2026 US Quality Core Implementation Guide
0.5.0 - cibuild US

2026 US Quality Core Implementation Guide, published by Office of the National Coordinator for Health Information Technology (ONC). This guide is not an authorized publication; it is the continuous build for version 0.5.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## Resource Profile: USQualityCoreCommunicationNotDone - XML Profile

Active as of 2026-05-15

XML representation of the us-quality-core-communicationnotdone resource profile.

Raw xml | Download

    <StructureDefinition xmlns="http://hl7.org/fhir">
      <id value="us-quality-core-communicationnotdone"/>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: StructureDefinition us-quality-core-communicationnotdone</b></p><a name="us-quality-core-communicationnotdone"> </a><a name="hcus-quality-core-communicationnotdone"> </a><table border="0" cellpadding="0" cellspacing="0" style="border: 0px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="The logical name of the element">Name</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Information about the use of the element">Flags</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Minimum and Maximum # of times the element can appear in the instance">Card.</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px; width: 100px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Reference to the type of the element">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Additional information about the element">Description &amp; Constraints</a><span style="float: right"><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_resource.png" alt="." style="background-color: white; background-color: inherit" title="Resource" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-communicationnotdone-definitions.html#Communication">Communication</a><a name="Communication"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( cnd-1 )">C</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">0</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">*</span></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/communication.html">Communication</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span style="opacity: 0.5">A record of information transmitted from a sender to a receiver</span><br class="constraint"/><span title="null" class="constraint">Constraints: </span><span style="font-weight:bold" title="to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided" class="constraint">cnd-1</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck13.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Slice Definition" class="hierarchy"/> Slices for extension<a name="Communication.extension"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Content/Rules for all slices</td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck124.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice_item.png" alt="." style="background-color: white; background-color: inherit" title="Slice Item" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-communicationnotdone-definitions.html#Communication.extension:recorded" title="Extension URL = http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded">extension:recorded</a><a name="Communication.extension.2"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#dateTime">dateTime</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Extension<br/><span style="font-weight:bold">URL: </span><a href="StructureDefinition-us-quality-core-recorded.html">http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded</a></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-communicationnotdone-definitions.html#Communication.status">status</a><a name="Communication.status"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/datatypes.html#code">code</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown<br/><span style="font-weight:bold">Fixed Value: </span><span style="color: darkgreen">not-done</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-communicationnotdone-definitions.html#Communication.statusReason">statusReason</a><a name="Communication.statusReason"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5; opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Reason for current status<br class="binding"/><span style="font-weight:bold" title="null" class="binding">Binding: </span><a href="ValueSet-us-quality-core-negation-reason.html" title="http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-negation-reason" class="binding">USQualityCore Negation Reason Codes</a><span title="null" class="binding"> (</span><a href="http://hl7.org/fhir/R4/terminologies.html#extensible" title="To be conformant, the concept in this element SHALL be from the specified value set if any of the codes within the value set can apply to the concept being communicated.  If the value set does not cover the concept (based on human review), alternate codings (or, data type allowing, text) may be included instead." class="binding">extensible</a><span title="null" class="binding">)</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_reference.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-communicationnotdone-definitions.html#Communication.subject">subject</a><a name="Communication.subject"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/references.html">Reference</a>(<a href="StructureDefinition-us-quality-core-patient.html">US Quality Core Patient</a> | <a href="http://hl7.org/fhir/R4/group.html">Group</a>)</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Focus of message</td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_element.gif" alt="." style="background-color: white; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-communicationnotdone-definitions.html#Communication.topic">topic</a><a name="Communication.topic"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a style="opacity: 0.5; opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#CodeableConcept">CodeableConcept</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Description of the purpose/content<br class="binding"/><span style="font-weight:bold" title="null" class="binding">Binding: </span><a href="http://hl7.org/fhir/R4/valueset-communication-topic.html" title="http://hl7.org/fhir/ValueSet/communication-topic" class="binding">CommunicationTopic</a><span title="null" class="binding"> (</span><a href="http://hl7.org/fhir/R4/terminologies.html#preferred" title="Instances are encouraged to draw from the specified codes for interoperability purposes but are not required to do so to be considered conformant." class="binding">preferred</a><span title="null" class="binding">)</span><span title="null" class="binding">: </span><span title="null" class="binding">Codes describing the purpose or content of the communication.</span></td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck003.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Slice Definition" class="hierarchy"/> Slices for extension<a name="Communication.topic.extension"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Content/Rules for all slices</td></tr>
    <tr style="border: 0px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0024.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end_slicer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_slice_item.png" alt="." style="background-color: white; background-color: inherit" title="Slice Item" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-communicationnotdone-definitions.html#Communication.topic.extension:notDoneValueSet" title="Extension URL = http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet">extension:notDoneValueSet</a><a name="Communication.topic.extension.2"> </a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/references.html">canonical</a>(<a href="http://hl7.org/fhir/R4/valueset.html">ValueSet</a>)</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Url of a value set of activities not requested or performed<br/><span style="font-weight:bold">URL: </span><a href="StructureDefinition-us-quality-core-notDoneValueSet.html">http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet</a></td></tr>
    <tr><td colspan="5" class="hierarchy"><br/><a href="https://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#table-views" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
      </text>
      <url
           value="http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-communicationnotdone"/>
      <version value="0.5.0"/>
      <name value="USQualityCoreCommunicationNotDone"/>
      <title value="US Quality Core Communication Not Done"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2026-05-15"/>
      <publisher
                 value="Office of the National Coordinator for Health Information Technology (ONC)"/>
      <contact>
        <name
              value="Office of the National Coordinator for Health Information Technology (ONC)"/>
        <telecom>
          <system value="url"/>
          <value value="https://www.healthit.gov/feedback"/>
        </telecom>
      </contact>
      <description
                   value="Profile of CommunicationNotDone for decision support/quality metrics. Defines the core set of elements and extensions for quality rule and measure authors."/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="US"/>
          <display value="United States of America"/>
        </coding>
        <text value="USA"/>
      </jurisdiction>
      <fhirVersion value="4.0.1"/>
      <mapping>
        <identity value="workflow"/>
        <uri value="http://hl7.org/fhir/workflow"/>
        <name value="Workflow Pattern"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <uri value="http://hl7.org/fhir/fivews"/>
        <name value="FiveWs Pattern Mapping"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <uri value="http://hl7.org/v3"/>
        <name value="RIM Mapping"/>
      </mapping>
      <kind value="resource"/>
      <abstract value="false"/>
      <type value="Communication"/>
      <baseDefinition
                      value="http://hl7.org/fhir/StructureDefinition/Communication"/>
      <derivation value="constraint"/>
      <snapshot>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">
          <valueString value="4.0.1"/>
        </extension>
        <element id="Communication">
          <path value="Communication"/>
          <short
                 value="A record of information transmitted from a sender to a receiver"/>
          <definition
                      value="An occurrence of information being transmitted; e.g. an alert that was sent to a responsible provider, a public health agency that was notified about a reportable condition."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <constraint>
            <key value="dom-2"/>
            <severity value="error"/>
            <human
                   value="If the resource is contained in another resource, it SHALL NOT contain nested Resources"/>
            <expression value="contained.contained.empty()"/>
            <xpath value="not(parent::f:contained and f:contained)"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-3"/>
            <severity value="error"/>
            <human
                   value="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"/>
            <expression
                        value="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()"/>
            <xpath
                   value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-4"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated"/>
            <expression
                        value="contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()"/>
            <xpath
                   value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="dom-5"/>
            <severity value="error"/>
            <human
                   value="If a resource is contained in another resource, it SHALL NOT have a security label"/>
            <expression value="contained.meta.security.empty()"/>
            <xpath value="not(exists(f:contained/*/f:meta/f:security))"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice">
              <valueBoolean value="true"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
              <valueMarkdown
                             value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."/>
            </extension>
            <key value="dom-6"/>
            <severity value="warning"/>
            <human
                   value="A resource should have narrative for robust management"/>
            <expression value="text.`div`.exists()"/>
            <xpath value="exists(f:text/h:div)"/>
            <source
                    value="http://hl7.org/fhir/StructureDefinition/DomainResource"/>
          </constraint>
          <constraint>
            <key value="cnd-1"/>
            <severity value="error"/>
            <human
                   value="to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided"/>
            <expression
                        value="topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()"/>
          </constraint>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="Entity. Role, or Act"/>
          </mapping>
          <mapping>
            <identity value="workflow"/>
            <map value="Event"/>
          </mapping>
        </element>
        <element id="Communication.id">
          <path value="Communication.id"/>
          <short value="Logical id of this artifact"/>
          <definition
                      value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes."/>
          <comment
                   value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="id"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="true"/>
        </element>
        <element id="Communication.meta">
          <path value="Communication.meta"/>
          <short value="Metadata about the resource"/>
          <definition
                      value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.meta"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Meta"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
        </element>
        <element id="Communication.implicitRules">
          <path value="Communication.implicitRules"/>
          <short value="A set of rules under which this content was created"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.implicitRules"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="uri"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="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"/>
          <isSummary value="true"/>
        </element>
        <element id="Communication.language">
          <path value="Communication.language"/>
          <short value="Language of the resource content"/>
          <definition
                      value="The base language in which the resource is written."/>
          <comment
                   value="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)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Resource.language"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-maxValueSet">
              <valueCanonical value="http://hl7.org/fhir/ValueSet/all-languages"/>
            </extension>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="Language"/>
            </extension>
            <strength value="preferred"/>
            <description value="A human language."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/languages|4.0.1"/>
          </binding>
        </element>
        <element id="Communication.text">
          <path value="Communication.text"/>
          <short value="Text summary of the resource, for human interpretation"/>
          <definition
                      value="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 &quot;clinically safe&quot; for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety."/>
          <comment
                   value="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 &quot;text blob&quot; or where text is additionally entered raw or narrated and encoded information is added later."/>
          <alias value="narrative"/>
          <alias value="html"/>
          <alias value="xhtml"/>
          <alias value="display"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="DomainResource.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Narrative"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="Act.text?"/>
          </mapping>
        </element>
        <element id="Communication.contained">
          <path value="Communication.contained"/>
          <short value="Contained, inline Resources"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="inline resources"/>
          <alias value="anonymous resources"/>
          <alias value="contained resources"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.contained"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Resource"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Communication.extension">
          <path value="Communication.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <ordered value="false"/>
            <rules value="open"/>
          </slicing>
          <short value="Extension"/>
          <definition value="An Extension"/>
          <min value="1"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
        </element>
        <element id="Communication.extension:recorded">
          <path value="Communication.extension"/>
          <sliceName value="recorded"/>
          <short value="Extension"/>
          <definition value="Captures the recorded date of the event."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="DomainResource.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
            <profile
                     value="http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded"/>
          </type>
          <condition value="ele-1"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), 'value')])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
        </element>
        <element id="Communication.modifierExtension">
          <path value="Communication.modifierExtension"/>
          <short value="Extensions that cannot be ignored"/>
          <definition
                      value="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)."/>
          <comment
                   value="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."/>
          <requirements
                        value="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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="DomainResource.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Communication.identifier">
          <path value="Communication.identifier"/>
          <short value="Unique identifier"/>
          <definition
                      value="Business identifiers assigned to this communication by the performer or other systems which remain constant as the resource is updated and propagates from server to server."/>
          <comment
                   value="This is a business identifier, not a resource identifier (see [discussion](http://hl7.org/fhir/R4/resource.html#identifiers)).  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."/>
          <requirements
                        value="Allows identification of the communication as it is known by various participating systems and in a way that remains consistent across servers."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.identifier"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Identifier"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.identifier"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.identifier"/>
          </mapping>
        </element>
        <element id="Communication.instantiatesCanonical">
          <path value="Communication.instantiatesCanonical"/>
          <short value="Instantiates FHIR protocol or definition"/>
          <definition
                      value="The URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.instantiatesCanonical"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="canonical"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/PlanDefinition|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/ActivityDefinition|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Measure|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/OperationDefinition|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Questionnaire|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.instantiatesCanonical"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship[typeCode=DEFN].target"/>
          </mapping>
        </element>
        <element id="Communication.instantiatesUri">
          <path value="Communication.instantiatesUri"/>
          <short value="Instantiates external protocol or definition"/>
          <definition
                      value="The URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this Communication."/>
          <comment
                   value="This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.instantiatesUri"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="uri"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.instantiatesUri"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship[typeCode=DEFN].target"/>
          </mapping>
        </element>
        <element id="Communication.basedOn">
          <path value="Communication.basedOn"/>
          <short value="Request fulfilled by this communication"/>
          <definition
                      value="An order, proposal or plan fulfilled in whole or in part by this Communication."/>
          <comment
                   value="This must point to some sort of a 'Request' resource, such as CarePlan, CommunicationRequest, ServiceRequest, MedicationRequest, etc."/>
          <alias value="fulfills"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.basedOn"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Resource|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.basedOn"/>
          </mapping>
        </element>
        <element id="Communication.partOf">
          <path value="Communication.partOf"/>
          <short value="Part of this action"/>
          <definition value="Part of this action."/>
          <alias value="container"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.partOf"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Resource|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.partOf"/>
          </mapping>
        </element>
        <element id="Communication.inResponseTo">
          <path value="Communication.inResponseTo"/>
          <short value="Reply to"/>
          <definition
                      value="Prior communication that this communication is in response to."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.inResponseTo"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Communication|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
        </element>
        <element id="Communication.status">
          <path value="Communication.status"/>
          <short
                 value="preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown"/>
          <definition value="The status of the transmission."/>
          <comment
                   value="This element is labeled as a modifier because the status contains the codes aborted and entered-in-error that mark the communication as not currently valid."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Communication.status"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <fixedCode value="not-done"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="CommunicationStatus"/>
            </extension>
            <strength value="required"/>
            <description value="The status of the communication."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/event-status|4.0.1"/>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.status"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.status"/>
          </mapping>
        </element>
        <element id="Communication.statusReason">
          <path value="Communication.statusReason"/>
          <short value="Reason for current status"/>
          <definition
                      value="Captures the reason for the current state of the Communication."/>
          <comment
                   value="This is generally only used for &quot;exception&quot; statuses such as &quot;not-done&quot;, &quot;suspended&quot; or &quot;aborted&quot;. The reason for performing the event at all is captured in reasonCode, not here."/>
          <alias value="Suspended Reason"/>
          <alias value="Cancelled Reason"/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Communication.statusReason"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <strength value="extensible"/>
            <valueSet
                      value="http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-negation-reason"/>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.statusReason"/>
          </mapping>
        </element>
        <element id="Communication.category">
          <path value="Communication.category"/>
          <short value="Message category"/>
          <definition
                      value="The type of message conveyed such as alert, notification, reminder, instruction, etc."/>
          <comment
                   value="There may be multiple axes of categorization and one communication may serve multiple purposes."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.category"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="CommunicationCategory"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Codes for general categories of communications such as alerts, instructions, etc."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/communication-category|4.0.1"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.class"/>
          </mapping>
        </element>
        <element id="Communication.priority">
          <path value="Communication.priority"/>
          <short value="routine | urgent | asap | stat"/>
          <definition
                      value="Characterizes how quickly the planned or in progress communication must be addressed. Includes concepts such as stat, urgent, routine."/>
          <comment
                   value="Used to prioritize workflow (such as which communication to read first) when the communication is planned or in progress."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Communication.priority"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="code"/>
          </type>
          <meaningWhenMissing
                              value="If missing, this communication should be treated with normal priority"/>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="CommunicationPriority"/>
            </extension>
            <strength value="required"/>
            <description
                         value="Codes indicating the relative importance of a communication."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/request-priority|4.0.1"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.grade"/>
          </mapping>
        </element>
        <element id="Communication.medium">
          <path value="Communication.medium"/>
          <short value="A channel of communication"/>
          <definition
                      value="A channel that was used for this communication (e.g. email, fax)."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.medium"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="CommunicationMedium"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Codes for communication mediums such as phone, fax, email, in person, etc."/>
            <valueSet
                      value="http://terminology.hl7.org/ValueSet/v3-ParticipationMode"/>
          </binding>
        </element>
        <element id="Communication.subject">
          <path value="Communication.subject"/>
          <short value="Focus of message"/>
          <definition
                      value="The patient or group that was the focus of this communication."/>
          <alias value="patient"/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Communication.subject"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient"/>
            <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.subject"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.subject[x]"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.subject"/>
          </mapping>
        </element>
        <element id="Communication.topic">
          <path value="Communication.topic"/>
          <short value="Description of the purpose/content"/>
          <definition
                      value="Description of the purpose/content, similar to a subject line in an email."/>
          <comment
                   value="Communication.topic.text can be used without any codings."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Communication.topic"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="CommunicationTopic"/>
            </extension>
            <strength value="preferred"/>
            <description
                         value="Codes describing the purpose or content of the communication."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/communication-topic"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.context"/>
          </mapping>
        </element>
        <element id="Communication.topic.id">
          <path value="Communication.topic.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Communication.topic.extension">
          <path value="Communication.topic.extension"/>
          <slicing>
            <discriminator>
              <type value="value"/>
              <path value="url"/>
            </discriminator>
            <description value="Extensions are always sliced by (at least) url"/>
            <rules value="open"/>
          </slicing>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Communication.topic.extension:notDoneValueSet">
          <path value="Communication.topic.extension"/>
          <sliceName value="notDoneValueSet"/>
          <short
                 value="Url of a value set of activities not requested or performed"/>
          <definition
                      value="A logical reference (e.g. a reference to ValueSet.url) to a value set/version that identifies a set of possible coded values representing activities that were not requested, ordered, or performed."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
            <profile
                     value="http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="v2"/>
            <map value="CWE."/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="CD.valueSet/CD.valueSetVersion"/>
          </mapping>
        </element>
        <element id="Communication.topic.coding">
          <path value="Communication.topic.coding"/>
          <short value="Code defined by a terminology system"/>
          <definition
                      value="A reference to a code defined by a terminology system."/>
          <comment
                   value="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."/>
          <requirements
                        value="Allows for alternative encodings within a code system, and translations to other code systems."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="CodeableConcept.coding"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Coding"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.1-8, C*E.10-22"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value="union(., ./translation)"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:CodeableConcept.coding rdfs:subPropertyOf dt:CD.coding"/>
          </mapping>
        </element>
        <element id="Communication.topic.text">
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/elementdefinition-translatable">
            <valueBoolean value="true"/>
          </extension>
          <path value="Communication.topic.text"/>
          <short value="Plain text representation of the concept"/>
          <definition
                      value="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."/>
          <comment
                   value="Very often the text is the same as a displayName of one of the codings."/>
          <requirements
                        value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="CodeableConcept.text"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="v2"/>
            <map value="C*E.9. But note many systems use C*E.2 for this"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value="./originalText[mediaType/code=&quot;text/plain&quot;]/data"/>
          </mapping>
          <mapping>
            <identity value="orim"/>
            <map
                 value="fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText"/>
          </mapping>
        </element>
        <element id="Communication.about">
          <path value="Communication.about"/>
          <short value="Resources that pertain to this communication"/>
          <definition
                      value="Other resources that pertain to this communication and to which this communication should be associated."/>
          <comment
                   value="Don't use Communication.about element when a more specific element exists, such as basedOn or reasonReference."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.about"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Resource|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.context"/>
          </mapping>
        </element>
        <element id="Communication.encounter">
          <path value="Communication.encounter"/>
          <short value="Encounter created as part of"/>
          <definition
                      value="The Encounter during which this Communication was created or to which the creation of this record is tightly associated."/>
          <comment
                   value="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."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Communication.encounter"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Encounter|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.context"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.context"/>
          </mapping>
        </element>
        <element id="Communication.sent">
          <path value="Communication.sent"/>
          <short value="When sent"/>
          <definition value="The time when this communication was sent."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Communication.sent"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="dateTime"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.occurrence[x] {Invariant: maps to period.start}"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.done[x]"/>
          </mapping>
        </element>
        <element id="Communication.received">
          <path value="Communication.received"/>
          <short value="When received"/>
          <definition
                      value="The time when this communication arrived at the destination."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Communication.received"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="dateTime"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.occurrence[x] {Invariant: maps to period.end}"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.done[x]"/>
          </mapping>
        </element>
        <element id="Communication.recipient">
          <path value="Communication.recipient"/>
          <short value="Message recipient"/>
          <definition
                      value="The entity (e.g. person, organization, clinical information system, care team or device) which was the target of the communication. If receipts need to be tracked by an individual, a separate resource instance will need to be created for each recipient.  Multiple recipient communications are intended where either receipts are not tracked (e.g. a mass mail-out) or a receipt is captured in aggregate (all emails confirmed received by a particular time)."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.recipient"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Device|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Organization|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Patient|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/RelatedPerson|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Group|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/CareTeam|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/HealthcareService|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer.actor"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.actor"/>
          </mapping>
        </element>
        <element id="Communication.sender">
          <path value="Communication.sender"/>
          <short value="Message sender"/>
          <definition
                      value="The entity (e.g. person, organization, clinical information system, or device) which was the source of the communication."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Communication.sender"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Device|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Organization|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Patient|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/RelatedPerson|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/HealthcareService|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.performer.actor"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.actor"/>
          </mapping>
        </element>
        <element id="Communication.reasonCode">
          <path value="Communication.reasonCode"/>
          <short value="Indication for message"/>
          <definition value="The reason or justification for the communication."/>
          <comment
                   value="Textual reasons can be captured using reasonCode.text."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.reasonCode"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="CommunicationReason"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Codes for describing reasons for the occurrence of a communication."/>
            <valueSet
                      value="http://hl7.org/fhir/ValueSet/clinical-findings|4.0.1"/>
          </binding>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.reasonCode"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.why[x]"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".reasonCode"/>
          </mapping>
        </element>
        <element id="Communication.reasonReference">
          <path value="Communication.reasonReference"/>
          <short value="Why was communication done?"/>
          <definition
                      value="Indicates another resource whose existence justifies this communication."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.reasonReference"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Condition|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Observation|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/DiagnosticReport|4.0.1"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/DocumentReference|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.reasonReference"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.why[x]"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship[typeCode=RSON].target"/>
          </mapping>
        </element>
        <element id="Communication.payload">
          <path value="Communication.payload"/>
          <short value="Message payload"/>
          <definition
                      value="Text, attachment(s), or resource(s) that was communicated to the recipient."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.payload"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
        </element>
        <element id="Communication.payload.id">
          <path value="Communication.payload.id"/>
          <representation value="xmlAttr"/>
          <short value="Unique id for inter-element referencing"/>
          <definition
                      value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Element.id"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fhir-type">
              <valueUrl value="string"/>
            </extension>
            <code value="http://hl7.org/fhirpath/System.String"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Communication.payload.extension">
          <path value="Communication.payload.extension"/>
          <short value="Additional content defined by implementations"/>
          <definition
                      value="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."/>
          <comment
                   value="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."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Element.extension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="n/a"/>
          </mapping>
        </element>
        <element id="Communication.payload.modifierExtension">
          <path value="Communication.payload.modifierExtension"/>
          <short value="Extensions that cannot be ignored even if unrecognized"/>
          <definition
                      value="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)."/>
          <comment
                   value="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."/>
          <requirements
                        value="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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension)."/>
          <alias value="extensions"/>
          <alias value="user content"/>
          <alias value="modifiers"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="BackboneElement.modifierExtension"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Extension"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <constraint>
            <key value="ext-1"/>
            <severity value="error"/>
            <human value="Must have either extensions or value[x], not both"/>
            <expression value="extension.exists() != value.exists()"/>
            <xpath
                   value="exists(f:extension)!=exists(f:*[starts-with(local-name(.), &quot;value&quot;)])"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Extension"/>
          </constraint>
          <isModifier value="true"/>
          <isModifierReason
                            value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Communication.payload.content[x]">
          <path value="Communication.payload.content[x]"/>
          <short value="Message part content"/>
          <definition
                      value="A communicated content (or for multi-part communications, one portion of the communication)."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Communication.payload.content[x]"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="string"/>
          </type>
          <type>
            <code value="Attachment"/>
          </type>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Resource|4.0.1"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
        </element>
        <element id="Communication.note">
          <path value="Communication.note"/>
          <short value="Comments made about the communication"/>
          <definition
                      value="Additional notes or commentary about the communication by the sender, receiver or other interested parties."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Communication.note"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Annotation"/>
          </type>
          <constraint>
            <key value="ele-1"/>
            <severity value="error"/>
            <human value="All FHIR elements must have a @value or children"/>
            <expression
                        value="hasValue() or (children().count() &gt; id.count())"/>
            <xpath value="@value|f:*|h:div"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Element"/>
          </constraint>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="workflow"/>
            <map value="Event.note"/>
          </mapping>
        </element>
      </snapshot>
      <differential>
        <element id="Communication">
          <path value="Communication"/>
          <constraint>
            <key value="cnd-1"/>
            <severity value="error"/>
            <human
                   value="to indicate what communication was not carried out, either at least one coding in the topic or a notDoneValueSet extension shall be provided"/>
            <expression
                        value="topic.extension('http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet').exists() xor topic.coding.exists()"/>
          </constraint>
          <mustSupport value="false"/>
        </element>
        <element id="Communication.extension:recorded">
          <path value="Communication.extension"/>
          <sliceName value="recorded"/>
          <short value="Extension"/>
          <min value="1"/>
          <max value="1"/>
          <type>
            <code value="Extension"/>
            <profile
                     value="http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-recorded"/>
          </type>
        </element>
        <element id="Communication.status">
          <path value="Communication.status"/>
          <short
                 value="preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown"/>
          <min value="1"/>
          <max value="1"/>
          <type>
            <code value="code"/>
          </type>
          <fixedCode value="not-done"/>
        </element>
        <element id="Communication.statusReason">
          <path value="Communication.statusReason"/>
          <short value="Reason for current status"/>
          <min value="1"/>
          <max value="1"/>
          <binding>
            <strength value="extensible"/>
            <valueSet
                      value="http://fhir.org/guides/onc/us-quality-core/ValueSet/us-quality-core-negation-reason"/>
          </binding>
        </element>
        <element id="Communication.subject">
          <path value="Communication.subject"/>
          <short value="Focus of message"/>
          <min value="0"/>
          <max value="1"/>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-patient"/>
            <targetProfile value="http://hl7.org/fhir/StructureDefinition/Group"/>
          </type>
        </element>
        <element id="Communication.topic">
          <path value="Communication.topic"/>
          <short value="Description of the purpose/content"/>
          <min value="1"/>
          <max value="1"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="CommunicationTopic"/>
            </extension>
            <strength value="preferred"/>
            <description
                         value="Codes describing the purpose or content of the communication."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/communication-topic"/>
          </binding>
        </element>
        <element id="Communication.topic.extension:notDoneValueSet">
          <path value="Communication.topic.extension"/>
          <sliceName value="notDoneValueSet"/>
          <short
                 value="Url of a value set of activities not requested or performed"/>
          <definition
                      value="A logical reference (e.g. a reference to ValueSet.url) to a value set/version that identifies a set of possible coded values representing activities that were not requested, ordered, or performed."/>
          <min value="0"/>
          <max value="1"/>
          <type>
            <code value="Extension"/>
            <profile
                     value="http://fhir.org/guides/onc/us-quality-core/StructureDefinition/us-quality-core-notDoneValueSet"/>
          </type>
        </element>
      </differential>
    </StructureDefinition>