Scope and usage

This model is used whenever a referral is created for a child or youth as part of the LTT. Notice that a referral does not necessarily mean that the LTT for the citizen is completed.

CarePlan.activity.detail.code holds the referral code, which has to come from the specified list of referrals.

Careplan.period.start is when the referral is issued.

CarePlan.status and CarePlan.intent are mandatory. CarePlan.intent is always 'plan' in this implementation guide. CarePlan.status should be either 'completed' or 'entered-in-error'.

CarePlan.activity.detail.status is also mandatory, and the status 'completed' is expected to be used. It is recommended not to use 'entered-in-error' - if the CarePlan is entered-in-error use CarePlan.status.

CarePlan.subject references the citizen.

Conversions between Danish information model and FHIR profile

Nedenstående tabel definerer kort den enkelte attribut på dansk og specificerer hvilke af FHIR-profilens atributter, der skal bruges til specifikation af indholdet.

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

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	1..1	Reference(KLGatewayLTTCarePlan)	[DK] forløbsreference
status	?!Σ	1..1	code	[DK] henvisningsstatus Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
intent	?!Σ	1..1	code	[DK] henvisningshensigt Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan. Required Pattern: plan
subject	Σ	1..1	Reference(KLGatewayLTTCitizen)	[DK] henvisningssubjekt
period	Σ	1..1	Period	Time period plan covers
start	ΣC	1..1	dateTime	[DK] henvisningstidspunkt
activity	C	1..1	BackboneElement	Action to occur as part of plan Constraints: cpl-3
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detail	C	1..1	BackboneElement	In-line definition of activity
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	[DK] henvisningskode Binding: Lettilgængeligt Tilbud - Henvisning (required)
coding	Σ	1..1	Coding	Code defined by a terminology system
status	?!	1..1	code	[DK] henvisningsAktivitetsstatus Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle. Required Pattern: completed
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CarePlan.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 From the FHIR Standard
CarePlan.intent	required	Pattern Value: plan http://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1 From the FHIR Standard
CarePlan.activity.detail.code	required	LTTTypeOfReferral http://fhir.kl.dk/ltt/ValueSet/fkgateway-ltt-type-of-referral From this IG
CarePlan.activity.detail.status	required	Pattern Value: completed http://hl7.org/fhir/ValueSet/care-plan-activity-status|4.0.1 From the FHIR Standard

Constraints

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

This structure is derived from CarePlan

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CarePlan			CarePlan
identifier		0..0
instantiatesCanonical		0..0
instantiatesUri		0..0
basedOn		1..1	Reference(KLGatewayLTTCarePlan)	[DK] forløbsreference
replaces		0..0
partOf		0..0
status		1..1	code	[DK] henvisningsstatus
intent		1..1	code	[DK] henvisningshensigt Required Pattern: plan
category		0..0
title		0..0
description		0..0
subject		1..1	Reference(KLGatewayLTTCitizen)	[DK] henvisningssubjekt
encounter		0..0
period		1..1	Period	Time period plan covers
start		1..1	dateTime	[DK] henvisningstidspunkt
end		0..0
created		0..0
author		0..0
contributor		0..0
careTeam		0..0
addresses		0..0
supportingInfo		0..0
goal		0..0
activity		1..1	BackboneElement	Action to occur as part of plan
outcomeCodeableConcept		0..0
outcomeReference		0..0
progress		0..0
reference		0..0
detail		1..1	BackboneElement	In-line definition of activity
kind		0..0
instantiatesCanonical		0..0
instantiatesUri		0..0
code		1..1	CodeableConcept	[DK] henvisningskode Binding: Lettilgængeligt Tilbud - Henvisning (required)
coding		1..1	Coding	Code defined by a terminology system
version		0..0
userSelected		0..0
text		0..0
reasonCode		0..0
reasonReference		0..0
goal		0..0
status		1..1	code	[DK] henvisningsAktivitetsstatus Required Pattern: completed
statusReason		0..0
doNotPerform		0..0
scheduled[x]		0..0
location		0..0
performer		0..0
product[x]		0..0
dailyAmount		0..0
quantity		0..0
description		0..0
note		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CarePlan.activity.detail.code	required	LTTTypeOfReferral http://fhir.kl.dk/ltt/ValueSet/fkgateway-ltt-type-of-referral From this IG

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	1..1	Reference(KLGatewayLTTCarePlan)	[DK] forløbsreference
status	?!Σ	1..1	code	[DK] henvisningsstatus Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
intent	?!Σ	1..1	code	[DK] henvisningshensigt Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan. Required Pattern: plan
subject	Σ	1..1	Reference(KLGatewayLTTCitizen)	[DK] henvisningssubjekt
period	Σ	1..1	Period	Time period plan covers
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	1..1	dateTime	[DK] henvisningstidspunkt
activity	C	1..1	BackboneElement	Action to occur as part of plan Constraints: cpl-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detail	C	1..1	BackboneElement	In-line definition of activity
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	[DK] henvisningskode Binding: Lettilgængeligt Tilbud - Henvisning (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
status	?!	1..1	code	[DK] henvisningsAktivitetsstatus Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle. Required Pattern: completed
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CarePlan.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CarePlan.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 From the FHIR Standard
CarePlan.intent	required	Pattern Value: plan http://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1 From the FHIR Standard
CarePlan.activity.detail.code	required	LTTTypeOfReferral http://fhir.kl.dk/ltt/ValueSet/fkgateway-ltt-type-of-referral From this IG
CarePlan.activity.detail.status	required	Pattern Value: completed http://hl7.org/fhir/ValueSet/care-plan-activity-status|4.0.1 From the FHIR Standard

Constraints

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

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	1..1	Reference(KLGatewayLTTCarePlan)	[DK] forløbsreference
status	?!Σ	1..1	code	[DK] henvisningsstatus Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
intent	?!Σ	1..1	code	[DK] henvisningshensigt Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan. Required Pattern: plan
subject	Σ	1..1	Reference(KLGatewayLTTCitizen)	[DK] henvisningssubjekt
period	Σ	1..1	Period	Time period plan covers
start	ΣC	1..1	dateTime	[DK] henvisningstidspunkt
activity	C	1..1	BackboneElement	Action to occur as part of plan Constraints: cpl-3
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detail	C	1..1	BackboneElement	In-line definition of activity
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	[DK] henvisningskode Binding: Lettilgængeligt Tilbud - Henvisning (required)
coding	Σ	1..1	Coding	Code defined by a terminology system
status	?!	1..1	code	[DK] henvisningsAktivitetsstatus Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle. Required Pattern: completed
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CarePlan.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 From the FHIR Standard
CarePlan.intent	required	Pattern Value: plan http://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1 From the FHIR Standard
CarePlan.activity.detail.code	required	LTTTypeOfReferral http://fhir.kl.dk/ltt/ValueSet/fkgateway-ltt-type-of-referral From this IG
CarePlan.activity.detail.status	required	Pattern Value: completed http://hl7.org/fhir/ValueSet/care-plan-activity-status|4.0.1 From the FHIR Standard

Constraints

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

Differential View

This structure is derived from CarePlan

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CarePlan			CarePlan
identifier		0..0
instantiatesCanonical		0..0
instantiatesUri		0..0
basedOn		1..1	Reference(KLGatewayLTTCarePlan)	[DK] forløbsreference
replaces		0..0
partOf		0..0
status		1..1	code	[DK] henvisningsstatus
intent		1..1	code	[DK] henvisningshensigt Required Pattern: plan
category		0..0
title		0..0
description		0..0
subject		1..1	Reference(KLGatewayLTTCitizen)	[DK] henvisningssubjekt
encounter		0..0
period		1..1	Period	Time period plan covers
start		1..1	dateTime	[DK] henvisningstidspunkt
end		0..0
created		0..0
author		0..0
contributor		0..0
careTeam		0..0
addresses		0..0
supportingInfo		0..0
goal		0..0
activity		1..1	BackboneElement	Action to occur as part of plan
outcomeCodeableConcept		0..0
outcomeReference		0..0
progress		0..0
reference		0..0
detail		1..1	BackboneElement	In-line definition of activity
kind		0..0
instantiatesCanonical		0..0
instantiatesUri		0..0
code		1..1	CodeableConcept	[DK] henvisningskode Binding: Lettilgængeligt Tilbud - Henvisning (required)
coding		1..1	Coding	Code defined by a terminology system
version		0..0
userSelected		0..0
text		0..0
reasonCode		0..0
reasonReference		0..0
goal		0..0
status		1..1	code	[DK] henvisningsAktivitetsstatus Required Pattern: completed
statusReason		0..0
doNotPerform		0..0
scheduled[x]		0..0
location		0..0
performer		0..0
product[x]		0..0
dailyAmount		0..0
quantity		0..0
description		0..0
note		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
CarePlan.activity.detail.code	required	LTTTypeOfReferral http://fhir.kl.dk/ltt/ValueSet/fkgateway-ltt-type-of-referral From this IG

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
CarePlan		0..*	CarePlan	Healthcare plan for patient or group
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained		0..*	Resource	Contained, inline Resources
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
basedOn	Σ	1..1	Reference(KLGatewayLTTCarePlan)	[DK] forløbsreference
status	?!Σ	1..1	code	[DK] henvisningsstatus Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.
intent	?!Σ	1..1	code	[DK] henvisningshensigt Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan. Required Pattern: plan
subject	Σ	1..1	Reference(KLGatewayLTTCitizen)	[DK] henvisningssubjekt
period	Σ	1..1	Period	Time period plan covers
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	ΣC	1..1	dateTime	[DK] henvisningstidspunkt
activity	C	1..1	BackboneElement	Action to occur as part of plan Constraints: cpl-3
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detail	C	1..1	BackboneElement	In-line definition of activity
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	[DK] henvisningskode Binding: Lettilgængeligt Tilbud - Henvisning (required)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
coding	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system
code	Σ	0..1	code	Symbol in syntax defined by the system
display	Σ	0..1	string	Representation defined by the system
status	?!	1..1	code	[DK] henvisningsAktivitetsstatus Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle. Required Pattern: completed
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
CarePlan.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages From the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
CarePlan.status	required	RequestStatus http://hl7.org/fhir/ValueSet/request-status|4.0.1 From the FHIR Standard
CarePlan.intent	required	Pattern Value: plan http://hl7.org/fhir/ValueSet/care-plan-intent|4.0.1 From the FHIR Standard
CarePlan.activity.detail.code	required	LTTTypeOfReferral http://fhir.kl.dk/ltt/ValueSet/fkgateway-ltt-type-of-referral From this IG
CarePlan.activity.detail.status	required	Pattern Value: completed http://hl7.org/fhir/ValueSet/care-plan-activity-status|4.0.1 From the FHIR Standard

Constraints

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

This structure is derived from CarePlan

Summary

Mandatory: 7 elements
Prohibited: 40 elements

Structures

This structure refers to these other structures:

• KLGatewayLTTCarePlan (http://fhir.kl.dk/ltt/StructureDefinition/klgateway-ltt-care-plan)
• KLGatewayLTTCitizen (http://fhir.kl.dk/ltt/StructureDefinition/klgateway-ltt-citizen)