C-CDA on FHIR
2.0.0-ballot - STU 2 Ballot

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

## Resource Profile: Care Plan Document

Official URL: http://hl7.org/fhir/us/ccda/StructureDefinition/Care-Plan-Document | Version: 2.0.0-ballot
Standards status: Trial-use | Computable Name: CarePlan

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

> 2025 Ballot of C-CDA ↔ FHIR US Core Mapping

> The current release of this IG adds relevant mapping content from C-CDA ↔ FHIR mapping project which was related to the original C-CDA on FHIR work. These mappings are included under the "Mapping" heading and will undergo future updates for additional content.

Usages:

- Examples for this Profile: Composition/Care-Plan-Example
- CapabilityStatements using this Profile: CCDA on FHIR Client and CCDA on FHIR Server

You can also check for usages in the FHIR IG Statistics

### Formal Views of Profile Content

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

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

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | USRealmHeader | A set of resources composed into a single coherent clinical statement with clinical attestation
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
Slices for extension |  |  |  | Content/Rules for all slices
extension:versionNumber |  | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:version_number_extension | S | 0..1 | integer | Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/VersionNumber
extension: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
extension: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
extension: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
extension: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
extension:performer_extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | performer URL: http://hl7.org/fhir/us/ccda/StructureDefinition/PerformerExtension
extension:authorization_extension | S | 0..* | Reference(Consent) | authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/AuthorizationExtension
extension: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 | S Σ | 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 | S Σ | 1..1 | CodeableConcept | Care Plan Document Binding: Care Plan Document Type (required)
subject | S Σ | 0..1 | Reference(US Core Patient Profile | Group) | Who and/or what the composition is about
encounter | S Σ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S Σ | 1..1 | dateTime | date
author | S Σ | 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 | S Σ | 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
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.
attester:legal_attester | S | 0..1 | BackboneElement | attester
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
party | S | 1..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | party
attester:professional_attester | S | 0..* | BackboneElement | attester
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
party | S | 1..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | party
attester:personal_attester | S | 0..* | BackboneElement | attester
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
party | S | 1..1 | Reference(US Core Patient Profile | RelatedPerson) | party
custodian | S Σ | 1..1 | Reference(US Core Organization Profile) | custodian
event | S Σ | 0..1 | BackboneElement | The clinical service(s) being documented
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
period | S Σ | 1..1 | Period | The period covered by the documentation
Slices for detail | S Σ | 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 Constraints: cmp-1, cmp-2
section:All Slices |  |  |  | Content/Rules for all slices
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
section:health_concerns_section | S C | 1..1 | BackboneElement | Health Concerns Section Constraints: cmp-1, cmp-2
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
text | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry | C | 0..* | Reference(Resource) | entry Slice: Unordered, Open by profile:reference
entry:health_concerns_entry | S C | 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 C | 1..1 | BackboneElement | Goals Section Constraints: cmp-1, cmp-2
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
text | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry | C | 0..* | Reference(Resource) | entry Slice: Unordered, Open by profile:reference
entry:goals_entry | S C | 0..* | Reference(US Core Goal Profile) | entry
section:interventions_section | S C | 0..1 | BackboneElement | Interventions Section Constraints: cmp-1, cmp-2
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
text | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry | C | 0..* | Reference(Resource) | entry Slice: Unordered, Open by profile:reference
entry:interventions_section | S C | 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 C | 0..1 | BackboneElement | Health Status Evaluations and Outcomes Section Constraints: cmp-1, cmp-2
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
text | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry | C | 0..* | Reference(Resource) | entry Slice: Unordered, Open by profile:reference
entry:eval_outcomes_entry | S C | 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

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 Value: LOINC Code 75310-3 `http://hl7.org/fhir/ValueSet/doc-section-codes` From the FHIR Standard
Composition.section:goals_section.code | example | Pattern Value: LOINC Code 61146-7 `http://hl7.org/fhir/ValueSet/doc-section-codes` From the FHIR Standard
Composition.section:interventions_section.code | example | Pattern Value: LOINC Code 62387-6 `http://hl7.org/fhir/ValueSet/doc-section-codes` From the FHIR Standard
Composition.section:eval_outcomes_section.code | example | Pattern Value: 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() |

This structure is derived from USRealmHeader

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:versionNumber |  | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:version_number_extension | S | 0..1 | integer | Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/VersionNumber
extension: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
extension: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
extension: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
extension: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
extension:performer_extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | performer URL: http://hl7.org/fhir/us/ccda/StructureDefinition/PerformerExtension
extension:authorization_extension | S | 0..* | Reference(Consent) | authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/AuthorizationExtension
extension: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 | S Σ | 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 | S Σ | 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 | S Σ | 0..1 | Reference(US Core Patient Profile | Group) | Who and/or what the composition is about
encounter | S Σ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S Σ | 1..1 | dateTime | date
author | S Σ | 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 | S Σ | 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 | S Σ | 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 | S Σ | 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 | S Σ | 1..1 | Period | The period covered by the documentation
Slices for detail | S Σ | 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 Constraints: cmp-1, cmp-2
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 1..1 | BackboneElement | Health Concerns Section Constraints: cmp-1, cmp-2
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 | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 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 | S C | 1..1 | BackboneElement | Goals Section Constraints: cmp-1, cmp-2
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 | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 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 | S C | 0..1 | BackboneElement | Interventions Section Constraints: cmp-1, cmp-2
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 | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 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 | S C | 0..1 | BackboneElement | Health Status Evaluations and Outcomes Section Constraints: cmp-1, cmp-2
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 | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 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 Value: 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 Value: 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 Value: 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 Value: 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

Key Elements View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
Composition |  | 0..* | USRealmHeader | A set of resources composed into a single coherent clinical statement with clinical attestation
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
Slices for extension |  |  |  | Content/Rules for all slices
extension:versionNumber |  | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:version_number_extension | S | 0..1 | integer | Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/VersionNumber
extension: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
extension: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
extension: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
extension: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
extension:performer_extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | performer URL: http://hl7.org/fhir/us/ccda/StructureDefinition/PerformerExtension
extension:authorization_extension | S | 0..* | Reference(Consent) | authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/AuthorizationExtension
extension: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 | S Σ | 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 | S Σ | 1..1 | CodeableConcept | Care Plan Document Binding: Care Plan Document Type (required)
subject | S Σ | 0..1 | Reference(US Core Patient Profile | Group) | Who and/or what the composition is about
encounter | S Σ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S Σ | 1..1 | dateTime | date
author | S Σ | 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 | S Σ | 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
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.
attester:legal_attester | S | 0..1 | BackboneElement | attester
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
party | S | 1..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | party
attester:professional_attester | S | 0..* | BackboneElement | attester
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
party | S | 1..1 | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | party
attester:personal_attester | S | 0..* | BackboneElement | attester
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
party | S | 1..1 | Reference(US Core Patient Profile | RelatedPerson) | party
custodian | S Σ | 1..1 | Reference(US Core Organization Profile) | custodian
event | S Σ | 0..1 | BackboneElement | The clinical service(s) being documented
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
period | S Σ | 1..1 | Period | The period covered by the documentation
Slices for detail | S Σ | 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 Constraints: cmp-1, cmp-2
section:All Slices |  |  |  | Content/Rules for all slices
modifierExtension | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized
section:health_concerns_section | S C | 1..1 | BackboneElement | Health Concerns Section Constraints: cmp-1, cmp-2
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
text | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry | C | 0..* | Reference(Resource) | entry Slice: Unordered, Open by profile:reference
entry:health_concerns_entry | S C | 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 C | 1..1 | BackboneElement | Goals Section Constraints: cmp-1, cmp-2
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
text | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry | C | 0..* | Reference(Resource) | entry Slice: Unordered, Open by profile:reference
entry:goals_entry | S C | 0..* | Reference(US Core Goal Profile) | entry
section:interventions_section | S C | 0..1 | BackboneElement | Interventions Section Constraints: cmp-1, cmp-2
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
text | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry | C | 0..* | Reference(Resource) | entry Slice: Unordered, Open by profile:reference
entry:interventions_section | S C | 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 C | 0..1 | BackboneElement | Health Status Evaluations and Outcomes Section Constraints: cmp-1, cmp-2
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
text | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Slices for entry | C | 0..* | Reference(Resource) | entry Slice: Unordered, Open by profile:reference
entry:eval_outcomes_entry | S C | 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

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 Value: LOINC Code 75310-3 `http://hl7.org/fhir/ValueSet/doc-section-codes` From the FHIR Standard
Composition.section:goals_section.code | example | Pattern Value: LOINC Code 61146-7 `http://hl7.org/fhir/ValueSet/doc-section-codes` From the FHIR Standard
Composition.section:interventions_section.code | example | Pattern Value: LOINC Code 62387-6 `http://hl7.org/fhir/ValueSet/doc-section-codes` From the FHIR Standard
Composition.section:eval_outcomes_section.code | example | Pattern Value: 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() |

Differential View

This structure is derived from USRealmHeader

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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

Snapshot View

Name | Flags | Card. | Type | Description & Constraints Filter: Bindings Constraints Obligations
--- | --- | --- | --- | ---
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
contained |  | 0..* | Resource | Contained, inline Resources
Slices for extension |  | 0..* | Extension | Extension Slice: Unordered, Open by value:url
extension:versionNumber |  | 0..* | string | Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:version_number_extension | S | 0..1 | integer | Extension URL: http://hl7.org/fhir/us/ccda/StructureDefinition/VersionNumber
extension: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
extension: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
extension: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
extension: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
extension:performer_extension | S | 0..* | Reference(US Core Practitioner Profile | US Core PractitionerRole Profile) | performer URL: http://hl7.org/fhir/us/ccda/StructureDefinition/PerformerExtension
extension:authorization_extension | S | 0..* | Reference(Consent) | authorization URL: http://hl7.org/fhir/us/ccda/StructureDefinition/AuthorizationExtension
extension: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 | S Σ | 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 | S Σ | 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 | S Σ | 0..1 | Reference(US Core Patient Profile | Group) | Who and/or what the composition is about
encounter | S Σ | 0..1 | Reference(US Core Encounter Profile) | Context of the Composition
date | S Σ | 1..1 | dateTime | date
author | S Σ | 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 | S Σ | 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 | S Σ | 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 | S Σ | 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 | S Σ | 1..1 | Period | The period covered by the documentation
Slices for detail | S Σ | 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 Constraints: cmp-1, cmp-2
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 This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 1..1 | BackboneElement | Health Concerns Section Constraints: cmp-1, cmp-2
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 | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 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 | S C | 1..1 | BackboneElement | Goals Section Constraints: cmp-1, cmp-2
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 | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 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 | S C | 0..1 | BackboneElement | Interventions Section Constraints: cmp-1, cmp-2
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 | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 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 | S C | 0..1 | BackboneElement | Health Status Evaluations and Outcomes Section Constraints: cmp-1, cmp-2
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 | S C | 1..1 | Narrative | text This profile does not constrain the narrative in regard to content, language, or traceability to data elements
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 | S C | 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 Value: 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 Value: 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 Value: 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 Value: 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

Other representations of profile: CSV, Excel, Schematron