US Core Implementation Guide
8.0.1 - STU 8 US

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 8.0.1 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: 8.0.1
Standards status: Trial-use | Maturity Level: 3 | Computable Name: USCoreCarePlanProfile
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.42.14
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. a category
3. an intent
4. a patient

Each CarePlan Must Support:

1. a narrative summary of the patient assessment and plan of treatment*
2. a category code of "assess-plan"

Additional USCDI Requirements:

These Additional USCDI Requirements elements are not Mandatory or Must Support but are required for ASTP Health IT certification testing and are included in the formal definition of the profile and the CarePlan examples.

1. a contributor*

*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.

- *The profile element `CarePlan.contributor` communicates the 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
- Examples for this Profile: CarePlan/colonoscopy
- CapabilityStatements using this Profile: US Core Client CapabilityStatement and US Core Server CapabilityStatement

You can also check for usages in the FHIR IG Statistics

Changes since version 7.0.0:

- The data elements list has changed

### Formal Views of Profile Content

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

- Key Elements Table
- Differential Table
- Snapshot Table
- Statistics/References
- All

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 This profile constrains the narrative content by fixing the status codes to generated and additional This profile does not constrain the narrative in regard to language specific sections This profile does not constrain the narrative in regard to traceability to data elements
status | S | 1..1 | code | generated | additional Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.
div | S C | 1..1 | xhtml | Limited xhtml content Constraints: txt-1, txt-2
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 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 Σ | 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 Σ | 1..* | CodeableConcept | Type of plan Slice: Unordered, Open by value:$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 | S Σ | 0..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
subject | S Σ | 1..1 | Reference(US Core Patient Profile S | Group) | Who the care plan is for
contributor |  | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
CarePlan.text.status | Base | required | US Core Narrative Status | 📦8.0.1 | This IG
CarePlan.status | Base | required | RequestStatus | 📦4.0.1 | FHIR Std.
CarePlan.intent | Base | required | Care Plan Intent | 📦4.0.1 | FHIR Std.
CarePlan.category | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std.
CarePlan.category:AssessPlan | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | CarePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | CarePlan | 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 | `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()`
dom-4 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | CarePlan | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
txt-1 | error | CarePlan.text.div | 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 | `htmlChecks()`
txt-2 | error | CarePlan.text.div | The narrative SHALL have some non-whitespace content | `htmlChecks()`

This structure is derived from CarePlan

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 value:$this
category:AssessPlan | S | 0..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
contributor |  | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
CarePlan.text.status | Base | required | US Core Narrative Status | 📦8.0.1 | This IG
CarePlan.status | Base | required | RequestStatus | 📦4.0.1 | FHIR Std.
CarePlan.intent | Base | required | Care Plan Intent | 📦4.0.1 | FHIR Std.

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 Bindings | Purpose
AllLanguages | Max Binding
text | S | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile constrains the narrative content by fixing the status codes to generated and additional This profile does not constrain the narrative in regard to language specific sections This profile does not constrain the narrative in regard to traceability to data elements
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 | S C | 1..1 | xhtml | Limited xhtml content Constraints: txt-1, txt-2
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 | ?!S Σ | 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 Σ | 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 Σ | 1..* | CodeableConcept | Type of plan Slice: Unordered, Open by value:$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 | S Σ | 0..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 | S Σ | 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(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: 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 Constraints: cpl-3
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(4.0.1) | How to consume/day?
quantity |  | 0..1 | SimpleQuantity(4.0.1) | How much to administer/supply/consume
description |  | 0..1 | string | Extra info describing activity to perform
note |  | 0..* | Annotation | Comments about the plan
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
CarePlan.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
CarePlan.text.status | Base | required | US Core Narrative Status | 📦8.0.1 | This IG
CarePlan.status | Base | required | RequestStatus | 📦4.0.1 | FHIR Std.
CarePlan.intent | Base | required | Care Plan Intent | 📦4.0.1 | FHIR Std.
CarePlan.category | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std.
CarePlan.category:AssessPlan | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std.
CarePlan.activity.outcomeCodeableConcept | Base | example | Care Plan Activity Outcome | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​kind | Base | required | Care Plan Activity Kind | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​code | Base | example | Procedure Codes (SNOMED CT) | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​reasonCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​status | Base | required | CarePlanActivityStatus | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​product[x] | Base | example | SNOMED CT Medication Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cpl-3 | error | CarePlan.activity | Provide a reference or detail, not both | `detail.empty() or reference.empty()`
dom-2 | error | CarePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | CarePlan | 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 | `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()`
dom-4 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | CarePlan | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
txt-1 | error | CarePlan.text.div | 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 | `htmlChecks()`
txt-2 | error | CarePlan.text.div | The narrative SHALL have some non-whitespace content | `htmlChecks()`

This structure is derived from CarePlan

Summary

Mandatory: 1 element
Must-Support: 8 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

Slices

This structure defines the following Slices:

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

Maturity: 3

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 This profile constrains the narrative content by fixing the status codes to generated and additional This profile does not constrain the narrative in regard to language specific sections This profile does not constrain the narrative in regard to traceability to data elements
status | S | 1..1 | code | generated | additional Binding: US Core Narrative Status (required): Constrained value set of narrative statuses.
div | S C | 1..1 | xhtml | Limited xhtml content Constraints: txt-1, txt-2
modifierExtension | ?! | 0..* | Extension | Extensions that cannot be ignored
status | ?!S Σ | 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 Σ | 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 Σ | 1..* | CodeableConcept | Type of plan Slice: Unordered, Open by value:$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 | S Σ | 0..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
subject | S Σ | 1..1 | Reference(US Core Patient Profile S | Group) | Who the care plan is for
contributor |  | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
CarePlan.text.status | Base | required | US Core Narrative Status | 📦8.0.1 | This IG
CarePlan.status | Base | required | RequestStatus | 📦4.0.1 | FHIR Std.
CarePlan.intent | Base | required | Care Plan Intent | 📦4.0.1 | FHIR Std.
CarePlan.category | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std.
CarePlan.category:AssessPlan | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
dom-2 | error | CarePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | CarePlan | 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 | `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()`
dom-4 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | CarePlan | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
txt-1 | error | CarePlan.text.div | 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 | `htmlChecks()`
txt-2 | error | CarePlan.text.div | The narrative SHALL have some non-whitespace content | `htmlChecks()`

Differential View

This structure is derived from CarePlan

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 value:$this
category:AssessPlan | S | 0..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
contributor |  | 0..* | Reference(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: Who provided the content of the care plan
Documentation for this format

#### Terminology Bindings (Differential)

Path | Status | Usage | ValueSet | Version | Source
CarePlan.text.status | Base | required | US Core Narrative Status | 📦8.0.1 | This IG
CarePlan.status | Base | required | RequestStatus | 📦4.0.1 | FHIR Std.
CarePlan.intent | Base | required | Care Plan Intent | 📦4.0.1 | FHIR Std.

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 Bindings | Purpose
AllLanguages | Max Binding
text | S | 0..1 | Narrative | Text summary of the resource, for human interpretation This profile constrains the narrative content by fixing the status codes to generated and additional This profile does not constrain the narrative in regard to language specific sections This profile does not constrain the narrative in regard to traceability to data elements
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 | S C | 1..1 | xhtml | Limited xhtml content Constraints: txt-1, txt-2
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 | ?!S Σ | 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 Σ | 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 Σ | 1..* | CodeableConcept | Type of plan Slice: Unordered, Open by value:$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 | S Σ | 0..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 | S Σ | 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(US Core Practitioner Profile | US Core Organization Profile | US Core Patient Profile | PractitionerRole | US Core CareTeam Profile | US Core RelatedPerson Profile | Device) | 𝗔𝗗𝗗𝗜𝗧𝗜𝗢𝗡𝗔𝗟 𝗨𝗦𝗖𝗗𝗜: 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 Constraints: cpl-3
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(4.0.1) | How to consume/day?
quantity |  | 0..1 | SimpleQuantity(4.0.1) | How much to administer/supply/consume
description |  | 0..1 | string | Extra info describing activity to perform
note |  | 0..* | Annotation | Comments about the plan
Documentation for this format

#### Terminology Bindings

Path | Status | Usage | ValueSet | Version | Source
CarePlan.language | Base | preferred | Common Languages | 📍4.0.1 | FHIR Std.
CarePlan.text.status | Base | required | US Core Narrative Status | 📦8.0.1 | This IG
CarePlan.status | Base | required | RequestStatus | 📦4.0.1 | FHIR Std.
CarePlan.intent | Base | required | Care Plan Intent | 📦4.0.1 | FHIR Std.
CarePlan.category | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std.
CarePlan.category:AssessPlan | Base | example | Care Plan Category | 📍4.0.1 | FHIR Std.
CarePlan.activity.outcomeCodeableConcept | Base | example | Care Plan Activity Outcome | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​kind | Base | required | Care Plan Activity Kind | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​code | Base | example | Procedure Codes (SNOMED CT) | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​reasonCode | Base | example | SNOMED CT Clinical Findings | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​status | Base | required | CarePlanActivityStatus | 📍4.0.1 | FHIR Std.
CarePlan.activity.detail.​product[x] | Base | example | SNOMED CT Medication Codes | 📍4.0.1 | FHIR Std.

#### Constraints

Id | Grade | Path(s) | Description | Expression
cpl-3 | error | CarePlan.activity | Provide a reference or detail, not both | `detail.empty() or reference.empty()`
dom-2 | error | CarePlan | If the resource is contained in another resource, it SHALL NOT contain nested Resources | `contained.contained.empty()`
dom-3 | error | CarePlan | 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 | `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()`
dom-4 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated | `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()`
dom-5 | error | CarePlan | If a resource is contained in another resource, it SHALL NOT have a security label | `contained.meta.security.empty()`
dom-6 | best practice | CarePlan | A resource should have narrative for robust management | `text.`div`.exists()`
ele-1 | error | **ALL** elements | All FHIR elements must have a @value or children | `hasValue() or (children().count() > id.count())`
ext-1 | error | **ALL** extensions | Must have either extensions or value[x], not both | `extension.exists() != value.exists()`
txt-1 | error | CarePlan.text.div | 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 | `htmlChecks()`
txt-2 | error | CarePlan.text.div | The narrative SHALL have some non-whitespace content | `htmlChecks()`

This structure is derived from CarePlan

Summary

Mandatory: 1 element
Must-Support: 8 elements

Structures

This structure refers to these other structures:

- US Core Patient Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-patient)
- US Core Practitioner Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner)
- US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
- US Core CareTeam Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careteam)
- US Core RelatedPerson Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-relatedperson)

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:

- resource level scopes: `<patient|user|system>/CarePlan.rs`

#### 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)