US Core Implementation Guide
7.0.0 - STU7 United States of America flag

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 7.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Resource Profile: US Core CarePlan Profile

Official URL: http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan Version: 7.0.0
Standards status: Trial-use Maturity Level: 3 Computable Name: USCoreCarePlanProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.12

Copyright/Legal: Used by permission of HL7 International, all rights reserved Creative Commons License

The US Core CarePlan Profile inherits from the FHIR CarePlan resource; refer to it for scope and usage definitions. This profile sets minimum expectations for the CarePlan resource to record, search, and fetch assessment and plan of treatment data associated with a patient. It specifies which core elements, extensions, vocabularies, and value sets SHALL be present and constrains how the elements are used. Providing the floor for standards development for specific use cases promotes interoperability and adoption.

Example Usage Scenarios:

The following are example usage scenarios for this profile:

  • Query for a care plan belonging to a Patient
  • Record or update an existing care plan

Mandatory and Must Support Data Elements

The following data elements must always be present (Mandatory definition) or must be supported if the data is present in the sending system (Must Support definition). They are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Views below provides the formal summary, definitions, and terminology requirements.

Each CarePlan Must Have:

  1. a status
  2. an intent
  3. a category code of “assess-plan”
  4. a patient

Each CarePlan Must Support:

  1. a narrative summary of the patient assessment and plan of treatment*

*see guidance below

Profile Specific Implementation Guidance:

  • *The original Assessment and Plan design in the CarePlan was to support the “Assessment and Plan” from a narrative Progress Note. Systems have advanced significantly since the introduction of this requirement in 2015. Relaxing this to 0..1 allows more sophisticated systems to discretely encode a CarePlan instead of providing the narrative portion.
  • Additional considerations for systems aligning with HL7 Consolidated (C-CDA) Care Plan requirements:
    • US Core Goal SHOULD be present in CarePlan.goal
    • US Core Condition SHOULD be present in CarePlan.addresses
    • Assessment and Plan MAY be included as narrative in CarePlan.text
  • As an alternative to the US Core CarePlan, Assessment and Plan of Treatment may be included in various types of Clinical Notes, such as Progress Notes, History & Physical (H&P), Discharge Summaries, etc.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from CarePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..* CarePlan Healthcare plan for patient or group
... text S 0..1 Narrative Text summary of the resource, for human interpretation
.... status S 1..1 code generated | additional
Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.

.... div S 1..1 xhtml Limited xhtml content
... status S 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent S 1..1 code proposal | plan | order | option
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan

... Slices for category S 1..* CodeableConcept Type of plan
Slice: Unordered, Open by pattern:$this
.... category:AssessPlan S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/careplan-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
... subject S 1..1 Reference(US Core Patient Profile S | Group) Who the care plan is for

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
CarePlan.text.statusrequiredNarrativeStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status
from this IG
CarePlan.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status
from the FHIR Standard
CarePlan.intentrequiredCarePlanIntent
http://hl7.org/fhir/ValueSet/care-plan-intent
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..* CarePlan Healthcare plan for patient or group
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text S 0..1 Narrative Text summary of the resource, for human interpretation
.... status S 1..1 code generated | additional
Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.

.... div SC 1..1 xhtml Limited xhtml content
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes
txt-2: The narrative SHALL have some non-whitespace content
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent ?!SΣ 1..1 code proposal | plan | order | option
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan

... Slices for category SΣ 1..* CodeableConcept Type of plan
Slice: Unordered, Open by pattern:$this
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.


.... category:AssessPlan SΣ 1..1 CodeableConcept Type of plan
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.



Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/careplan-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
... subject SΣ 1..1 Reference(US Core Patient Profile) Who the care plan is for

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
CarePlan.text.statusrequiredNarrativeStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status
from this IG
CarePlan.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status
from the FHIR Standard
CarePlan.intentrequiredCarePlanIntent
http://hl7.org/fhir/ValueSet/care-plan-intent
from the FHIR Standard
CarePlan.categoryexampleCarePlanCategory
http://hl7.org/fhir/ValueSet/care-plan-category
from the FHIR Standard
CarePlan.category:AssessPlanexamplePattern: assess-plan
http://hl7.org/fhir/ValueSet/care-plan-category
from the FHIR Standard
NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..* CarePlan Healthcare plan for patient or group
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text S 0..1 Narrative Text summary of the resource, for human interpretation
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... status S 1..1 code generated | additional
Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.

.... div SC 1..1 xhtml Limited xhtml content
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes
txt-2: The narrative SHALL have some non-whitespace content
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier External Ids for this plan
... instantiatesCanonical Σ 0..* canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(CarePlan) Fulfills CarePlan
... replaces Σ 0..* Reference(CarePlan) CarePlan replaced by this CarePlan
... partOf Σ 0..* Reference(CarePlan) Part of referenced CarePlan
... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent ?!SΣ 1..1 code proposal | plan | order | option
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan

... Slices for category SΣ 1..* CodeableConcept Type of plan
Slice: Unordered, Open by pattern:$this
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.


.... category:AssessPlan SΣ 1..1 CodeableConcept Type of plan
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.



Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/careplan-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... title Σ 0..1 string Human-friendly name for the care plan
... description Σ 0..1 string Summary of nature of plan
... subject SΣ 1..1 Reference(US Core Patient Profile S | Group) Who the care plan is for
... encounter Σ 0..1 Reference(Encounter) Encounter created as part of
... period Σ 0..1 Period Time period plan covers
... created Σ 0..1 dateTime Date record was first recorded
... author Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) Who is the designated responsible party
... contributor 0..* Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) Who provided the content of the care plan
... careTeam 0..* Reference(CareTeam) Who's involved in plan?
... addresses Σ 0..* Reference(Condition) Health issues this plan addresses
... supportingInfo 0..* Reference(Resource) Information considered as part of plan
... goal 0..* Reference(Goal) Desired outcome of plan
... activity C 0..* BackboneElement Action to occur as part of plan
cpl-3: Provide a reference or detail, not both
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... outcomeCodeableConcept 0..* CodeableConcept Results of the activity
Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.


.... outcomeReference 0..* Reference(Resource) Appointment, Encounter, Procedure, etc.
.... progress 0..* Annotation Comments about the activity status/progress
.... reference C 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) Activity details defined in specific resource
.... detail C 0..1 BackboneElement In-line definition of activity
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... kind 0..1 code Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
Binding: CarePlanActivityKind (required): Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.

..... instantiatesCanonical 0..* canonical(PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition) Instantiates FHIR protocol or definition
..... instantiatesUri 0..* uri Instantiates external protocol or definition
..... code 0..1 CodeableConcept Detail type of activity
Binding: ProcedureCodes(SNOMEDCT) (example): Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.

..... reasonCode 0..* CodeableConcept Why activity should be done or why activity was prohibited
Binding: SNOMEDCTClinicalFindings (example): Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc.


..... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why activity is needed
..... goal 0..* Reference(Goal) Goals this activity relates to
..... status ?! 1..1 code not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle.

..... statusReason 0..1 CodeableConcept Reason for current status
..... doNotPerform ?! 0..1 boolean If true, activity is prohibiting action
..... scheduled[x] 0..1 When activity is to occur
...... scheduledTiming Timing
...... scheduledPeriod Period
...... scheduledString string
..... location 0..1 Reference(Location) Where it should happen
..... performer 0..* Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device) Who will be responsible?
..... product[x] 0..1 What is to be administered/supplied
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.

...... productCodeableConcept CodeableConcept
...... productReference Reference(Medication | Substance)
..... dailyAmount 0..1 SimpleQuantity How to consume/day?
..... quantity 0..1 SimpleQuantity How much to administer/supply/consume
..... description 0..1 string Extra info describing activity to perform
... note 0..* Annotation Comments about the plan

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
CarePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
CarePlan.text.statusrequiredNarrativeStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status
from this IG
CarePlan.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status
from the FHIR Standard
CarePlan.intentrequiredCarePlanIntent
http://hl7.org/fhir/ValueSet/care-plan-intent
from the FHIR Standard
CarePlan.categoryexampleCarePlanCategory
http://hl7.org/fhir/ValueSet/care-plan-category
from the FHIR Standard
CarePlan.category:AssessPlanexamplePattern: assess-plan
http://hl7.org/fhir/ValueSet/care-plan-category
from the FHIR Standard
CarePlan.activity.outcomeCodeableConceptexampleCarePlanActivityOutcome
http://hl7.org/fhir/ValueSet/care-plan-activity-outcome
from the FHIR Standard
CarePlan.activity.detail.kindrequiredCarePlanActivityKind
http://hl7.org/fhir/ValueSet/care-plan-activity-kind|4.0.1
from the FHIR Standard
CarePlan.activity.detail.codeexampleProcedureCodes(SNOMEDCT)
http://hl7.org/fhir/ValueSet/procedure-code
from the FHIR Standard
CarePlan.activity.detail.reasonCodeexampleSNOMEDCTClinicalFindings
http://hl7.org/fhir/ValueSet/clinical-findings
from the FHIR Standard
CarePlan.activity.detail.statusrequiredCarePlanActivityStatus
http://hl7.org/fhir/ValueSet/care-plan-activity-status|4.0.1
from the FHIR Standard
CarePlan.activity.detail.product[x]exampleSNOMEDCTMedicationCodes
http://hl7.org/fhir/ValueSet/medication-codes
from the FHIR Standard

This structure is derived from CarePlan

Summary

Mandatory: 2 elements
Must-Support: 8 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of CarePlan.category

Maturity: 3

Differential View

This structure is derived from CarePlan

NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..* CarePlan Healthcare plan for patient or group
... text S 0..1 Narrative Text summary of the resource, for human interpretation
.... status S 1..1 code generated | additional
Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.

.... div S 1..1 xhtml Limited xhtml content
... status S 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent S 1..1 code proposal | plan | order | option
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan

... Slices for category S 1..* CodeableConcept Type of plan
Slice: Unordered, Open by pattern:$this
.... category:AssessPlan S 1..1 CodeableConcept Type of plan
Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/careplan-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
... subject S 1..1 Reference(US Core Patient Profile S | Group) Who the care plan is for

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSetURI
CarePlan.text.statusrequiredNarrativeStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status
from this IG
CarePlan.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status
from the FHIR Standard
CarePlan.intentrequiredCarePlanIntent
http://hl7.org/fhir/ValueSet/care-plan-intent
from the FHIR Standard

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..* CarePlan Healthcare plan for patient or group
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text S 0..1 Narrative Text summary of the resource, for human interpretation
.... status S 1..1 code generated | additional
Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.

.... div SC 1..1 xhtml Limited xhtml content
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes
txt-2: The narrative SHALL have some non-whitespace content
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent ?!SΣ 1..1 code proposal | plan | order | option
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan

... Slices for category SΣ 1..* CodeableConcept Type of plan
Slice: Unordered, Open by pattern:$this
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.


.... category:AssessPlan SΣ 1..1 CodeableConcept Type of plan
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.



Required Pattern: At least the following
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/careplan-category
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
... subject SΣ 1..1 Reference(US Core Patient Profile) Who the care plan is for

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
CarePlan.text.statusrequiredNarrativeStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status
from this IG
CarePlan.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status
from the FHIR Standard
CarePlan.intentrequiredCarePlanIntent
http://hl7.org/fhir/ValueSet/care-plan-intent
from the FHIR Standard
CarePlan.categoryexampleCarePlanCategory
http://hl7.org/fhir/ValueSet/care-plan-category
from the FHIR Standard
CarePlan.category:AssessPlanexamplePattern: assess-plan
http://hl7.org/fhir/ValueSet/care-plan-category
from the FHIR Standard

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. CarePlan 0..* CarePlan Healthcare plan for patient or group
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... language 0..1 code Language of the resource content
Binding: CommonLanguages (preferred): A human language.

Additional BindingsPurpose
AllLanguages Max Binding
... text S 0..1 Narrative Text summary of the resource, for human interpretation
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... status S 1..1 code generated | additional
Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.

.... div SC 1..1 xhtml Limited xhtml content
txt-1: The narrative SHALL contain only the basic html formatting elements and attributes described in chapters 7-11 (except section 4 of chapter 9) and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained style attributes
txt-2: The narrative SHALL have some non-whitespace content
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier External Ids for this plan
... instantiatesCanonical Σ 0..* canonical(PlanDefinition | Questionnaire | Measure | ActivityDefinition | OperationDefinition) Instantiates FHIR protocol or definition
... instantiatesUri Σ 0..* uri Instantiates external protocol or definition
... basedOn Σ 0..* Reference(CarePlan) Fulfills CarePlan
... replaces Σ 0..* Reference(CarePlan) CarePlan replaced by this CarePlan
... partOf Σ 0..* Reference(CarePlan) Part of referenced CarePlan
... status ?!SΣ 1..1 code draft | active | on-hold | revoked | completed | entered-in-error | unknown
Binding: RequestStatus (required): Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.

... intent ?!SΣ 1..1 code proposal | plan | order | option
Binding: CarePlanIntent (required): Codes indicating the degree of authority/intentionality associated with a care plan

... Slices for category SΣ 1..* CodeableConcept Type of plan
Slice: Unordered, Open by pattern:$this
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.


.... category:AssessPlan SΣ 1..1 CodeableConcept Type of plan
Binding: CarePlanCategory (example): Identifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", etc.



Required Pattern: At least the following
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... coding 1..* Coding Code defined by a terminology system
Fixed Value: (complex)
...... id 0..1 string Unique id for inter-element referencing
...... extension 0..* Extension Additional content defined by implementations
...... system 1..1 uri Identity of the terminology system
Fixed Value: http://hl7.org/fhir/us/core/CodeSystem/careplan-category
...... version 0..1 string Version of the system - if relevant
...... code 1..1 code Symbol in syntax defined by the system
Fixed Value: assess-plan
...... display 0..1 string Representation defined by the system
...... userSelected 0..1 boolean If this coding was chosen directly by the user
..... text 0..1 string Plain text representation of the concept
... title Σ 0..1 string Human-friendly name for the care plan
... description Σ 0..1 string Summary of nature of plan
... subject SΣ 1..1 Reference(US Core Patient Profile S | Group) Who the care plan is for
... encounter Σ 0..1 Reference(Encounter) Encounter created as part of
... period Σ 0..1 Period Time period plan covers
... created Σ 0..1 dateTime Date record was first recorded
... author Σ 0..1 Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) Who is the designated responsible party
... contributor 0..* Reference(Patient | Practitioner | PractitionerRole | Device | RelatedPerson | Organization | CareTeam) Who provided the content of the care plan
... careTeam 0..* Reference(CareTeam) Who's involved in plan?
... addresses Σ 0..* Reference(Condition) Health issues this plan addresses
... supportingInfo 0..* Reference(Resource) Information considered as part of plan
... goal 0..* Reference(Goal) Desired outcome of plan
... activity C 0..* BackboneElement Action to occur as part of plan
cpl-3: Provide a reference or detail, not both
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... outcomeCodeableConcept 0..* CodeableConcept Results of the activity
Binding: CarePlanActivityOutcome (example): Identifies the results of the activity.


.... outcomeReference 0..* Reference(Resource) Appointment, Encounter, Procedure, etc.
.... progress 0..* Annotation Comments about the activity status/progress
.... reference C 0..1 Reference(Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription | RequestGroup) Activity details defined in specific resource
.... detail C 0..1 BackboneElement In-line definition of activity
..... id 0..1 string Unique id for inter-element referencing
..... extension 0..* Extension Additional content defined by implementations
..... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
..... kind 0..1 code Appointment | CommunicationRequest | DeviceRequest | MedicationRequest | NutritionOrder | Task | ServiceRequest | VisionPrescription
Binding: CarePlanActivityKind (required): Resource types defined as part of FHIR that can be represented as in-line definitions of a care plan activity.

..... instantiatesCanonical 0..* canonical(PlanDefinition | ActivityDefinition | Questionnaire | Measure | OperationDefinition) Instantiates FHIR protocol or definition
..... instantiatesUri 0..* uri Instantiates external protocol or definition
..... code 0..1 CodeableConcept Detail type of activity
Binding: ProcedureCodes(SNOMEDCT) (example): Detailed description of the type of activity; e.g. What lab test, what procedure, what kind of encounter.

..... reasonCode 0..* CodeableConcept Why activity should be done or why activity was prohibited
Binding: SNOMEDCTClinicalFindings (example): Identifies why a care plan activity is needed. Can include any health condition codes as well as such concepts as "general wellness", prophylaxis, surgical preparation, etc.


..... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why activity is needed
..... goal 0..* Reference(Goal) Goals this activity relates to
..... status ?! 1..1 code not-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-error
Binding: CarePlanActivityStatus (required): Codes that reflect the current state of a care plan activity within its overall life cycle.

..... statusReason 0..1 CodeableConcept Reason for current status
..... doNotPerform ?! 0..1 boolean If true, activity is prohibiting action
..... scheduled[x] 0..1 When activity is to occur
...... scheduledTiming Timing
...... scheduledPeriod Period
...... scheduledString string
..... location 0..1 Reference(Location) Where it should happen
..... performer 0..* Reference(Practitioner | PractitionerRole | Organization | RelatedPerson | Patient | CareTeam | HealthcareService | Device) Who will be responsible?
..... product[x] 0..1 What is to be administered/supplied
Binding: SNOMEDCTMedicationCodes (example): A product supplied or administered as part of a care plan activity.

...... productCodeableConcept CodeableConcept
...... productReference Reference(Medication | Substance)
..... dailyAmount 0..1 SimpleQuantity How to consume/day?
..... quantity 0..1 SimpleQuantity How much to administer/supply/consume
..... description 0..1 string Extra info describing activity to perform
... note 0..* Annotation Comments about the plan

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
CarePlan.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
http://hl7.org/fhir/ValueSet/languages
from the FHIR Standard
CarePlan.text.statusrequiredNarrativeStatus
http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status
from this IG
CarePlan.statusrequiredRequestStatus
http://hl7.org/fhir/ValueSet/request-status
from the FHIR Standard
CarePlan.intentrequiredCarePlanIntent
http://hl7.org/fhir/ValueSet/care-plan-intent
from the FHIR Standard
CarePlan.categoryexampleCarePlanCategory
http://hl7.org/fhir/ValueSet/care-plan-category
from the FHIR Standard
CarePlan.category:AssessPlanexamplePattern: assess-plan
http://hl7.org/fhir/ValueSet/care-plan-category
from the FHIR Standard
CarePlan.activity.outcomeCodeableConceptexampleCarePlanActivityOutcome
http://hl7.org/fhir/ValueSet/care-plan-activity-outcome
from the FHIR Standard
CarePlan.activity.detail.kindrequiredCarePlanActivityKind
http://hl7.org/fhir/ValueSet/care-plan-activity-kind|4.0.1
from the FHIR Standard
CarePlan.activity.detail.codeexampleProcedureCodes(SNOMEDCT)
http://hl7.org/fhir/ValueSet/procedure-code
from the FHIR Standard
CarePlan.activity.detail.reasonCodeexampleSNOMEDCTClinicalFindings
http://hl7.org/fhir/ValueSet/clinical-findings
from the FHIR Standard
CarePlan.activity.detail.statusrequiredCarePlanActivityStatus
http://hl7.org/fhir/ValueSet/care-plan-activity-status|4.0.1
from the FHIR Standard
CarePlan.activity.detail.product[x]exampleSNOMEDCTMedicationCodes
http://hl7.org/fhir/ValueSet/medication-codes
from the FHIR Standard

This structure is derived from CarePlan

Summary

Mandatory: 2 elements
Must-Support: 8 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element 1 is sliced based on the value of CarePlan.category

Maturity: 3

 

Other representations of profile: CSV, Excel, Schematron

Notes:

Quick Start

Below is an overview of the required Server RESTful FHIR interactions for this profile - for example, search and read operations - when supporting the US Core interactions to access this profile’s information (Profile Support + Interaction Support). Note that systems that support only US Core Profiles (Profile Only Support) are not required to support these interactions. See the US Core Server CapabilityStatement for a complete list of supported RESTful interactions for this IG.

  • See the Scopes Format section for a description of the SMART scopes syntax.
  • See the Search Syntax section for a description of the US Core search syntax.
  • See the General Requirements section for additional rules and expectations when a server requires status parameters.
  • See the General Guidance section for additional guidance on searching for multiple patients.

US Core Scopes

Servers providing access to care plan data SHALL support these US Core SMART Scopes:

Mandatory Search Parameters:

The following search parameters and search parameter combinations SHALL be supported:

  1. SHALL support searching using the combination of the patient and category search parameters:

    GET [base]/CarePlan?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan

    Example:

    1. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan

    Implementation Notes: Fetches a bundle of all CarePlan resources for the specified patient and category=assess-plan (how to search by reference and how to search by token)

Optional Search Parameters:

The following search parameter combinations SHOULD be supported:

  1. SHOULD support searching using the combination of the patient and category and date search parameters:
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/CarePlan?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&date=ge2019-01-01T00:00:00Z
    2. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&date=ge2018-01-01T00:00:00Z&date=le2019-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all CarePlan resources for the specified patient and category=assess-plan and date (how to search by reference and how to search by token and how to search by date)

  2. SHOULD support searching using the combination of the patient and category and status search parameters:
    • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)

    GET [base]/CarePlan?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status={system|}[code]{,{system|}[code],...}

    Example:

    1. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status=active

    Implementation Notes: Fetches a bundle of all CarePlan resources for the specified patient and category=assess-plan and status=active (how to search by reference and how to search by token)

  3. SHOULD support searching using the combination of the patient and category and status and date search parameters:
    • including support for OR search on status (e.g.status={system|}[code],{system|}[code],...)
    • including support for these date comparators: gt,lt,ge,le
    • including optional support for AND search on date (e.g.date=[date]&date=[date]]&...)

    GET [base]/CarePlan?patient={Type/}[id]&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status={system|}[code]{,{system|}[code],...}&date={gt|lt|ge|le}[date]{&date={gt|lt|ge|le}[date]&...}

    Example:

    1. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status=active&date=ge2019-01-01T00:00:00Z
    2. GET [base]/CarePlan?patient=1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status=active&date=ge2018-01-01T00:00:00Z&date=le2019-01-01T00:00:00Z

    Implementation Notes: Fetches a bundle of all CarePlan resources for the specified patient and category=assess-plan and status=active and date (how to search by reference and how to search by token and how to search by date)