US Quality Core Implementation Guide
0.1.0 - cibuild

US Quality Core Implementation Guide, published by ASTP. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/FHIR/us-quality-core/ and changes regularly. See the Directory of published versions

## Resource Profile: USQualityCoreGoal - XML Profile

Active as of 2026-03-31

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

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    <StructureDefinition xmlns="http://hl7.org/fhir">
      <id value="us-quality-core-goal"/>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: StructureDefinition us-quality-core-goal</b></p><a name="us-quality-core-goal"> </a><a name="hcus-quality-core-goal"> </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, " 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-goal-definitions.html#Goal">Goal</a><a name="Goal"> </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"><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/us/core/STU6.1/StructureDefinition-us-core-goal.html">USCoreGoalProfile</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">Describes the intended objective(s) for a patient, group or organization</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_element.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Element" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-goal-definitions.html#Goal.description">description</a><a name="Goal.description"> </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"><span style="opacity: 0.5">1</span><span style="opacity: 0.5">..</span><span style="opacity: 0.5">1</span></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 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: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">(USCDI+ Quality) (USCDI) Code or text describing goal</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_reference.png" alt="." style="background-color: white; background-color: inherit" title="Reference to another Resource" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-goal-definitions.html#Goal.subject">subject</a><a name="Goal.subject"> </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/references.html">Reference</a>(<a href="StructureDefinition-us-quality-core-patient.html">US Quality Core Patient</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">(USCDI) Who this goal is intended for</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_bck11.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_choice.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Choice of Types" class="hierarchy"/> <a href="StructureDefinition-us-quality-core-goal-definitions.html#Goal.start[x]" title="The date or event after which the goal should begin being pursued.">start[x]</a><a name="Goal.start_x_"> </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"><span style="padding-left: 3px; padding-right: 3px; color: black; null" title="This element is included in summaries">Σ</span></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">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"/><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">(USCDI) When goal pursuit begins<br class="binding"/><span style="font-weight:bold" title="null" class="binding">Binding: </span><a href="http://hl7.org/fhir/R4/valueset-goal-start-event.html" title="http://hl7.org/fhir/ValueSet/goal-start-event" class="binding">GoalStartEvent</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 events that can trigger the initiation of a goal.</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_bck110.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.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_primitive.png" alt="." style="background-color: white; background-color: inherit" title="Primitive Data Type" class="hierarchy"/> <span title="Base StructureDefinition for date Type: A date or partial date (e.g. just year or year + month). There is no time zone. The format is a union of the schema types gYear, gYearMonth and date.  Dates SHALL be valid dates.">startDate</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"/><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"><a href="http://hl7.org/fhir/R4/datatypes.html#date">date</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"/></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_bck100.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.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_datatype.gif" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Data Type" class="hierarchy"/> <span title="Base StructureDefinition for CodeableConcept Type: A concept that may be defined by a formal reference to a terminology or ontology or may be provided by text.">startCodeableConcept</span></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"><a 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: #F7F7F7; border: 0px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></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_bck00.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-goal-definitions.html#Goal.target">target</a><a name="Goal.target"> </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"><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 style="opacity: 0.5; opacity: 0.5" href="http://hl7.org/fhir/R4/datatypes.html#BackboneElement">BackboneElement</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">(USCDI+ Quality) (USCDI) Target outcome for the goal</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, " alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
      </text>
      <url
           value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-goal"/>
      <version value="0.1.0"/>
      <name value="USQualityCoreGoal"/>
      <title value="US Quality Core Goal"/>
      <status value="active"/>
      <experimental value="false"/>
      <date value="2026-03-31"/>
      <publisher value="ASTP"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="https://www.healthit.gov/"/>
        </telecom>
      </contact>
      <description
                   value="Profile of Goal 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="v2"/>
        <uri value="http://hl7.org/v2"/>
        <name value="HL7 v2 Mapping"/>
      </mapping>
      <mapping>
        <identity value="rim"/>
        <uri value="http://hl7.org/v3"/>
        <name value="RIM Mapping"/>
      </mapping>
      <mapping>
        <identity value="w5"/>
        <uri value="http://hl7.org/fhir/fivews"/>
        <name value="FiveWs Pattern Mapping"/>
      </mapping>
      <kind value="resource"/>
      <abstract value="false"/>
      <type value="Goal"/>
      <baseDefinition
                      value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal"/>
      <derivation value="constraint"/>
      <snapshot>
        <extension
                   url="http://hl7.org/fhir/tools/StructureDefinition/snapshot-base-version">
          <valueString value="6.1.0"/>
        </extension>
        <element id="Goal">
          <path value="Goal"/>
          <short
                 value="Describes the intended objective(s) for a patient, group or organization"/>
          <definition value="\-"/>
          <comment value="\-"/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Goal"/>
            <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>
          <mustSupport value="false"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
          <mapping>
            <identity value="rim"/>
            <map value="Entity. Role, or Act"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="GOL.1"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".outboundRelationship[typeCode&lt;=OBJ]."/>
          </mapping>
          <mapping>
            <identity value="argonaut-dq-dstu2"/>
            <map value="Goal"/>
          </mapping>
        </element>
        <element id="Goal.id">
          <path value="Goal.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="Goal.meta">
          <path value="Goal.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="Goal.implicitRules">
          <path value="Goal.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="Goal.language">
          <path value="Goal.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"/>
          </binding>
        </element>
        <element id="Goal.text">
          <path value="Goal.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="Goal.contained">
          <path value="Goal.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="Goal.extension">
          <path value="Goal.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 resource. To make the use of extensions safe and manageable, there is a strict set of governance  applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension."/>
          <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="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"/>
          <mapping>
            <identity value="rim"/>
            <map value="N/A"/>
          </mapping>
        </element>
        <element id="Goal.modifierExtension">
          <path value="Goal.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="Goal.identifier">
          <path value="Goal.identifier"/>
          <short value="External Ids for this goal"/>
          <definition
                      value="Business identifiers assigned to this goal 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 goal 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="Goal.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="false"/>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.identifier"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".id"/>
          </mapping>
        </element>
        <element id="Goal.lifecycleStatus">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.lifecycleStatus"/>
          <short
                 value="(USCDI) proposed | planned | accepted | active | on-hold | completed | cancelled | entered-in-error | rejected"/>
          <definition value="The state of the goal throughout its lifecycle."/>
          <comment
                   value="This element is labeled as a modifier because the lifecycleStatus contains codes that mark the resource as not currently valid."/>
          <requirements
                        value="Allows knowing whether goal needs to be further tracked."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Goal.lifecycleStatus"/>
            <min value="1"/>
            <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>
          <mustSupport value="true"/>
          <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>
            <strength value="required"/>
            <valueSet value="http://hl7.org/fhir/ValueSet/goal-status"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.status"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="GOL-18-goal life cycle status"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".statusCode in-progress = active (classCode = OBJ) cancelled = aborted"/>
          </mapping>
          <mapping>
            <identity value="argonaut-dq-dstu2"/>
            <map value="Goal.status"/>
          </mapping>
        </element>
        <element id="Goal.achievementStatus">
          <path value="Goal.achievementStatus"/>
          <short
                 value="in-progress | improving | worsening | no-change | achieved | sustaining | not-achieved | no-progress | not-attainable"/>
          <definition
                      value="Describes the progression, or lack thereof, towards the goal against the target."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.achievementStatus"/>
            <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>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="GoalAchievementStatus"/>
            </extension>
            <strength value="preferred"/>
            <description
                         value="Indicates the progression, or lack thereof, towards the goal against the target."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/goal-achievement"/>
          </binding>
          <mapping>
            <identity value="rim"/>
            <map value=".statusCode achieved = complete sustaining = active"/>
          </mapping>
        </element>
        <element id="Goal.category">
          <path value="Goal.category"/>
          <short value="E.g. Treatment, dietary, behavioral, etc."/>
          <definition value="Indicates a category the goal falls within."/>
          <requirements value="Allows goals to be filtered and sorted."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Goal.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="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="GoalCategory"/>
            </extension>
            <strength value="example"/>
            <description value="Codes for grouping and sorting goals."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/goal-category"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.class"/>
          </mapping>
        </element>
        <element id="Goal.priority">
          <path value="Goal.priority"/>
          <short value="high-priority | medium-priority | low-priority"/>
          <definition
                      value="Identifies the mutually agreed level of importance associated with reaching/sustaining the goal."/>
          <comment
                   value="Extensions are available to track priorities as established by each participant (i.e. Priority from the patient's perspective, different practitioners' perspectives, family member's perspectives)

    The ordinal extension on Coding can be used to convey a numerically comparable ranking to priority.  (Keep in mind that different coding systems may use a &quot;low value=important&quot;."/>
          <requirements value="Used for sorting and presenting goals."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.priority"/>
            <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>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="GoalPriority"/>
            </extension>
            <strength value="preferred"/>
            <description value="The level of importance associated with a goal."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/goal-priority"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.grade"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".priorityCode"/>
          </mapping>
        </element>
        <element id="Goal.description">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <extension
                     url="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/uscdiplusquality">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.description"/>
          <short value="(USCDI+ Quality) (USCDI) Code or text describing goal"/>
          <definition
                      value="Human-readable and/or coded description of a specific desired objective of care, such as &quot;control blood pressure&quot; or &quot;negotiate an obstacle course&quot; or &quot;dance with child at wedding&quot;."/>
          <comment value="If no code is available, use CodeableConcept.text."/>
          <requirements
                        value="Without a description of what's trying to be achieved, element has no purpose."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Goal.description"/>
            <min value="1"/>
            <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>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <strength value="extensible"/>
            <description value="Value set to describe the Goal"/>
            <valueSet
                      value="http://hl7.org/fhir/us/core/ValueSet/us-core-goal-description"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.what[x]"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="GOL-3.2-goal ID.text"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".text"/>
          </mapping>
          <mapping>
            <identity value="argonaut-dq-dstu2"/>
            <map value="Goal.description"/>
          </mapping>
        </element>
        <element id="Goal.subject">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.subject"/>
          <short value="(USCDI) Who this goal is intended for"/>
          <definition
                      value="Identifies the patient, group or organization for whom the goal is being established."/>
          <comment
                   value="Should include us-quality-core-organization, but the base profile only allows USCore-Patient derivatives."/>
          <requirements
                        value="Subject is optional to support annonymized reporting."/>
          <min value="1"/>
          <max value="1"/>
          <base>
            <path value="Goal.subject"/>
            <min value="1"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"/>
          </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>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.subject[x]"/>
          </mapping>
          <mapping>
            <identity value="v2"/>
            <map value="PID-3-patient ID list"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map value=".participation[typeCode=PAT].role[classCode=PAT]"/>
          </mapping>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.subject"/>
          </mapping>
          <mapping>
            <identity value="argonaut-dq-dstu2"/>
            <map value="Goal.subject"/>
          </mapping>
        </element>
        <element id="Goal.start[x]">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.start[x]"/>
          <short value="(USCDI) When goal pursuit begins"/>
          <definition
                      value="The date or event after which the goal should begin being pursued."/>
          <requirements
                        value="Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.start[x]"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support">
              <valueBoolean value="true"/>
            </extension>
            <code value="date"/>
          </type>
          <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>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="GoalStartEvent"/>
            </extension>
            <strength value="preferred"/>
            <description
                         value="Codes describing events that can trigger the initiation of a goal."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/goal-start-event"/>
          </binding>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.planned"/>
          </mapping>
        </element>
        <element id="Goal.target">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <extension
                     url="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/uscdiplusquality">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.target"/>
          <short value="(USCDI+ Quality) (USCDI) Target outcome for the goal"/>
          <definition value="Indicates what should be done by when."/>
          <comment
                   value="When multiple targets are present for a single goal instance, all targets must be met for the overall goal to be met."/>
          <requirements
                        value="Allows the progress of the goal to be monitored against an observation or due date.  Target is 0..* to support Observations with multiple components, such as blood pressure goals with both a systolic and diastolic target."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Goal.target"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="BackboneElement"/>
          </type>
          <condition value="gol-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="gol-1"/>
            <severity value="error"/>
            <human
                   value="Goal.target.measure is required if Goal.target.detail is populated"/>
            <expression
                        value="(detail.exists() and measure.exists()) or detail.exists().not()"/>
            <xpath
                   value="(exists(f:*[starts-with(local-name(.), 'detail')]) and exists(f:measure)) or not(exists(f:*[starts-with(local-name(.), 'detail')]))"/>
            <source value="http://hl7.org/fhir/StructureDefinition/Goal"/>
          </constraint>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="false"/>
        </element>
        <element id="Goal.target.id">
          <path value="Goal.target.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="Goal.target.extension">
          <path value="Goal.target.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="Goal.target.modifierExtension">
          <path value="Goal.target.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="Goal.target.measure">
          <path value="Goal.target.measure"/>
          <short value="The parameter whose value is being tracked"/>
          <definition
                      value="The parameter whose value is being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.target.measure"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <condition value="gol-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>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="GoalTargetMeasure"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Codes to identify the value being tracked, e.g. body weight, blood pressure, or hemoglobin A1c level."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/observation-codes"/>
          </binding>
        </element>
        <element id="Goal.target.detail[x]">
          <path value="Goal.target.detail[x]"/>
          <short value="The target value to be achieved"/>
          <definition
                      value="The target value of the focus to be achieved to signify the fulfillment of the goal, e.g. 150 pounds, 7.0%. Either the high or low or both values of the range can be specified. When a low value is missing, it indicates that the goal is achieved at any focus value at or below the high value. Similarly, if the high value is missing, it indicates that the goal is achieved at any focus value at or above the low value."/>
          <comment
                   value="A CodeableConcept with just a text would be used instead of a string if the field was usually coded, or if the type associated with the Goal.target.measure defines a coded value."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.target.detail[x]"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Quantity"/>
          </type>
          <type>
            <code value="Range"/>
          </type>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <type>
            <code value="string"/>
          </type>
          <type>
            <code value="boolean"/>
          </type>
          <type>
            <code value="integer"/>
          </type>
          <type>
            <code value="Ratio"/>
          </type>
          <condition value="gol-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>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="GoalTargetDetail"/>
            </extension>
            <strength value="example"/>
            <description
                         value="Codes to identify the target value of the focus to be achieved to signify the fulfillment of the goal."/>
          </binding>
        </element>
        <element id="Goal.target.due[x]">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.target.due[x]"/>
          <short value="(USCDI) Reach goal on or before"/>
          <definition
                      value="Indicates either the date or the duration after start by which the goal should be met."/>
          <requirements value="Identifies when the goal should be evaluated."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.target.due[x]"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support">
              <valueBoolean value="true"/>
            </extension>
            <code value="date"/>
          </type>
          <type>
            <code value="Duration"/>
          </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>
          <mustSupport value="true"/>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <mapping>
            <identity value="w5"/>
            <map value="FiveWs.done[x]"/>
          </mapping>
        </element>
        <element id="Goal.statusDate">
          <path value="Goal.statusDate"/>
          <short value="When goal status took effect"/>
          <definition
                      value="Identifies when the current status.  I.e. When initially created, when achieved, when cancelled, etc."/>
          <comment value="To see the date for past statuses, query history."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.statusDate"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="date"/>
          </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="w5"/>
            <map value="FiveWs.recorded"/>
          </mapping>
        </element>
        <element id="Goal.statusReason">
          <path value="Goal.statusReason"/>
          <short value="Reason for current status"/>
          <definition value="Captures the reason for the current status."/>
          <comment
                   value="This will typically be captured for statuses such as rejected, on-hold or cancelled, but could be present for others."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.statusReason"/>
            <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="false"/>
        </element>
        <element id="Goal.expressedBy">
          <path value="Goal.expressedBy"/>
          <short value="Who's responsible for creating Goal?"/>
          <definition
                      value="Indicates whose goal this is - patient goal, practitioner goal, etc."/>
          <comment
                   value="This is the individual responsible for establishing the goal, not necessarily who recorded it.  (For that, use the Provenance resource.)."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.expressedBy"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Patient"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Practitioner"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/PractitionerRole"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/RelatedPerson"/>
          </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="w5"/>
            <map value="FiveWs.source"/>
          </mapping>
        </element>
        <element id="Goal.addresses">
          <path value="Goal.addresses"/>
          <short value="Issues addressed by this goal"/>
          <definition
                      value="The identified conditions and other health record elements that are intended to be addressed by the goal."/>
          <requirements
                        value="Allows specific goals to explicitly linked to the concerns they're dealing with - makes the goal more understandable."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Goal.addresses"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Condition"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Observation"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/MedicationStatement"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/NutritionOrder"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/ServiceRequest"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/RiskAssessment"/>
          </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.why[x]"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".outboundRelationship[typeCode=SUBJ].target[classCode=CONC]"/>
          </mapping>
        </element>
        <element id="Goal.note">
          <path value="Goal.note"/>
          <short value="Comments about the goal"/>
          <definition value="Any comments related to the goal."/>
          <comment
                   value="May be used for progress notes, concerns or other related information that doesn't actually describe the goal itself."/>
          <requirements
                        value="There's a need to capture information about the goal that doesn't actually describe the goal."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Goal.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="v2"/>
            <map value="GOL-16-goal evaluation + NTE?"/>
          </mapping>
          <mapping>
            <identity value="rim"/>
            <map
                 value=".inboundRelationship[typeCode=SUBJ].source[classCode=OBS, moodCode=EVN, code=&quot;annotation&quot;].value"/>
          </mapping>
        </element>
        <element id="Goal.outcomeCode">
          <path value="Goal.outcomeCode"/>
          <short value="What result was achieved regarding the goal?"/>
          <definition
                      value="Identifies the change (or lack of change) at the point when the status of the goal is assessed."/>
          <comment value="Note that this should not duplicate the goal status."/>
          <requirements
                        value="Outcome tracking is a key aspect of care planning."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Goal.outcomeCode"/>
            <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="GoalOutcome"/>
            </extension>
            <strength value="example"/>
            <description
                         value="The result of the goal; e.g. &quot;25% increase in shoulder mobility&quot;, &quot;Anxiety reduced to moderate levels&quot;.  &quot;15 kg weight loss sustained over 6 months&quot;."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/clinical-findings"/>
          </binding>
        </element>
        <element id="Goal.outcomeReference">
          <path value="Goal.outcomeReference"/>
          <short value="Observation that resulted from goal"/>
          <definition value="Details of what's changed (or not changed)."/>
          <comment
                   value="The goal outcome is independent of the outcome of the related activities.  For example, if the Goal is to achieve a target body weight of 150 lb and a care plan activity is defined to diet, then the care plan’s activity outcome could be calories consumed whereas goal outcome is an observation for the actual body weight measured."/>
          <requirements
                        value="Outcome tracking is a key aspect of care planning."/>
          <min value="0"/>
          <max value="*"/>
          <base>
            <path value="Goal.outcomeReference"/>
            <min value="0"/>
            <max value="*"/>
          </base>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://hl7.org/fhir/StructureDefinition/Observation"/>
          </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>
      </snapshot>
      <differential>
        <element id="Goal">
          <path value="Goal"/>
        </element>
        <element id="Goal.description">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <extension
                     url="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/uscdiplusquality">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.description"/>
          <short value="(USCDI+ Quality) (USCDI) Code or text describing goal"/>
        </element>
        <element id="Goal.subject">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.subject"/>
          <short value="(USCDI) Who this goal is intended for"/>
          <comment
                   value="Should include us-quality-core-organization, but the base profile only allows USCore-Patient derivatives."/>
          <min value="1"/>
          <max value="1"/>
          <type>
            <code value="Reference"/>
            <targetProfile
                           value="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/us-quality-core-patient"/>
          </type>
        </element>
        <element id="Goal.start[x]">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.start[x]"/>
          <short value="(USCDI) When goal pursuit begins"/>
          <definition
                      value="The date or event after which the goal should begin being pursued."/>
          <requirements
                        value="Goals can be established prior to there being an intention to start pursuing them; e.g. Goals for post-surgical recovery established prior to surgery."/>
          <min value="0"/>
          <max value="1"/>
          <base>
            <path value="Goal.start[x]"/>
            <min value="0"/>
            <max value="1"/>
          </base>
          <type>
            <code value="date"/>
          </type>
          <type>
            <code value="CodeableConcept"/>
          </type>
          <isModifier value="false"/>
          <isSummary value="true"/>
          <binding>
            <extension
                       url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName">
              <valueString value="GoalStartEvent"/>
            </extension>
            <strength value="preferred"/>
            <description
                         value="Codes describing events that can trigger the initiation of a goal."/>
            <valueSet value="http://hl7.org/fhir/ValueSet/goal-start-event"/>
          </binding>
        </element>
        <element id="Goal.target">
          <extension
                     url="http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement">
            <valueBoolean value="true"/>
          </extension>
          <extension
                     url="http://fhir.org/guides/astp/us-quality-core/StructureDefinition/uscdiplusquality">
            <valueBoolean value="true"/>
          </extension>
          <path value="Goal.target"/>
          <short value="(USCDI+ Quality) (USCDI) Target outcome for the goal"/>
        </element>
      </differential>
    </StructureDefinition>