Defines the logic and rules around determining: whether or not a condition is reportable to public health, which jurisdiction(s) is/are responsible, which jurisdiction(s) need to be notified, and if the condition is reportable, gives timing information, next steps and condition information to the clinician.

Defines variables for the PlanDefinition.

• value @ url

• value @ id

The set of actions that can be used to create plan definition

Defines extensions for the action.

• value @ url

The duration quantity may include a comparator, indicating how the offset should be applied. For example, <= 1 hour, meaning that the offset should be no more than 1 hour. This allows systems flexibility in scheduling the actions to isolate reporting activities to off hours.

Defines the "start" action

Description of the "start" action.

Text equivalent of the "start" action.

The US-PH-PlanDefinition-Action code for the "start" action.

When the "start" action should be triggered.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

Indicates the types of named events to subscribe to from the EHR.

The name of the event, encounter-start in this case. For any action invoked as a result of this trigger, the triggering encounter is accessible via the context variable %encounter

Defines the "check-suspected-disorder" action

Description of the check for suspected disorders action.

The US-PH-PlanDefinition-Action code for the "check-suspected-disorder" action.

• value @ id

Defines input data requirements for the action. Required data is accessible via a context variable named %[id] using the id of the input data requirement

The id of the input requirement, allowing the data to be referenced via a context variable named %[id]

Defines the checking of the encounter for reportability.

Description of the Periodic Update of eICR action within the eICR action.

• value @ id

Defines input data requirements for the action. Required data is accessible via a context variable named %[id] using the id of the input data requirement

The id of the input requirement, allowing the data to be referenced via a context variable named %[id]

Defines the "create-eicr" action

Defines the "validate-eicr" action

Defines the routing and sending of the eICR.

Description of the route and send action.

Defines the "encounter-modified" action

Description of the "encounter-modified" action.

Text equivalent of the "encounter-modified" action.

The US-PH-PlanDefinition-Action code for the "encounter-modified" action.

When the "encounter-modified" action should be triggered.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

Indicates the types of named events to subscribe to from the EHR.

The name of the event, encounter-start in this case. For any action invoked as a result of this trigger, the triggering encounter is accessible via the context variable %encounter

Defines the logic and rules around determining: whether or not a condition is reportable to public health, which jurisdiction(s) is/are responsible, which jurisdiction(s) need to be notified, and if the condition is reportable, gives timing information, next steps and condition information to the clinician.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.

Defines variables for the PlanDefinition.

• value @ url

Indicates the address where the report has to be sent.

Variable specifying a logic to generate a variable for use in subsequent logic. The name of the variable will be added to FHIRPath's context when processing descendants of the element that contains this extension.

Ordering of variable extension declarations is significant as variables declared in one repetition of this extension might be used in subsequent extension repetitions.

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

An absolute URI that is used to identify this plan definition when it is referenced in a specification, model, design or an instance; also called its canonical identifier. This SHOULD be globally unique and SHOULD be a literal address at which at which an authoritative instance of this plan definition is (or will be) published. This URL can be the target of a canonical reference. It SHALL remain the same when the plan definition is stored on different servers.

Can be a urn:uuid: or a urn:oid: but real http: addresses are preferred. Multiple instances may share the same URL if they have a distinct version.

The determination of when to create a new version of a resource (same url, new version) vs. defining a new artifact is up to the author. Considerations for making this decision are found in Technical and Business Versions.

In some cases, the resource can no longer be found at the stated url, but the url itself cannot change. Implementations can use the meta.source element to indicate where the current master source of the resource can be found.

Allows the plan definition to be referenced by a single globally unique identifier.

A formal identifier that is used to identify this plan definition when it is represented in other formats, or referenced in a specification, model, design or an instance.

Typically, this is used for identifiers that can go in an HL7 V3 II (instance identifier) data type, and can then identify this plan definition outside of FHIR, where it is not possible to use the logical URI.

Allows externally provided and/or usable business identifiers to be easily associated with the module.

Business version of the PlanDefinition

There may be different plan definition instances that have the same identifier but different versions. The version can be appended to the url in a reference to allow a reference to a particular business version of the plan definition with the format [url]|[version].

Name for this PlanDefinition (computer friendly)

The name is not expected to be globally unique. The name should be a simple alphanumeric type name to ensure that it is machine-processing friendly.

Support human navigation and code generation.

Title for this PlanDefinition

This name does not need to be machine-processing friendly and may contain punctuation, white-space, etc.

Type of this PlanDefinition

The type of PlanDefinition.

The status of this plan definition. Enables tracking the life-cycle of the content.

Allows filtering of plan definitions that are appropriate for use versus not.

The lifecycle status of an artifact.

A Boolean value to indicate that this plan definition is authored for testing purposes (or education/evaluation/marketing) and is not intended to be used for genuine usage.

Allows filtering of plan definitions that are appropriate for use versus not.

Enables experimental content to be developed following the same lifecycle that would be used for a production-level plan definition.

A code or group definition that describes the intended subject of the plan definition.

The possible types of subjects for a plan definition (E.g. Patient, Practitioner, Organization, Location, etc.).

Date the PlanDefinition was last changed

Note that this is not the same as the resource last-modified-date, since the resource may be a secondary representation of the plan definition. Additional specific dates may be added as extensions or be found by consulting Provenances associated with past versions of the resource.

Name of the agency that published this PlanDefinition

Usually an organization but may be an individual. The publisher (or steward) of the plan definition is the organization or individual primarily responsible for the maintenance and upkeep of the plan definition. This is not necessarily the same individual or organization that developed and initially authored the content. The publisher is the primary point of contact for questions or issues with the plan definition. This item SHOULD be populated unless the information is available from context.

Helps establish the "authority/credibility" of the plan definition. May also allow for contact.

Contact details to assist a user in finding and communicating with the publisher.

May be a web site, an email address, a telephone number, etc.

A free text natural language description of the plan definition from a consumer's perspective.

This description can be used to capture details such as why the plan definition was built, comments about misuse, instructions for clinical use and interpretation, literature references, examples from the paper world, etc. It is not a rendering of the plan definition as conveyed in the 'text' field of the resource itself. This item SHOULD be populated unless the information is available from context (e.g. the language of the plan definition is presumed to be the predominant language in the place the plan definition was created).

The content was developed with a focus and intent of supporting the contexts that are listed. These contexts may be general categories (gender, age, ...) or may be references to specific programs (insurance plans, studies, ...) and may be used to assist with indexing and searching for appropriate plan definition instances.

When multiple useContexts are specified, there is no expectation that all or any of the contexts apply.

Assist in searching for appropriate content.

A legal or geographic region in which the plan definition is intended to be used.

It may be possible for the plan definition to be used in jurisdictions other than those for which it was originally designed or intended.

Countries and regions within which this artifact is targeted for use.

The period during which the PlanDefinition is valid

The effective period for a plan definition determines when the content is applicable for usage and is independent of publication and review dates. For example, a measure intended to be used for the year 2016 might be published in 2015.

Allows establishing a transition before a resource comes into effect and also allows for a sunsetting process when new versions of the plan definition are or are expected to be used instead.

The start of the time period when this PlanDefinition goes into effect

If the low element is missing, the meaning is that the low boundary is not known.

A reference to a Library resource containing any formal logic used by the plan definition.

An action or group of actions to be taken as part of the plan.

Note that there is overlap between many of the elements defined here and the ActivityDefinition resource. When an ActivityDefinition is referenced (using the definition element), the overlapping elements in the plan override the content of the referenced ActivityDefinition unless otherwise documented in the specific elements. See the PlanDefinition resource for more detailed information.

• value @ id

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

A brief description of the action used to provide a summary to display to the user.

A code that provides meaning for the action or action group. For example, a section may have a LOINC code for the section of a documentation template.

The set of actions that can be used to create plan definition

A description of when the action should be triggered.

Indicates the types of named events to subscribe to from the EHR.

The type of triggering event.

The type of trigger.

An expression that describes applicability criteria or start/stop conditions for the action.

When multiple conditions of the same kind are present, the effects are combined using AND semantics, so the overall condition is true only if all the conditions are true.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The kind of condition.

Applicability criteria are used to determine immediate applicability when a plan definition is applied to a given context. Start and stop criteria are carried through application and used to describe enter/exit criteria for an action.

Defines the kinds of conditions that can appear on actions.

An expression that returns true or false, indicating whether the condition is satisfied.

The expression may be inlined or may be a reference to a named expression within a logic library referenced by the library element.

Defines input data requirements for the action.

Defines extensions for the action.

• value @ url

Points to an existing input or output element that provides data to this input or results as output for the action.

What FHIR query pattern?

Source of the definition for the extension code - a logical name or a URL.

The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension.

The type of the required data, specified as the type name of a resource. For profiles, this value is set to the type of the base resource of the profile.

A list of all the concrete types defined in this version of the FHIR specification - Abstract Types, Data Types and Resource Types.

Defines the outputs of the action, if any.

The type of the required data, specified as the type name of a resource. For profiles, this value is set to the type of the base resource of the profile.

A list of all the concrete types defined in this version of the FHIR specification - Abstract Types, Data Types and Resource Types.

A relationship to another action such as "before" or "30-60 minutes after start of".

When an action depends on multiple actions, the meaning is that all actions are dependencies, rather than that any of the actions are a dependency.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The element id of the related action.

The relationship of this action to the related action.

Defines the types of relationships between actions.

A duration or range of durations to apply to the relationship. For example, 30-60 minutes before.

• type @ $this

The duration quantity may include a comparator, indicating how the offset should be applied. For example, <= 1 hour, meaning that the offset should be no more than 1 hour. This allows systems flexibility in scheduling the actions to isolate reporting activities to off hours.

An optional value describing when the action should be performed.

Defines the "start" action

Note that there is overlap between many of the elements defined here and the ActivityDefinition resource. When an ActivityDefinition is referenced (using the definition element), the overlapping elements in the plan override the content of the referenced ActivityDefinition unless otherwise documented in the specific elements. See the PlanDefinition resource for more detailed information.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Description of the "start" action.

Text equivalent of the "start" action.

The US-PH-PlanDefinition-Action code for the "start" action.

The set of actions that can be used to create plan definition

When the "start" action should be triggered.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

Indicates the types of named events to subscribe to from the EHR.

The type of triggering event.

The type of trigger.

The name of the event, encounter-start in this case. For any action invoked as a result of this trigger, the triggering encounter is accessible via the context variable %encounter

An event name can be provided for all event types, but is required for named events. If a name is provided for a type other than named events, it is considered to be a shorthand for the semantics described by the formal description of the event.

An expression that describes applicability criteria or start/stop conditions for the action.

When multiple conditions of the same kind are present, the effects are combined using AND semantics, so the overall condition is true only if all the conditions are true.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The kind of condition.

Applicability criteria are used to determine immediate applicability when a plan definition is applied to a given context. Start and stop criteria are carried through application and used to describe enter/exit criteria for an action.

Defines the kinds of conditions that can appear on actions.

An expression that returns true or false, indicating whether the condition is satisfied.

The expression may be inlined or may be a reference to a named expression within a logic library referenced by the library element.

Defines input data requirements for the action.

Points to an existing input or output element that provides data to this input or results as output for the action.

The type of the required data, specified as the type name of a resource. For profiles, this value is set to the type of the base resource of the profile.

A list of all the concrete types defined in this version of the FHIR specification - Abstract Types, Data Types and Resource Types.

Defines the outputs of the action, if any.

The type of the required data, specified as the type name of a resource. For profiles, this value is set to the type of the base resource of the profile.

A list of all the concrete types defined in this version of the FHIR specification - Abstract Types, Data Types and Resource Types.

A relationship to another action such as "before" or "30-60 minutes after start of".

When an action depends on multiple actions, the meaning is that all actions are dependencies, rather than that any of the actions are a dependency.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The element id of the related action.

The relationship of this action to the related action.

Defines the types of relationships between actions.

A duration or range of durations to apply to the relationship. For example, 30-60 minutes before.

• type @ $this

A duration or range of durations to apply to the relationship. For example, 30-60 minutes before.

An optional value describing when the action should be performed.

Defines the "check-suspected-disorder" action

Note that there is overlap between many of the elements defined here and the ActivityDefinition resource. When an ActivityDefinition is referenced (using the definition element), the overlapping elements in the plan override the content of the referenced ActivityDefinition unless otherwise documented in the specific elements. See the PlanDefinition resource for more detailed information.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Description of the check for suspected disorders action.

The US-PH-PlanDefinition-Action code for the "check-suspected-disorder" action.

The set of actions that can be used to create plan definition

A description of when the action should be triggered.

Indicates the types of named events to subscribe to from the EHR.

The type of triggering event.

The type of trigger.

An expression that describes applicability criteria or start/stop conditions for the action.

When multiple conditions of the same kind are present, the effects are combined using AND semantics, so the overall condition is true only if all the conditions are true.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The kind of condition.

Applicability criteria are used to determine immediate applicability when a plan definition is applied to a given context. Start and stop criteria are carried through application and used to describe enter/exit criteria for an action.

Defines the kinds of conditions that can appear on actions.

An expression that returns true or false, indicating whether the condition is satisfied.

The expression may be inlined or may be a reference to a named expression within a logic library referenced by the library element.

Defines input data requirements for the action.

Points to an existing input or output element that provides data to this input or results as output for the action.

The type of the required data, specified as the type name of a resource. For profiles, this value is set to the type of the base resource of the profile.

A list of all the concrete types defined in this version of the FHIR specification - Abstract Types, Data Types and Resource Types.

Defines the outputs of the action, if any.

The type of the required data, specified as the type name of a resource. For profiles, this value is set to the type of the base resource of the profile.

A list of all the concrete types defined in this version of the FHIR specification - Abstract Types, Data Types and Resource Types.

A relationship to another action such as "before" or "30-60 minutes after start of".

When an action depends on multiple actions, the meaning is that all actions are dependencies, rather than that any of the actions are a dependency.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.