments

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

            Control1..1
            This element is affected by the following invariants: ele-1
            BindingThe codes SHOULD be taken from Problem Type - IPS
            (preferred to http://hl7.org/fhir/uv/ips/ValueSet/problem-type-uv-ips)
            Additional BindingsPurposeDocumentation
            Problem Type (LOINC)candidate

            An alternative additional binding to the LOINC "Problem" code - retained for backward compatibility.

            TypeCodeableConcept(Codeable Concept (IPS))
            Is Modifierfalse
            Must Supporttrue
            Pattern Value{
              "coding" : [{
                "system" : "http://terminology.hl7.org/CodeSystem/condition-category",
                "code" : "encounter-diagnosis"
              }]
            }
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            28. Condition.category:poa
            Slice Namepoa
            Definition

            Present on admission, Hospital acquired condition, Not applicable or unknown

            ShortPOA, HAC, NA
            Comments

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

            Control1..1
            This element is affected by the following invariants: ele-1
            BindingThe codes SHALL be taken from Condition Present on Admission (POA) Value Set
            (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/hdr-poa-indicator-xpandh-vs)
            TypeCodeableConcept(Codeable Concept (IPS))
            Is Modifierfalse
            Must Supporttrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            30. Condition.category:treated
            Slice Nametreated
            Definition

            Class of the problem (treated, other) in relation to the hospital encounter. Treated problems were treated or affected provisioning of care (diagnostics, therapy, nursing, monitoring) during the hospital encounter. At least one problem should be marked as Treated. Other problems are recorded only if they are important for continuity of care (after discharge).

            ShortTreated or untreated
            Comments

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

            Control1..1
            This element is affected by the following invariants: ele-1
            BindingThe codes SHALL be taken from Treatment Class Value Set
            (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/hdr-treated-xpandh-vs)
            TypeCodeableConcept(Codeable Concept (IPS))
            Is Modifierfalse
            Must Supporttrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            32. Condition.severity
            Definition

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

            ShortConcept - reference to a terminology or just text
            Comments

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

            Control0..1
            This element is affected by the following invariants: ele-1
            BindingThe codes SHOULD be taken from Condition/DiagnosisSeverity
            (preferred to http://hl7.org/fhir/ValueSet/condition-severity)
            Additional BindingsPurposeDocumentation
            Problem Severity - IPScandidate

            An alternative additional binding to LOINC answer codes for condition/problem severity

            TypeCodeableConcept(Codeable Concept (IPS))
            Is Modifierfalse
            Must Supporttrue
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            34. Condition.code
            Definition

            The problem code specifies the problem. Depending on the setting, different code systems can be used. The ProblemCodelist provides an overview of the possible code systems.

            ShortConcept - reference to a terminology or just text
            Comments

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

            Control1..1
            This element is affected by the following invariants: ele-1
            BindingThe codes SHALL be taken from Condition Value Set
            (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/hdr-condition-xpandh-vs)

            Valueset to describe the actual problem experienced by the patient

            TypeCodeableConcept(Codeable Concept (IPS))
            Is Modifierfalse
            Must Supporttrue
            Requirements

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

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

            Anatomical location which is the focus of the problem.

            ShortConcept - reference to a terminology or just text
            Comments

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

            Control0..*
            This element is affected by the following invariants: ele-1
            BindingFor example codes, see SNOMEDCTBodyStructures
            (example to http://hl7.org/fhir/ValueSet/body-site)
            TypeCodeableConcept(Codeable Concept (IPS))
            Is Modifierfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            38. Condition.bodySite.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
            40. Condition.bodySite.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 Condition.bodySite.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 42. Condition.bodySite.extension:laterality
              Slice Namelaterality
              Definition

              Qualifier to specify laterality.

              ShortLaterality Qualifier Extension
              Control0..1
              TypeExtension(Laterality Qualifier Extension) (Extension Type: CodeableConcept)
              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())
              44. Condition.bodySite.coding
              Definition

              A reference to a code defined by a terminology system.

              ShortA reference to a code 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.

              Control0..*
              This element is affected by the following invariants: ele-1
              TypeCoding(Coding with translations)
              Is Modifierfalse
              Must Supporttrue
              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()))
              46. Condition.bodySite.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
              Must Supporttrue
              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()))
              48. Condition.subject
              Definition

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

              ShortWho has the condition?
              Control1..1
              TypeReference(Patient: HDR)
              Is Modifierfalse
              Must Supporttrue
              Summarytrue
              Requirements

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

              Alternate Namespatient
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              50. Condition.subject.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. Condition.subject.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 Condition.subject.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 54. Condition.subject.reference
                Definition

                A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                ShortLiteral reference, Relative, internal or absolute URL
                Comments

                Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "/[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                Control1..1
                This element is affected by the following invariants: ref-1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supporttrue
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                56. Condition.subject.type
                Definition

                The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                ShortType the reference refers to (e.g. "Patient")
                Comments

                This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified.

                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from ResourceType
                (extensible to http://hl7.org/fhir/ValueSet/resource-types)

                Aa resource (or, for logical models, the URI of the logical model).

                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()))
                58. Condition.subject.identifier
                Definition

                An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                ShortLogical reference, when literal reference is not known
                Comments

                When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                NoteThis is a business identifier, not a resource identifier (see discussion)
                Control0..1
                TypeIdentifier
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                60. Condition.subject.display
                Definition

                Plain text narrative that identifies the resource in addition to the resource reference.

                ShortText alternative for the resource
                Comments

                This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                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()))
                62. Condition.encounter
                Definition

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

                ShortEncounter created as part of
                Comments

                This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. This record indicates the encounter this particular record is associated with. In the case of a "new" diagnosis reflecting ongoing/revised information about the condition, this might be distinct from the first encounter in which the underlying condition was first "known".

                Control0..1
                TypeReference(Encounter)
                Is Modifierfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                64. Condition.onset[x]
                Definition

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

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

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

                Control0..1
                TypeChoice of: dateTime, Age, Period, Range, 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
                Must Supporttrue
                Must Support TypesdateTime
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Condition.onset[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • type @ $this
                • 66. Condition.onset[x]:onsetDateTime
                  Slice NameonsetDateTime
                  Definition

                  Onset of the symptom, complaint, functional limitation, complication or date of diagnosis. A ‘vague’ date, such as only the year or the month and the year, is permitted.

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

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

                  Control0..1
                  TypedateTime
                  [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Must Supporttrue
                  Must Support TypesdateTime
                  Summarytrue
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  68. Condition.abatement[x]
                  Definition

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

                  ShortWhen in resolution/remission
                  Comments

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

                  Control0..1
                  This element is affected by the following invariants: con-4
                  TypeChoice of: dateTime, Age, Period, Range, 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
                  Must Supporttrue
                  Must Support TypesdateTime
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on Condition.abatement[x]. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • type @ $this
                  • 70. Condition.abatement[x]:abatementDateTime
                    Slice NameabatementDateTime
                    Definition

                    The date or estimated date that the condition resolved or went into remission. A ‘vague’ date, such as only the year or the month and the year, is permitted

                    ShortWhen in resolution/remission
                    Comments

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

                    Control0..1
                    This element is affected by the following invariants: con-4
                    TypedateTime
                    [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
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    72. Condition.recordedDate
                    Definition

                    Date (and time) when this problem was recorded into information system.

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

                    A healthcare professional who authored information about the problem.

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

                    Individual who is making the condition statement.

                    ShortPerson who asserts this condition
                    Control0..1
                    TypeReference(Practitioner, PractitionerRole, Patient, RelatedPerson)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    78. Condition.stage
                    Definition

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

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

                    As for mCODE, in IDEA4RC staging information MUST be captured in an Observation that conforms to the CancerStageGroup profile. For convenience, the stage group MAY appear in this element, copied from the CancerStageGroup, but Data Senders and Receivers MAY ignore it.

                    ShortMost recent Stage Group
                    Control0..1
                    This element is affected by the following invariants: con-1
                    BindingThe codes SHALL be taken from Cancer Stage Grading: Snomed CT
                    (required to http://hl7.eu/fhir/ig/xpandh/hdr/ValueSet/cancer-stage-grading-vs)
                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    88. Condition.stage.assessment
                    Definition

                    Reference to a formal record of the evidence on which the staging assessment is based.

                    ShortFormal record of assessment
                    Control0..*
                    This element is affected by the following invariants: con-1
                    TypeReference(Observation: Cancer Stage Group)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    90. Condition.stage.type
                    Definition

                    As for mCODE, in IDEA4RC staging information MUST be captured in an Observation that conforms to the CancerStageGroup profile. For convenience, the staging system MAY appear in this element, but Data Senders and Receivers MAY ignore it.

                    ShortStaging system used.
                    Control0..1
                    BindingFor example codes, see ConditionStageType
                    (example to http://hl7.org/fhir/ValueSet/condition-stage-type)

                    Codes describing the kind of condition staging (e.g. clinical or pathological).

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

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

                    ShortSupporting evidence
                    Comments

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

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

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

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

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

                    ShortAdditional content defined by implementations
                    Comments

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

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

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

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

                    ShortExtensions that cannot be ignored even if unrecognized
                    Comments

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

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

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

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

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

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

                    Codes that describe the manifestation or symptoms of a condition.

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

                    Links to other relevant information, including pathology reports.

                    ShortSupporting information found elsewhere
                    Control0..*
                    This element is affected by the following invariants: con-2
                    TypeReference(Resource)
                    Is Modifierfalse
                    Summarytrue
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    104. Condition.note
                    Definition

                    Comment by the one who determined or updated the Problem.

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