<?xml version="1.0" encoding="UTF-8"?>
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  Generated on Tue, May 19, 2026 20:26+0000 for FHIR v6.0.0-ballot4 

  Note: the schemas &amp; schematrons do not contain all of the rules about what makes resources
  valid. Implementers will still need to be familiar with the content of the specification and with
  any profiles that apply to the resources in order to make a conformant implementation.

-->
<xs:schema xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns="http://hl7.org/fhir" xmlns:xhtml="http://www.w3.org/1999/xhtml" targetNamespace="http://hl7.org/fhir" elementFormDefault="qualified" version="1.0">
  <xs:include schemaLocation="fhir-base.xsd"/>
  <xs:element name="DetectedIssue" type="DetectedIssue">
    <xs:annotation>
      <xs:documentation xml:lang="en">Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, Ineffective treatment frequency, Procedure-condition conflict, gaps in care, etc.</xs:documentation>
    </xs:annotation>
  </xs:element>
  <xs:complexType name="DetectedIssue">
    <xs:annotation>
      <xs:documentation xml:lang="en">Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, Ineffective treatment frequency, Procedure-condition conflict, gaps in care, etc.</xs:documentation>
      <xs:documentation xml:lang="en">If the element is present, it must have either a @value, an @id, or extensions</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="DomainResource">
        <xs:sequence>
          <xs:element name="identifier" minOccurs="0" maxOccurs="unbounded" type="Identifier">
            <xs:annotation>
              <xs:documentation xml:lang="en">Business identifiers assigned to this detected issue by the performer and/or other systems.  These identifiers remain constant as the resource is updated and propagates from server to server.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="status" minOccurs="1" maxOccurs="1" type="DetectedIssueStatus">
            <xs:annotation>
              <xs:documentation xml:lang="en">The current state of the detected issue.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="category" minOccurs="0" maxOccurs="unbounded" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Partitions the detected issue into one or more categories that can be used to filter searching, to govern access control and/or to guide system behavior.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="code" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">A code that identifies the specific type of issue detected.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="severity" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Indicates the degree of importance associated with the identified issue based on the potential impact on the patient.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="subject" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Indicates the subject whose record the detected issue is associated with.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="encounter" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">The Encounter during which this detected issue was created or to which the creation of this record is tightly associated.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:choice minOccurs="0" maxOccurs="1" >
            <xs:annotation>
              <xs:documentation xml:lang="en">The date, period or timing when the detected issue did occur or is occurring.</xs:documentation>
            </xs:annotation>
            <xs:element name="identifiedDateTime" type="dateTime"/>
            <xs:element name="identifiedPeriod" type="Period"/>
            <xs:element name="identifiedTiming" type="Timing"/>
          </xs:choice>
          <xs:element name="author" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Individual or device responsible for the issue being raised.  For example, a decision support application or a pharmacist conducting a medication review.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="implicated" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Indicates the resource representing the current activity or proposed activity that is potentially problematic.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="evidence" type="DetectedIssue.Evidence" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Supporting evidence or manifestations that provide the basis for identifying the detected issue such as a GuidanceResponse or MeasureReport.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="detail" minOccurs="0" maxOccurs="1" type="markdown">
            <xs:annotation>
              <xs:documentation xml:lang="en">A textual explanation of the detected issue.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="reference" minOccurs="0" maxOccurs="1" type="uri">
            <xs:annotation>
              <xs:documentation xml:lang="en">The literature, knowledge-base or similar reference that describes the propensity for the detected issue identified.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="qualityOfEvidence" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The quality of the evidence supporting identification of the detected issue. The code system used specifies the quality scale used to grade this evidence source while the code specifies the actual quality score (represented as a coded value) associated with the evidence.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="expectedOnsetType" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">The time frame in which the clinical effects of the detected issue may be expected to occur. Rapid refers to an expected onset within 24 hours. Delayed refers to an expected onset in more than 24 hours.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="medicationClass" minOccurs="0" maxOccurs="unbounded" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Represents the medication class that is responsible for the detected issue.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="managementCode" minOccurs="0" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">An indication of the importance or type of step that should or may be taken in order to address the detected issue. This is different than mitigation in that it is not specifically providing actions to be taken, rather general suggestions about approach.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="mitigation" type="DetectedIssue.Mitigation" minOccurs="0" maxOccurs="unbounded">
            <xs:annotation>
              <xs:documentation xml:lang="en">Indicates an action that has been taken or is committed to reduce or eliminate the likelihood of the risk identified by the detected issue from manifesting.  Can also reflect an observation of known mitigating factors that may reduce/eliminate the need for any action.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="DetectedIssue.Evidence">
    <xs:annotation>
      <xs:documentation xml:lang="en">Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, Ineffective treatment frequency, Procedure-condition conflict, gaps in care, etc.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="code" minOccurs="0" maxOccurs="unbounded" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">A manifestation that led to the recording of this detected issue.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="detail" minOccurs="0" maxOccurs="unbounded" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Links to resources that constitute evidence for the detected issue such as a GuidanceResponse or MeasureReport.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:complexType name="DetectedIssue.Mitigation">
    <xs:annotation>
      <xs:documentation xml:lang="en">Indicates an actual or potential clinical issue with or between one or more active or proposed clinical actions for a patient; e.g. Drug-drug interaction, Ineffective treatment frequency, Procedure-condition conflict, gaps in care, etc.</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="BackboneElement">
        <xs:sequence>
          <xs:element name="action" minOccurs="1" maxOccurs="1" type="CodeableConcept">
            <xs:annotation>
              <xs:documentation xml:lang="en">Describes the action that was taken or the observation that was made that reduces/eliminates the risk associated with the identified issue.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="date" minOccurs="0" maxOccurs="1" type="dateTime">
            <xs:annotation>
              <xs:documentation xml:lang="en">Indicates when the mitigating action was documented.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="author" minOccurs="0" maxOccurs="1" type="Reference">
            <xs:annotation>
              <xs:documentation xml:lang="en">Identifies the practitioner who determined the mitigation and takes responsibility for the mitigation step occurring.</xs:documentation>
           </xs:annotation>
          </xs:element>
          <xs:element name="note" minOccurs="0" maxOccurs="unbounded" type="Annotation">
            <xs:annotation>
              <xs:documentation xml:lang="en">Clinicians may add additional notes or justifications about the mitigation action. For example, patient can have this drug because they have had it before without any issues. Multiple justifications may be provided.</xs:documentation>
           </xs:annotation>
          </xs:element>
        </xs:sequence>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
  <xs:simpleType name="DetectedIssueStatusEnum">
    <xs:restriction base="code-primitive">
      <xs:enumeration value="preliminary">
        <xs:annotation>
          <xs:documentation xml:lang="en">Preliminary</xs:documentation>
        </xs:annotation>
      </xs:enumeration>
      <xs:enumeration value="final">
        <xs:annotation>
          <xs:documentation xml:lang="en">Final</xs:documentation>
        </xs:annotation>
      </xs:enumeration>
      <xs:enumeration value="entered-in-error">
        <xs:annotation>
          <xs:documentation xml:lang="en">Entered in Error</xs:documentation>
        </xs:annotation>
      </xs:enumeration>
      <xs:enumeration value="unknown">
        <xs:annotation>
          <xs:documentation xml:lang="en">Unknwon</xs:documentation>
        </xs:annotation>
      </xs:enumeration>
      <xs:enumeration value="mitigated">
        <xs:annotation>
          <xs:documentation xml:lang="en">Mitigated</xs:documentation>
        </xs:annotation>
      </xs:enumeration>
    </xs:restriction>
  </xs:simpleType>
  <xs:complexType name="DetectedIssueStatus">
    <xs:annotation>
      <xs:documentation xml:lang="en"></xs:documentation>
      <xs:documentation xml:lang="en">If the element is present, it must have either a @value, an @id, or extensions</xs:documentation>
    </xs:annotation>
    <xs:complexContent>
      <xs:extension base="Element">
        <xs:attribute name="value" type="DetectedIssueStatusEnum" use="optional"/>
      </xs:extension>
    </xs:complexContent>
  </xs:complexType>
</xs:schema>
