C-CDA on FHIR, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ccda-on-fhir/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• XML
• JSON
• TTL

Resource Profile: Care Plan Document

CARE PLAN FRAMEWORK: A Care Plan (including Home Health Plan of Care (HHPoC)) is a consensus-driven dynamic plan that represents a patient and Care Team Members prioritized concerns, goals, and planned interventions. It serves as a blueprint shared by all Care Team Members (including the patient, their caregivers and providers), to guide the patients care. A Care Plan integrates multiple interventions proposed by multiple providers and disciplines for multiple conditions.

A Care Plan represents one or more Plan(s) of Care and serves to reconcile and resolve conflicts between the various Plans of Care developed for a specific patient by different providers. While both a plan of care and a care plan include the patient's life goals and require Care Team Members (including patients) to prioritize goals and interventions, the reconciliation process becomes more complex as the number of plans of care increases. The Care Plan also serves to enable longitudinal coordination of care.

The Care Plan represents an instance of this dynamic Care Plan at a point in time. The composition itself is NOT dynamic.

Key differentiators between a Care Plan profile and CCD profile (another snapshot in time document):

• Requires relationships between various concepts:

   *  Health Concerns
  
   *  Interventions
  
   *  Goals
  
   *  Outcomes
  

• Provides the ability to identify patient and provider priorities with each act

• Provides a header participant to indicate occurrences of Care Plan review

Usage:

• Examples for this Resource Profile: Composition/Care-Plan-Example

Formal Views of Profile Content

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

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

This structure is derived from USRealmHeader

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	USRealmHeader	A set of resources composed into a single coherent clinical statement with clinical attestation
type	S	1..1	CodeableConcept	Care Plan Document Binding: Care Plan Document Type (required)
event	S	0..1	BackboneElement	The clinical service(s) being documented
period	S	1..1	Period	The period covered by the documentation
Slices for detail	S	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:reference
detail:care_plan		0..*	Reference(US Core CarePlan Profile)	Care Plan Detail
Slices for section		0..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by value:code
section:health_concerns_section	S	1..1	BackboneElement	Health Concerns Section
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Health concerns section code 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75310-3
text	S	1..1	Narrative	text
Slices for entry		0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:health_concerns_entry	S	0..*	Reference(US Core AllergyIntolerance Profile | US Core Condition Profile | US Core Laboratory Result Observation Profile | US Core Smoking Status Observation Profile | Vital Signs Profile | ClinicalImpression | Observation | RiskAssessment | List | DocumentReference)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
section:goals_section	S	1..1	BackboneElement	Goals Section
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Goals 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61146-7
text	S	1..1	Narrative	text
Slices for entry		0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:goals_entry	S	0..*	Reference(US Core Goal Profile)	entry
section:interventions_section	S	0..1	BackboneElement	Interventions Section
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Interventions provided 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 62387-6
text	S	1..1	Narrative	text
Slices for entry		0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:interventions_section	S	0..*	Reference(List | RequestGroup | MedicationDispense | Communication | ServiceRequest | US Core Procedure Profile | MedicationStatement | US Core Medication Profile | US Core MedicationRequest Profile)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
section:eval_outcomes_section	S	0..1	BackboneElement	Health Status Evaluations and Outcomes Section
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Patient problem outcome 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11383-7
text	S	1..1	Narrative	text
Slices for entry		0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:eval_outcomes_entry	S	0..*	Reference(Observation)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Composition.type	required	CarePlanDocumentType http://hl7.org/fhir/us/ccda/ValueSet/2.16.840.1.113762.1.4.1099.10 from this IG

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	USRealmHeader	A set of resources composed into a single coherent clinical statement with clinical attestation dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language	S	1..1	code	language Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
version_number_extension	S	0..1	integer	Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/VersionNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
data_enterer_extension	S	0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/DataEntererExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
informant_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	informant URL: http://hl7.org/fhir/us/ccda/StructureDefinition/InformantExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
information_recipient_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile)	informationRecipient URL: http://hl7.org/fhir/us/ccda/StructureDefinition/InformationRecipientExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
participant_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	participant URL: http://hl7.org/fhir/us/ccda/StructureDefinition/ParticipantExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
performer_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	performer URL: http://hl7.org/fhir/us/ccda/StructureDefinition/PerformerExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
authorization_extension	S	0..*	Reference(Consent)	authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/AuthorizationExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
order_extension	S	0..*	Reference(ServiceRequest)	authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/OrderExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	1..1	Identifier	identifier ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Care Plan Document Binding: Care Plan Document Type (required) ele-1: All FHIR elements must have a @value or children
subject	SΣ	0..1	Reference(US Core Patient Profile | Group)	Who and/or what the composition is about ele-1: All FHIR elements must have a @value or children
encounter	SΣ	0..1	Reference(US Core Encounter Profile)	Context of the Composition ele-1: All FHIR elements must have a @value or children
date	SΣ	1..1	dateTime	date ele-1: All FHIR elements must have a @value or children
author	SΣ	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition ele-1: All FHIR elements must have a @value or children
title	SΣ	1..1	string	Document Title ele-1: All FHIR elements must have a @value or children
Slices for attester		0..*	BackboneElement	Attests to accuracy of composition Slice: Unordered, Open by value:mode ele-1: All FHIR elements must have a @value or children
attester:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children
attester:legal_attester	S	0..1	BackboneElement	attester ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children Fixed Value: legal
party	S	1..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	party ele-1: All FHIR elements must have a @value or children
attester:professional_attester	S	0..*	BackboneElement	attester ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children Fixed Value: professional
party	S	1..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	party ele-1: All FHIR elements must have a @value or children
attester:personal_attester	S	0..*	BackboneElement	attester ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children Fixed Value: personal
party	S	1..1	Reference(US Core Patient Profile | RelatedPerson)	party ele-1: All FHIR elements must have a @value or children
custodian	SΣ	1..1	Reference(US Core Organization Profile)	custodian ele-1: All FHIR elements must have a @value or children
event	SΣ	0..1	BackboneElement	The clinical service(s) being documented ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
period	SΣ	1..1	Period	The period covered by the documentation ele-1: All FHIR elements must have a @value or children
Slices for detail	SΣ	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
detail:care_plan	Σ	0..*	Reference(US Core CarePlan Profile)	Care Plan Detail ele-1: All FHIR elements must have a @value or children
Slices for section	C	0..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by value:code cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
section:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
section:health_concerns_section	SC	1..1	BackboneElement	Health Concerns Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
title	S	1..1	string	title ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Health concerns section code Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. ele-1: All FHIR elements must have a @value or children 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75310-3
text	SC	1..1	Narrative	text ele-1: All FHIR elements must have a @value or children
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
entry:health_concerns_entry	SC	0..*	Reference(US Core AllergyIntolerance Profile | US Core Condition Profile | US Core Laboratory Result Observation Profile | US Core Smoking Status Observation Profile | Vital Signs Profile | ClinicalImpression | Observation | RiskAssessment | List | DocumentReference)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc. ele-1: All FHIR elements must have a @value or children
section:goals_section	SC	1..1	BackboneElement	Goals Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
title	S	1..1	string	title ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Goals Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. ele-1: All FHIR elements must have a @value or children 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61146-7
text	SC	1..1	Narrative	text ele-1: All FHIR elements must have a @value or children
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
entry:goals_entry	SC	0..*	Reference(US Core Goal Profile)	entry ele-1: All FHIR elements must have a @value or children
section:interventions_section	SC	0..1	BackboneElement	Interventions Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
title	S	1..1	string	title ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Interventions provided Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. ele-1: All FHIR elements must have a @value or children 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 62387-6
text	SC	1..1	Narrative	text ele-1: All FHIR elements must have a @value or children
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
entry:interventions_section	SC	0..*	Reference(List | RequestGroup | MedicationDispense | Communication | ServiceRequest | US Core Procedure Profile | MedicationStatement | US Core Medication Profile | US Core MedicationRequest Profile)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc. ele-1: All FHIR elements must have a @value or children
section:eval_outcomes_section	SC	0..1	BackboneElement	Health Status Evaluations and Outcomes Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
title	S	1..1	string	title ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Patient problem outcome Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. ele-1: All FHIR elements must have a @value or children 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11383-7
text	SC	1..1	Narrative	text ele-1: All FHIR elements must have a @value or children
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
entry:eval_outcomes_entry	SC	0..*	Reference(Observation)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc. ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
Composition.type	required	CarePlanDocumentType http://hl7.org/fhir/us/ccda/ValueSet/2.16.840.1.113762.1.4.1099.10 from this IG
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:legal_attester.mode	required	Fixed Value: legal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:professional_attester.mode	required	Fixed Value: professional http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:personal_attester.mode	required	Fixed Value: personal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.section:health_concerns_section.code	example	Pattern: LOINC Code 75310-3 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:goals_section.code	example	Pattern: LOINC Code 61146-7 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:interventions_section.code	example	Pattern: LOINC Code 62387-6 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:eval_outcomes_section.code	example	Pattern: LOINC Code 11383-7 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section, Composition.section:health_concerns_section, Composition.section:goals_section, Composition.section:interventions_section, Composition.section:eval_outcomes_section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:health_concerns_section, Composition.section:goals_section, Composition.section:interventions_section, Composition.section:eval_outcomes_section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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	Composition	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	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	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()

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	USRealmHeader	A set of resources composed into a single coherent clinical statement with clinical attestation
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	S	1..1	code	language Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
version_number_extension	S	0..1	integer	Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/VersionNumber
data_enterer_extension	S	0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/DataEntererExtension
informant_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	informant URL: http://hl7.org/fhir/us/ccda/StructureDefinition/InformantExtension
information_recipient_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile)	informationRecipient URL: http://hl7.org/fhir/us/ccda/StructureDefinition/InformationRecipientExtension
participant_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	participant URL: http://hl7.org/fhir/us/ccda/StructureDefinition/ParticipantExtension
performer_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	performer URL: http://hl7.org/fhir/us/ccda/StructureDefinition/PerformerExtension
authorization_extension	S	0..*	Reference(Consent)	authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/AuthorizationExtension
order_extension	S	0..*	Reference(ServiceRequest)	authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/OrderExtension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	identifier
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	SΣ	1..1	CodeableConcept	Care Plan Document Binding: Care Plan Document Type (required)
category	Σ	0..*	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(US Core Patient Profile | Group)	Who and/or what the composition is about
encounter	SΣ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	date
author	SΣ	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition
title	SΣ	1..1	string	Document Title
Slices for attester		0..*	BackboneElement	Attests to accuracy of composition Slice: Unordered, Open by value:mode
attester:All Slices				Content/Rules for all slices
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
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the composition
attester:legal_attester	S	0..1	BackboneElement	attester
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
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Fixed Value: legal
time		0..1	dateTime	When the composition was attested
party	S	1..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	party
attester:professional_attester	S	0..*	BackboneElement	attester
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
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Fixed Value: professional
time		0..1	dateTime	When the composition was attested
party	S	1..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	party
attester:personal_attester	S	0..*	BackboneElement	attester
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
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Fixed Value: personal
time		0..1	dateTime	When the composition was attested
party	S	1..1	Reference(US Core Patient Profile | RelatedPerson)	party
custodian	SΣ	1..1	Reference(US Core Organization Profile)	custodian
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
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
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	SΣ	0..1	BackboneElement	The clinical service(s) being documented
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
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	1..1	Period	The period covered by the documentation
Slices for detail	SΣ	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:reference
detail:care_plan	Σ	0..*	Reference(US Core CarePlan Profile)	Care Plan Detail
Slices for section	C	0..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by value:code cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
section:All Slices				Content/Rules for all slices
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
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:health_concerns_section	SC	1..1	BackboneElement	Health Concerns Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
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
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Health concerns section code Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. 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://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75310-3
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
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	text
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:health_concerns_entry	SC	0..*	Reference(US Core AllergyIntolerance Profile | US Core Condition Profile | US Core Laboratory Result Observation Profile | US Core Smoking Status Observation Profile | Vital Signs Profile | ClinicalImpression | Observation | RiskAssessment | List | DocumentReference)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:goals_section	SC	1..1	BackboneElement	Goals Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
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
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Goals Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. 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://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61146-7
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
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	text
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:goals_entry	SC	0..*	Reference(US Core Goal Profile)	entry
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:interventions_section	SC	0..1	BackboneElement	Interventions Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
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
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Interventions provided Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. 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://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 62387-6
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
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	text
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:interventions_section	SC	0..*	Reference(List | RequestGroup | MedicationDispense | Communication | ServiceRequest | US Core Procedure Profile | MedicationStatement | US Core Medication Profile | US Core MedicationRequest Profile)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:eval_outcomes_section	SC	0..1	BackboneElement	Health Status Evaluations and Outcomes Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
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
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Patient problem outcome Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. 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://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11383-7
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
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	text
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:eval_outcomes_entry	SC	0..*	Reference(Observation)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
Composition.type	required	CarePlanDocumentType http://hl7.org/fhir/us/ccda/ValueSet/2.16.840.1.113762.1.4.1099.10 from this IG
Composition.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:legal_attester.mode	required	Fixed Value: legal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:professional_attester.mode	required	Fixed Value: professional http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:personal_attester.mode	required	Fixed Value: personal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
Composition.event.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Composition.section.code	example	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard
Composition.section:health_concerns_section.code	example	Pattern: LOINC Code 75310-3 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:health_concerns_section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section:health_concerns_section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section:health_concerns_section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard
Composition.section:goals_section.code	example	Pattern: LOINC Code 61146-7 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:goals_section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section:goals_section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section:goals_section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard
Composition.section:interventions_section.code	example	Pattern: LOINC Code 62387-6 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:interventions_section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section:interventions_section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section:interventions_section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard
Composition.section:eval_outcomes_section.code	example	Pattern: LOINC Code 11383-7 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:eval_outcomes_section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section:eval_outcomes_section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section:eval_outcomes_section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section, Composition.section:health_concerns_section, Composition.section:goals_section, Composition.section:interventions_section, Composition.section:eval_outcomes_section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:health_concerns_section, Composition.section:goals_section, Composition.section:interventions_section, Composition.section:eval_outcomes_section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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	Composition	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	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	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()

This structure is derived from USRealmHeader

Summary

Mandatory: 8 elements(7 nested mandatory elements)
Must-Support: 24 elements

Structures

This structure refers to these other structures:

• US Core CarePlan Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan)
• US Core AllergyIntolerance Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance)
• US Core Condition Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition)
• US Core Laboratory Result Observation Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab)
• US Core Smoking Status Observation Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus)
• Vital Signs Profile (http://hl7.org/fhir/StructureDefinition/vitalsigns)
• US Core Goal Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal)
• US Core Procedure Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure)
• US Core Medication Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication)
• US Core MedicationRequest Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Composition.event.detail
• The element 1 is sliced based on the value of Composition.section
• The element 1 is sliced based on the value of Composition.section.entry

Differential View

This structure is derived from USRealmHeader

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	USRealmHeader	A set of resources composed into a single coherent clinical statement with clinical attestation
type	S	1..1	CodeableConcept	Care Plan Document Binding: Care Plan Document Type (required)
event	S	0..1	BackboneElement	The clinical service(s) being documented
period	S	1..1	Period	The period covered by the documentation
Slices for detail	S	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:reference
detail:care_plan		0..*	Reference(US Core CarePlan Profile)	Care Plan Detail
Slices for section		0..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by value:code
section:health_concerns_section	S	1..1	BackboneElement	Health Concerns Section
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Health concerns section code 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75310-3
text	S	1..1	Narrative	text
Slices for entry		0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:health_concerns_entry	S	0..*	Reference(US Core AllergyIntolerance Profile | US Core Condition Profile | US Core Laboratory Result Observation Profile | US Core Smoking Status Observation Profile | Vital Signs Profile | ClinicalImpression | Observation | RiskAssessment | List | DocumentReference)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
section:goals_section	S	1..1	BackboneElement	Goals Section
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Goals 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61146-7
text	S	1..1	Narrative	text
Slices for entry		0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:goals_entry	S	0..*	Reference(US Core Goal Profile)	entry
section:interventions_section	S	0..1	BackboneElement	Interventions Section
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Interventions provided 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 62387-6
text	S	1..1	Narrative	text
Slices for entry		0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:interventions_section	S	0..*	Reference(List | RequestGroup | MedicationDispense | Communication | ServiceRequest | US Core Procedure Profile | MedicationStatement | US Core Medication Profile | US Core MedicationRequest Profile)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
section:eval_outcomes_section	S	0..1	BackboneElement	Health Status Evaluations and Outcomes Section
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Patient problem outcome 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11383-7
text	S	1..1	Narrative	text
Slices for entry		0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:eval_outcomes_entry	S	0..*	Reference(Observation)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Composition.type	required	CarePlanDocumentType http://hl7.org/fhir/us/ccda/ValueSet/2.16.840.1.113762.1.4.1099.10 from this IG

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	USRealmHeader	A set of resources composed into a single coherent clinical statement with clinical attestation dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: 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 dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
language	S	1..1	code	language Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
version_number_extension	S	0..1	integer	Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/VersionNumber ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
data_enterer_extension	S	0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/DataEntererExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
informant_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	informant URL: http://hl7.org/fhir/us/ccda/StructureDefinition/InformantExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
information_recipient_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile)	informationRecipient URL: http://hl7.org/fhir/us/ccda/StructureDefinition/InformationRecipientExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
participant_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	participant URL: http://hl7.org/fhir/us/ccda/StructureDefinition/ParticipantExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
performer_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	performer URL: http://hl7.org/fhir/us/ccda/StructureDefinition/PerformerExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
authorization_extension	S	0..*	Reference(Consent)	authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/AuthorizationExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
order_extension	S	0..*	Reference(ServiceRequest)	authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/OrderExtension ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
identifier	SΣ	1..1	Identifier	identifier ele-1: All FHIR elements must have a @value or children
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition. ele-1: All FHIR elements must have a @value or children
type	SΣ	1..1	CodeableConcept	Care Plan Document Binding: Care Plan Document Type (required) ele-1: All FHIR elements must have a @value or children
subject	SΣ	0..1	Reference(US Core Patient Profile | Group)	Who and/or what the composition is about ele-1: All FHIR elements must have a @value or children
encounter	SΣ	0..1	Reference(US Core Encounter Profile)	Context of the Composition ele-1: All FHIR elements must have a @value or children
date	SΣ	1..1	dateTime	date ele-1: All FHIR elements must have a @value or children
author	SΣ	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition ele-1: All FHIR elements must have a @value or children
title	SΣ	1..1	string	Document Title ele-1: All FHIR elements must have a @value or children
Slices for attester		0..*	BackboneElement	Attests to accuracy of composition Slice: Unordered, Open by value:mode ele-1: All FHIR elements must have a @value or children
attester:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children
attester:legal_attester	S	0..1	BackboneElement	attester ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children Fixed Value: legal
party	S	1..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	party ele-1: All FHIR elements must have a @value or children
attester:professional_attester	S	0..*	BackboneElement	attester ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children Fixed Value: professional
party	S	1..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	party ele-1: All FHIR elements must have a @value or children
attester:personal_attester	S	0..*	BackboneElement	attester ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. ele-1: All FHIR elements must have a @value or children Fixed Value: personal
party	S	1..1	Reference(US Core Patient Profile | RelatedPerson)	party ele-1: All FHIR elements must have a @value or children
custodian	SΣ	1..1	Reference(US Core Organization Profile)	custodian ele-1: All FHIR elements must have a @value or children
event	SΣ	0..1	BackboneElement	The clinical service(s) being documented ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
period	SΣ	1..1	Period	The period covered by the documentation ele-1: All FHIR elements must have a @value or children
Slices for detail	SΣ	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
detail:care_plan	Σ	0..*	Reference(US Core CarePlan Profile)	Care Plan Detail ele-1: All FHIR elements must have a @value or children
Slices for section	C	0..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by value:code cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
section:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
section:health_concerns_section	SC	1..1	BackboneElement	Health Concerns Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
title	S	1..1	string	title ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Health concerns section code Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. ele-1: All FHIR elements must have a @value or children 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75310-3
text	SC	1..1	Narrative	text ele-1: All FHIR elements must have a @value or children
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
entry:health_concerns_entry	SC	0..*	Reference(US Core AllergyIntolerance Profile | US Core Condition Profile | US Core Laboratory Result Observation Profile | US Core Smoking Status Observation Profile | Vital Signs Profile | ClinicalImpression | Observation | RiskAssessment | List | DocumentReference)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc. ele-1: All FHIR elements must have a @value or children
section:goals_section	SC	1..1	BackboneElement	Goals Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
title	S	1..1	string	title ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Goals Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. ele-1: All FHIR elements must have a @value or children 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61146-7
text	SC	1..1	Narrative	text ele-1: All FHIR elements must have a @value or children
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
entry:goals_entry	SC	0..*	Reference(US Core Goal Profile)	entry ele-1: All FHIR elements must have a @value or children
section:interventions_section	SC	0..1	BackboneElement	Interventions Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
title	S	1..1	string	title ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Interventions provided Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. ele-1: All FHIR elements must have a @value or children 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 62387-6
text	SC	1..1	Narrative	text ele-1: All FHIR elements must have a @value or children
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
entry:interventions_section	SC	0..*	Reference(List | RequestGroup | MedicationDispense | Communication | ServiceRequest | US Core Procedure Profile | MedicationStatement | US Core Medication Profile | US Core MedicationRequest Profile)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc. ele-1: All FHIR elements must have a @value or children
section:eval_outcomes_section	SC	0..1	BackboneElement	Health Status Evaluations and Outcomes Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
title	S	1..1	string	title ele-1: All FHIR elements must have a @value or children
code	S	1..1	CodeableConcept	Patient problem outcome Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. ele-1: All FHIR elements must have a @value or children 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://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11383-7
text	SC	1..1	Narrative	text ele-1: All FHIR elements must have a @value or children
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference ele-1: All FHIR elements must have a @value or children
entry:eval_outcomes_entry	SC	0..*	Reference(Observation)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc. ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
Composition.type	required	CarePlanDocumentType http://hl7.org/fhir/us/ccda/ValueSet/2.16.840.1.113762.1.4.1099.10 from this IG
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:legal_attester.mode	required	Fixed Value: legal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:professional_attester.mode	required	Fixed Value: professional http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:personal_attester.mode	required	Fixed Value: personal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.section:health_concerns_section.code	example	Pattern: LOINC Code 75310-3 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:goals_section.code	example	Pattern: LOINC Code 61146-7 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:interventions_section.code	example	Pattern: LOINC Code 62387-6 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:eval_outcomes_section.code	example	Pattern: LOINC Code 11383-7 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section, Composition.section:health_concerns_section, Composition.section:goals_section, Composition.section:interventions_section, Composition.section:eval_outcomes_section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:health_concerns_section, Composition.section:goals_section, Composition.section:interventions_section, Composition.section:eval_outcomes_section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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	Composition	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	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	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()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Composition		0..*	USRealmHeader	A set of resources composed into a single coherent clinical statement with clinical attestation
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	S	1..1	code	language Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
version_number_extension	S	0..1	integer	Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/VersionNumber
data_enterer_extension	S	0..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/DataEntererExtension
informant_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	informant URL: http://hl7.org/fhir/us/ccda/StructureDefinition/InformantExtension
information_recipient_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile)	informationRecipient URL: http://hl7.org/fhir/us/ccda/StructureDefinition/InformationRecipientExtension
participant_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | US Core Patient Profile | RelatedPerson)	participant URL: http://hl7.org/fhir/us/ccda/StructureDefinition/ParticipantExtension
performer_extension	S	0..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	performer URL: http://hl7.org/fhir/us/ccda/StructureDefinition/PerformerExtension
authorization_extension	S	0..*	Reference(Consent)	authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/AuthorizationExtension
order_extension	S	0..*	Reference(ServiceRequest)	authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/OrderExtension
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	1..1	Identifier	identifier
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	SΣ	1..1	CodeableConcept	Care Plan Document Binding: Care Plan Document Type (required)
category	Σ	0..*	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
subject	SΣ	0..1	Reference(US Core Patient Profile | Group)	Who and/or what the composition is about
encounter	SΣ	0..1	Reference(US Core Encounter Profile)	Context of the Composition
date	SΣ	1..1	dateTime	date
author	SΣ	1..*	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile | PractitionerRole | US Core Patient Profile | Device | RelatedPerson)	Who and/or what authored the composition
title	SΣ	1..1	string	Document Title
Slices for attester		0..*	BackboneElement	Attests to accuracy of composition Slice: Unordered, Open by value:mode
attester:All Slices				Content/Rules for all slices
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
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
time		0..1	dateTime	When the composition was attested
party		0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole | Organization)	Who attested the composition
attester:legal_attester	S	0..1	BackboneElement	attester
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
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Fixed Value: legal
time		0..1	dateTime	When the composition was attested
party	S	1..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	party
attester:professional_attester	S	0..*	BackboneElement	attester
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
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Fixed Value: professional
time		0..1	dateTime	When the composition was attested
party	S	1..1	Reference(US Core Practitioner Profile | US Core PractitionerRole Profile)	party
attester:personal_attester	S	0..*	BackboneElement	attester
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
mode	S	1..1	code	mode Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Fixed Value: personal
time		0..1	dateTime	When the composition was attested
party	S	1..1	Reference(US Core Patient Profile | RelatedPerson)	party
custodian	SΣ	1..1	Reference(US Core Organization Profile)	custodian
relatesTo		0..*	BackboneElement	Relationships to other compositions/documents
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
code		1..1	code	replaces | transforms | signs | appends Binding: DocumentRelationshipType (required): The type of relationship between documents.
target[x]		1..1		Target of the relationship
targetIdentifier			Identifier
targetReference			Reference(Composition)
event	SΣ	0..1	BackboneElement	The clinical service(s) being documented
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
code	Σ	0..*	CodeableConcept	Code(s) that apply to the event being documented Binding: v3 Code System ActCode (example): This list of codes represents the main clinical acts being documented.
period	SΣ	1..1	Period	The period covered by the documentation
Slices for detail	SΣ	0..*	Reference(Resource)	The event(s) being documented Slice: Unordered, Open by profile:reference
detail:care_plan	Σ	0..*	Reference(US Core CarePlan Profile)	Care Plan Detail
Slices for section	C	0..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by value:code cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
section:All Slices				Content/Rules for all slices
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
title		0..1	string	Label for section (e.g. for ToC)
code		0..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	C	0..1	Narrative	Text summary of the section, for human interpretation
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
entry	C	0..*	Reference(Resource)	A reference to data that supports this section
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:health_concerns_section	SC	1..1	BackboneElement	Health Concerns Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
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
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Health concerns section code Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. 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://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 75310-3
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
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	text
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:health_concerns_entry	SC	0..*	Reference(US Core AllergyIntolerance Profile | US Core Condition Profile | US Core Laboratory Result Observation Profile | US Core Smoking Status Observation Profile | Vital Signs Profile | ClinicalImpression | Observation | RiskAssessment | List | DocumentReference)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:goals_section	SC	1..1	BackboneElement	Goals Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
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
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Goals Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. 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://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 61146-7
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
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	text
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:goals_entry	SC	0..*	Reference(US Core Goal Profile)	entry
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:interventions_section	SC	0..1	BackboneElement	Interventions Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
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
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Interventions provided Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. 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://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 62387-6
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
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	text
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:interventions_section	SC	0..*	Reference(List | RequestGroup | MedicationDispense | Communication | ServiceRequest | US Core Procedure Profile | MedicationStatement | US Core Medication Profile | US Core MedicationRequest Profile)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
section:eval_outcomes_section	SC	0..1	BackboneElement	Health Status Evaluations and Outcomes Section cmp-1: A section must contain at least one of text, entries, or sub-sections cmp-2: A section can only have an emptyReason if it is empty
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
title	S	1..1	string	title
code	S	1..1	CodeableConcept	Patient problem outcome Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. 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://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11383-7
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
author		0..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the section
focus		0..1	Reference(Resource)	Who/what the section is about, when it is not about the subject of composition
text	SC	1..1	Narrative	text
mode		0..1	code	working | snapshot | changes Binding: ListMode (required): The processing mode that applies to this section.
orderedBy		0..1	CodeableConcept	Order of section entries Binding: ListOrderCodes (preferred): What order applies to the items in the entry.
Slices for entry	C	0..*	Reference(Resource)	entry Slice: Unordered, Open by profile:reference
entry:eval_outcomes_entry	SC	0..*	Reference(Observation)	This section contains unprofiled resources not covered by US Core. Please refer to C-CDA R2.1 for guidance on terminology, etc.
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: ListEmptyReasons (preferred): If a section is empty, why it is empty.
section	C	0..*	See section (Composition)	Nested Section
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Composition.status	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 from the FHIR Standard
Composition.type	required	CarePlanDocumentType http://hl7.org/fhir/us/ccda/ValueSet/2.16.840.1.113762.1.4.1099.10 from this IG
Composition.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes from the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:legal_attester.mode	required	Fixed Value: legal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:professional_attester.mode	required	Fixed Value: professional http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.attester:personal_attester.mode	required	Fixed Value: personal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 from the FHIR Standard
Composition.relatesTo.code	required	DocumentRelationshipType http://hl7.org/fhir/ValueSet/document-relationship-type|4.0.1 from the FHIR Standard
Composition.event.code	example	ActCode http://terminology.hl7.org/ValueSet/v3-ActCode
Composition.section.code	example	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard
Composition.section:health_concerns_section.code	example	Pattern: LOINC Code 75310-3 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:health_concerns_section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section:health_concerns_section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section:health_concerns_section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard
Composition.section:goals_section.code	example	Pattern: LOINC Code 61146-7 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:goals_section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section:goals_section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section:goals_section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard
Composition.section:interventions_section.code	example	Pattern: LOINC Code 62387-6 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:interventions_section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section:interventions_section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section:interventions_section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard
Composition.section:eval_outcomes_section.code	example	Pattern: LOINC Code 11383-7 http://hl7.org/fhir/ValueSet/doc-section-codes from the FHIR Standard
Composition.section:eval_outcomes_section.mode	required	ListMode http://hl7.org/fhir/ValueSet/list-mode|4.0.1 from the FHIR Standard
Composition.section:eval_outcomes_section.orderedBy	preferred	ListOrderCodes http://hl7.org/fhir/ValueSet/list-order from the FHIR Standard
Composition.section:eval_outcomes_section.emptyReason	preferred	ListEmptyReasons http://hl7.org/fhir/ValueSet/list-empty-reason from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section, Composition.section:health_concerns_section, Composition.section:goals_section, Composition.section:interventions_section, Composition.section:eval_outcomes_section	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:health_concerns_section, Composition.section:goals_section, Composition.section:interventions_section, Composition.section:eval_outcomes_section	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	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	Composition	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	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	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()

This structure is derived from USRealmHeader

Summary

Mandatory: 8 elements(7 nested mandatory elements)
Must-Support: 24 elements

Structures

This structure refers to these other structures:

• US Core CarePlan Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-careplan)
• US Core AllergyIntolerance Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-allergyintolerance)
• US Core Condition Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-condition)
• US Core Laboratory Result Observation Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-lab)
• US Core Smoking Status Observation Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-smokingstatus)
• Vital Signs Profile (http://hl7.org/fhir/StructureDefinition/vitalsigns)
• US Core Goal Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-goal)
• US Core Procedure Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure)
• US Core Medication Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medication)
• US Core MedicationRequest Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-medicationrequest)

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Composition.event.detail
• The element 1 is sliced based on the value of Composition.section
• The element 1 is sliced based on the value of Composition.section.entry