# US Core CarePlan Profile - US Core Implementation Guide v9.0.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **US Core CarePlan Profile**

## Resource Profile: US Core CarePlan Profile 

| | | |
| :--- | :--- | :--- |
| *Official URL*:http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan | *Version*:9.0.0 | |
| * Standards status: *[Trial-use](http://hl7.org/fhir/R4/versions.html#std-process) | [Maturity Level](changes-between-versions.md#us-core-maturity-levels): 4 | *Computable Name*:USCoreCarePlanProfile |
| *Other Identifiers:*OID:2.16.840.1.113883.4.642.40.2.42.15 | | |

 
The US Core CarePlan Profile inherits from the FHIR [CarePlan](https://hl7.org/fhir/R4/careplan.html) 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](us-core-roadmap.md#future-candidate-requirements-under-consideration) an existing care plan

### Mandatory and Must Support Data Elements

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

**Each CarePlan Must Have:**

1. a status
1. an intent
1. a patient

**Each CarePlan Must Support:**

1. a narrative summary of the patient assessment and plan of treatment1
1. a category

**Additional USCDI Requirements:**

These [Additional USCDI Requirements](must-support.md#additional-uscdi-requirements) elements are not Mandatory or Must Support but are required for ONC Health IT certification testing and are included in the formal definition of the profile and the CarePlan examples.

1. a contributor2
1. references to health issues this plan addresses1

1,2 see guidance below

### Profile Specific Implementation Guidance

This section provides detailed implementation guidance for the US Core Profile to support implementation and certification.

* 1The original US Core CarePlan Profile was designed to support the "Assessment and Plan" in a narrative Progress Note. Its future direction is to move from text-based content to discrete references to conditions/needs (`CarePlan.addresses`), goals (`CarePlan.goal`), and strategies (`CarePlan.activities`).
* Additional considerations for systems aligning with [HL7 Consolidated (C-CDA)](http://www.hl7.org/implement/standards/product_brief.cfm?product_id=492) Care Plan requirements: 
* US Core Goal **SHOULD** be present in `CarePlan.goal`[§](requirements.md#CONF-0310)
* US Core Condition **SHOULD** be present in `CarePlan.addresses`[§](requirements.md#CONF-0311)
* Assessment and Plan **MAY** be included as narrative in `CarePlan.text`[§](requirements.md#CONF-0312)
 
* As an alternative to the US Core CarePlan, Assessment and Plan of Treatment may be included in various types of [Clinical Notes](clinical-notes.md), such as Progress Notes, History & Physical (H&P), Discharge Summaries, etc.

* 2The profile element `CarePlan.contributor` communicates the [individual level provenance](basic-provenance.md#individual-level-provenance) author data corresponding to the U.S. Core Data for Interoperability (USCDI) Provenance Author Data Elements.

**Usages:**

* Refer to this Profile: [US Core Procedure Profile](StructureDefinition-us-core-procedure.md)
* Examples for this Profile: [CarePlan/careplan-ulcer-example](CarePlan-careplan-ulcer-example.md) and [CarePlan/colonoscopy](CarePlan-colonoscopy.md)
* CapabilityStatements using this Profile: [US Core Client CapabilityStatement](CapabilityStatement-us-core-client.md) and [US Core Server CapabilityStatement](CapabilityStatement-us-core-server.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.core|current/StructureDefinition/us-core-careplan)

**Changes since version 8.0.1:**

* The resource metadata has changed (copyright)

* The data elements list has changed

### Formal Views of Profile Content

 [Description of Profiles, Differentials, Snapshots and how the different presentations work](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](StructureDefinition-us-core-careplan.csv), [Excel](StructureDefinition-us-core-careplan.xlsx), [Schematron](StructureDefinition-us-core-careplan.sch) 

### 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](CapabilityStatement-us-core-server.md) for a complete list of supported RESTful interactions for this IG.

* See the [Scopes Format](scopes.md#scopes-format) section for a description of the SMART scopes syntax.
* See the [Search Syntax](general-guidance.md#search-syntax) section for a description of the US Core search syntax.
* See the [General Requirements](general-requirements.md) section for additional rules and expectations when a Server requires status parameters.
* See the [General Guidance](general-guidance.md) 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](scopes.md#smart-scopes):

* [resource level scopes](http://hl7.org/fhir/smart-app-launch/STU2.2/scopes-and-launch-context.html#scopes-for-requesting-clinical-data): `<patient|user|system>/CarePlan.rs` [§](requirements.md#CONF-0133)

-------

#### Mandatory Search Parameters:

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

1. **SHALL** support searching using the combination of the [patient](SearchParameter-us-core-careplan-patient.md) and [category](SearchParameter-us-core-careplan-category.md) search parameters`GET [base]/CarePlan?patient={Patient/}[id]&category={system|}[search_code]`Example:
> 
1. GET [base]/CarePlan?patient=Patient/1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan

**Implementation Notes**: Fetches a bundle of all resources for the specified ="assess-plan" ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).

#### Optional Search Parameters:

The following search parameters and search parameter combinations **SHOULD** be supported

1. **SHOULD** support searching using the combination of the [patient](SearchParameter-us-core-careplan-patient.md) and [category](SearchParameter-us-core-careplan-category.md) and [date](SearchParameter-us-core-careplan-date.md) search parameters
* Including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]&...`)
* Including support for these `date` comparators: "gt", "lt", "ge", "le"
`GET [base]/CarePlan?patient={Patient/}[id]&category={system|}[search_code]&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`Examples:
> 
1. GET [base]/CarePlan?patient=Patient/1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&date=ge2019-01-01T00:00:00Z
1. GET [base]/CarePlan?patient=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 resources for the specified patient and category="assess-plan" and date ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).
1. **SHOULD** support searching using the combination of the [patient](SearchParameter-us-core-careplan-patient.md) and [category](SearchParameter-us-core-careplan-category.md) and [status](SearchParameter-us-core-careplan-status.md) search parameters
* Including support **OR** search on `status` (e.g.`status={system|}[code],{system|}[code],...`)
`GET [base]/CarePlan?patient={Patient/}[id]&category={system|}[search_code]&status={system|}[search_code]{,{system|}[code],...}`Example:
> 
1. GET [base]/CarePlan?patient=Patient/1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status=active

**Implementation Notes**: Fetches a bundle of all resources for the specified patient and category="assess-plan" and status="active" ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token)).
1. **SHOULD** support searching using the combination of the [patient](SearchParameter-us-core-careplan-patient.md) and [category](SearchParameter-us-core-careplan-category.md) and [status](SearchParameter-us-core-careplan-status.md) and [date](SearchParameter-us-core-careplan-date.md) search parameters
* Including support **OR** search on `status` (e.g.`status={system|}[code],{system|}[code],...`)
* Including optional support for **AND** search on `date` (e.g.`date=[date]&date=[date]&...`)
* Including support for these `date` comparators: "gt", "lt", "ge", "le"
`GET [base]/CarePlan?patient={Patient/}[id]&category={system|}[search_code]&status={system|}[search_code]{,{system|}[code],...}&date={gt|lt|ge|le}[dateTime]{&date={gt|lt|ge|le}[dateTime]&...}`Examples:
> 
1. GET [base]/CarePlan?patient=Patient/1137192&category=http://hl7.org/fhir/us/core/CodeSystem/careplan-category|assess-plan&status=active&date=ge2019-01-01T00:00:00Z
1. GET [base]/CarePlan?patient=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 resources for the specified patient and category="assess-plan" and status="active" and date ( see [how to search by reference](http://hl7.org/fhir/R4/search.html#reference) and [how to search by token](http://hl7.org/fhir/R4/search.html#token) and [how to search by date](http://hl7.org/fhir/R4/search.html#date)).



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "us-core-careplan",
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 4
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "cgp"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
    "valueCode" : "trial-use",
    "_valueCode" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
        "valueCanonical" : "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core"
      }]
    }
  }],
  "url" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan",
  "identifier" : [{
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.42.15"
  }],
  "version" : "9.0.0",
  "name" : "USCoreCarePlanProfile",
  "title" : "US Core CarePlan Profile",
  "status" : "active",
  "experimental" : false,
  "date" : "2023-10-17",
  "publisher" : "HL7 International / Cross-Group Projects",
  "contact" : [{
    "name" : "HL7 International / Cross-Group Projects",
    "telecom" : [{
      "system" : "url",
      "value" : "http://www.hl7.org/Special/committees/cgp"
    },
    {
      "system" : "email",
      "value" : "cgp@lists.HL7.org"
    }]
  }],
  "description" : "The US Core CarePlan Profile inherits from the FHIR [CarePlan](https://hl7.org/fhir/R4/careplan.html) 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.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "CarePlan",
  "baseDefinition" : "http://hl7.org/fhir/StructureDefinition/CarePlan",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "CarePlan",
      "path" : "CarePlan",
      "mustSupport" : false
    },
    {
      "id" : "CarePlan.text",
      "path" : "CarePlan.text",
      "short" : "Text summary of the resource, for human interpretation",
      "mustSupport" : true
    },
    {
      "id" : "CarePlan.text.status",
      "path" : "CarePlan.text.status",
      "short" : "generated | additional",
      "mustSupport" : true,
      "binding" : {
        "strength" : "required",
        "description" : "Constrained value set of narrative statuses.",
        "valueSet" : "http://hl7.org/fhir/us/core/ValueSet/us-core-narrative-status"
      }
    },
    {
      "id" : "CarePlan.text.div",
      "path" : "CarePlan.text.div",
      "short" : "Limited xhtml content",
      "mustSupport" : true
    },
    {
      "id" : "CarePlan.status",
      "path" : "CarePlan.status",
      "requirements" : "Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.",
      "mustSupport" : true,
      "binding" : {
        "strength" : "required",
        "description" : "Indicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.",
        "valueSet" : "http://hl7.org/fhir/ValueSet/request-status"
      }
    },
    {
      "id" : "CarePlan.intent",
      "path" : "CarePlan.intent",
      "mustSupport" : true,
      "binding" : {
        "strength" : "required",
        "description" : "Codes indicating the degree of authority/intentionality associated with a care plan",
        "valueSet" : "http://hl7.org/fhir/ValueSet/care-plan-intent"
      }
    },
    {
      "id" : "CarePlan.category",
      "path" : "CarePlan.category",
      "definition" : "Type of plan.",
      "requirements" : "Identifies what \"kind\" of plan this is to support differentiation between multiple co-existing plans; e.g., \"Home health\", \"psychiatric\", \"asthma\", \"disease management\", \"wellness plan\", etc.",
      "min" : 0,
      "mustSupport" : true,
      "binding" : {
        "strength" : "preferred",
        "valueSet" : "http://hl7.org/fhir/ValueSet/care-plan-category"
      }
    },
    {
      "id" : "CarePlan.subject",
      "path" : "CarePlan.subject",
      "definition" : "Who care plan is for.",
      "requirements" : "Identifies the patient or group whose intended care is described by the plan.",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/StructureDefinition/Group"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : true
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }],
      "mustSupport" : true
    },
    {
      "id" : "CarePlan.contributor",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "CarePlan.contributor",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient",
        "http://hl7.org/fhir/StructureDefinition/PractitionerRole",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson",
        "http://hl7.org/fhir/us/core/StructureDefinition/us-core-device"],
        "_targetProfile" : [{
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        },
        {
          "extension" : [{
            "url" : "http://hl7.org/fhir/StructureDefinition/elementdefinition-type-must-support",
            "valueBoolean" : false
          }]
        }]
      }]
    },
    {
      "id" : "CarePlan.addresses",
      "extension" : [{
        "url" : "http://hl7.org/fhir/us/core/StructureDefinition/uscdi-requirement",
        "valueBoolean" : true
      }],
      "path" : "CarePlan.addresses",
      "short" : "𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Health issues this plan addresses",
      "type" : [{
        "code" : "Reference",
        "targetProfile" : ["http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition-problems-health-concerns"]
      }],
      "mustSupport" : false
    }]
  }
}

```
