Evidence Based Medicine on FHIR Implementation Guide
2.0.0-ballot - ballot International flag

Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. 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/ebm/ and changes regularly. See the Directory of published versions

Resource Profile: EvidenceMeasureReportPackage - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the evidence-measure-report-package resource profile.

Guidance on how to interpret the contents of this table can be found here

0. Composition
2. Composition.relatesTo
Control1..?
4. Composition.relatesTo:interventionGroup
Slice NameinterventionGroup
Control0..*
Must Supporttrue
6. Composition.relatesTo:interventionGroup.type
Pattern Valuedepends-on
8. Composition.relatesTo:interventionGroup.label
Control1..?
Pattern ValueIntervention Group
10. Composition.relatesTo:interventionGroup.resourceReference
TypeReference(ExposureGroup, ComparatorGroup)
12. Composition.relatesTo:comparatorGroup
Slice NamecomparatorGroup
Control0..*
Must Supporttrue
14. Composition.relatesTo:comparatorGroup.type
Pattern Valuedepends-on
16. Composition.relatesTo:comparatorGroup.label
Control1..?
Pattern ValueComparator Group
18. Composition.relatesTo:comparatorGroup.resourceReference
TypeReference(ExposureGroup, ComparatorGroup)
20. Composition.relatesTo:totalGroup
Slice NametotalGroup
Control0..1
Must Supporttrue
22. Composition.relatesTo:totalGroup.type
Pattern Valuedepends-on
24. Composition.relatesTo:totalGroup.label
Control1..?
Pattern ValueTotal Group
26. Composition.relatesTo:totalGroup.resourceReference
TypeReference(StudyGroup)
28. Composition.relatesTo:groupAssignment
Slice NamegroupAssignment
Control0..*
30. Composition.relatesTo:groupAssignment.type
Pattern Valuecomposed-of
32. Composition.relatesTo:groupAssignment.label
Control1..?
Pattern ValueGroup Assignment
34. Composition.relatesTo:groupAssignment.resourceReference
TypeReference(GroupAssignment)

Guidance on how to interpret the contents of this table can be found here

0. Composition
Definition

A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).

ShortA set of resources composed into a single coherent clinical statement with clinical attestation
Comments

While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.

Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. Composition.implicitRules
Definition

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

ShortA set of rules under which this content was created
Comments

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

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. Composition.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

Control0..*
This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
TypeResource
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
6. Composition.extension:versionAlgorithm
Slice NameversionAlgorithm
Definition

Indicates the mechanism used to compare versions to determine which is more current.

ShortHow to compare versions
Comments

If set as a string, this is a FHIRPath expression that has two additional context variables passed in - %version1 and %version2 and will return a negative number if version1 is newer, a positive number if version2 and a 0 if the version ordering can't be successfully be determined.

Control0..1
TypeExtension(Artifact Version Algorithm) (Extension Type: Choice of: string, Coding)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
8. Composition.extension:experimental
Slice Nameexperimental
Definition

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

ShortFor testing purposes, not real usage
Control0..1
TypeExtension(Artifact Experimental) (Extension Type: boolean)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
10. Composition.extension:description
Slice Namedescription
Definition

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

ShortNatural language description of the artifact
Comments

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

Control0..1
TypeExtension(Artifact Description) (Extension Type: markdown)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
12. Composition.extension:purpose
Slice Namepurpose
Definition

Explanation of why this artifact is needed and why it has been designed as it has.

ShortWhy this artifact is defined
Comments

This element does not describe the usage of the artifact. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this artifact.

Control0..1
TypeExtension(Artifact Purpose) (Extension Type: markdown)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
14. Composition.extension:copyright
Slice Namecopyright
Definition

A copyright statement relating to the artifact and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the artifact.

ShortUse and/or publishing restrictions
Comments

The short copyright declaration (e.g. (c) '2015+ xyz organization' should be sent in the copyrightLabel element.

Control0..1
TypeExtension(Artifact Copyright) (Extension Type: markdown)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
16. Composition.extension:copyrightLabel
Slice NamecopyrightLabel
Definition

A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are resctricted. (e.g. 'All rights reserved', 'Some rights reserved').

ShortCopyright holder and year(s)
Comments

Defines the content expected to be rendered in all representations of the artifact. The (c) symbol should NOT be included in this string. It is expected to be added by software when rendering the notation. Full details about licensing, restrictions, warrantees, etc. goes in the more general 'copyright' element.

Control0..1
TypeExtension(Artifact Copyright Label) (Extension Type: string)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
18. Composition.extension:approvalDate
Slice NameapprovalDate
Definition

The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.

ShortWhen the resource was approved by publisher
Control0..1
TypeExtension(ArtifactApprovalDate) (Extension Type: date)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
20. Composition.extension:lastReviewDate
Slice NamelastReviewDate
Definition

The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.

ShortWhen the resource was last reviewed by the publisher
Control0..1
TypeExtension(ArtifactLastReviewDate) (Extension Type: date)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
22. Composition.extension:effectivePeriod
Slice NameeffectivePeriod
Definition

The period during which the resource content was or is planned to be in active use.

ShortWhen the resource is expected to be used
Control0..1
TypeExtension(ArtifactEffectivePeriod) (Extension Type: Period)
Is Modifierfalse
Must Supportfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
24. Composition.modifierExtension
Definition

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

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

ShortExtensions that cannot be ignored
Comments

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

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Supportfalse
Summarytrue
Requirements

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

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
26. Composition.status
Definition

The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.

Shortregistered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown
Comments

If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements.

Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.

Control1..1
BindingThe codes SHALL be taken from CompositionStatushttp://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot2
(required to http://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot2)

The workflow/clinical status of the composition.

Typecode
Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Requirements

Need to be able to mark interim, amended, or withdrawn compositions or documents.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
28. Composition.type
Definition

Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.

ShortKind of composition (LOINC if possible)
Comments

For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.

Control1..1
BindingThe codes SHOULD be taken from FHIRDocumentTypeCodeshttp://hl7.org/fhir/ValueSet/doc-typecodes
(preferred to http://hl7.org/fhir/ValueSet/doc-typecodes)

Type of a composition.

TypeCodeableConcept
Is Modifierfalse
Must Supportfalse
Summarytrue
Requirements

Key metadata element describing the composition, used in searching/filtering.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
30. Composition.subject
Definition

Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).

ShortWho and/or what the composition is about
Comments

Reference a single Citation Resource, EvidenceVariable Resource (EvidenceReportSubject Profile), or ReserchStudy Resource to define the subject of this EvidenceReport.


For clinical documents, this is usually the patient.

Control0..1*
TypeReference(Citation, Classification, EvidenceReportSubject, ResearchStudy, Resource)
Is Modifierfalse
Must Supportfalse
Summarytrue
Requirements

Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
32. Composition.date
Definition

The composition editing time, when the composition was last logically changed by the author.

ShortComposition editing time
Comments

The Last Modified Date on the composition may be after the date of the document was attested without being changed. This means that the date on an amended document is the date of the amendment, not the date of original authorship.

Control1..1
TypedateTime
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Requirements

dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring this version of the Composition. When packaged in a document, Bundle.timestamp is the date of packaging.


dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring this version of the Composition. When packaged in a document, Bundle.timestamp is the date of packaging.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
34. Composition.author
Definition

Identifies who is responsible for the information in the composition, not necessarily who typed it in.

ShortWho and/or what authored the composition
Control1..*
TypeReference(Practitioner, PractitionerRole, Device, Patient, RelatedPerson, Organization)
Is Modifierfalse
Must Supportfalse
Summarytrue
Requirements

Identifies who is responsible for the content.

Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
36. Composition.title
Definition

Official human-readable label for the composition.

ShortHuman Readable name/title
Comments

For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.

Control1..1
Typestring
Is Modifierfalse
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
38. Composition.relatesTo
Definition

Relationships that this composition has with other compositions or documents that already exist.

ShortRelationships to other compositions/documents
Comments

To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

"relatesTo": [{
  "type": "replaces",
  "resourceReference": {
    "identifier": { 
      "system": "...", 
      "value": "..."
    }
  } 
}]
Control10..*
TypeRelatedArtifact
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on Composition.relatesTo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ label
  • 40. Composition.relatesTo:citeAs
    Slice NameciteAs
    Definition

    Relationships that this composition has with other compositions or documents that already exist.

    ShortRelationships to other compositions/documents
    Comments

    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

    "relatesTo": [{
      "type": "replaces",
      "resourceReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..1*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    42. Composition.relatesTo:citeAs.type
    Definition

    The type of relationship to the related artifact.

    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
    Comments

    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern Valuecite-as
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    44. Composition.relatesTo:citeAs.label
    Definition

    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

    ShortShort label
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern ValueCite as
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    46. Composition.relatesTo:partOf
    Slice NamepartOf
    Definition

    Relationships that this composition has with other compositions or documents that already exist.

    ShortRelationships to other compositions/documents
    Comments

    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

    "relatesTo": [{
      "type": "replaces",
      "resourceReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    48. Composition.relatesTo:partOf.type
    Definition

    The type of relationship to the related artifact.

    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
    Comments

    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern Valuepart-of
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    50. Composition.relatesTo:partOf.label
    Definition

    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

    ShortShort label
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern ValuePart of
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    52. Composition.relatesTo:derivedFrom
    Slice NamederivedFrom
    Definition

    Relationships that this composition has with other compositions or documents that already exist.

    ShortRelationships to other compositions/documents
    Comments

    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

    "relatesTo": [{
      "type": "replaces",
      "resourceReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    54. Composition.relatesTo:derivedFrom.type
    Definition

    The type of relationship to the related artifact.

    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
    Comments

    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern Valuederived-from
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    56. Composition.relatesTo:derivedFrom.label
    Definition

    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

    ShortShort label
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern ValueDerived from
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    58. Composition.relatesTo:specificationOfOriginal
    Slice NamespecificationOfOriginal
    Definition

    Relationships that this composition has with other compositions or documents that already exist.

    ShortRelationships to other compositions/documents
    Comments

    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

    "relatesTo": [{
      "type": "replaces",
      "resourceReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    60. Composition.relatesTo:specificationOfOriginal.type
    Definition

    The type of relationship to the related artifact.

    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
    Comments

    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern Valuespecification-of
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    62. Composition.relatesTo:specificationOfOriginal.label
    Definition

    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

    ShortShort label
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern ValueOriginal publication
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    64. Composition.relatesTo:interventionGroup
    Slice NameinterventionGroup
    Definition

    Relationships that this composition has with other compositions or documents that already exist.

    ShortRelationships to other compositions/documents
    Comments

    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

    "relatesTo": [{
      "type": "replaces",
      "resourceReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    66. Composition.relatesTo:interventionGroup.type
    Definition

    The type of relationship to the related artifact.

    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
    Comments

    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern Valuedepends-on
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    68. Composition.relatesTo:interventionGroup.label
    Definition

    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

    ShortShort label
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern ValueIntervention Group
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    70. Composition.relatesTo:interventionGroup.resourceReference
    Definition

    The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

    ShortWhat artifact, if not a conformance resource
    Comments

    If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

    Control0..1
    TypeReference(ExposureGroup, ComparatorGroup, Resource)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    72. Composition.relatesTo:comparatorGroup
    Slice NamecomparatorGroup
    Definition

    Relationships that this composition has with other compositions or documents that already exist.

    ShortRelationships to other compositions/documents
    Comments

    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

    "relatesTo": [{
      "type": "replaces",
      "resourceReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    74. Composition.relatesTo:comparatorGroup.type
    Definition

    The type of relationship to the related artifact.

    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
    Comments

    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern Valuedepends-on
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    76. Composition.relatesTo:comparatorGroup.label
    Definition

    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

    ShortShort label
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern ValueComparator Group
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    78. Composition.relatesTo:comparatorGroup.resourceReference
    Definition

    The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

    ShortWhat artifact, if not a conformance resource
    Comments

    If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

    Control0..1
    TypeReference(ExposureGroup, ComparatorGroup, Resource)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    80. Composition.relatesTo:totalGroup
    Slice NametotalGroup
    Definition

    Relationships that this composition has with other compositions or documents that already exist.

    ShortRelationships to other compositions/documents
    Comments

    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

    "relatesTo": [{
      "type": "replaces",
      "resourceReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..1*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supporttrue
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    82. Composition.relatesTo:totalGroup.type
    Definition

    The type of relationship to the related artifact.

    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
    Comments

    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern Valuedepends-on
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    84. Composition.relatesTo:totalGroup.label
    Definition

    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

    ShortShort label
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern ValueTotal Group
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    86. Composition.relatesTo:totalGroup.resourceReference
    Definition

    The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

    ShortWhat artifact, if not a conformance resource
    Comments

    If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

    Control0..1
    TypeReference(StudyGroup, Resource)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    88. Composition.relatesTo:groupAssignment
    Slice NamegroupAssignment
    Definition

    Relationships that this composition has with other compositions or documents that already exist.

    ShortRelationships to other compositions/documents
    Comments

    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

    "relatesTo": [{
      "type": "replaces",
      "resourceReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..*
    TypeRelatedArtifact
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    90. Composition.relatesTo:groupAssignment.type
    Definition

    The type of relationship to the related artifact.

    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
    Comments

    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

    Control1..1
    BindingThe codes SHALL be taken from RelatedArtifactTypehttp://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

    The type of relationship to the related artifact.

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern Valuecomposed-of
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    92. Composition.relatesTo:groupAssignment.label
    Definition

    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

    ShortShort label
    Control10..1
    Typestring
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Pattern ValueGroup Assignment
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    94. Composition.relatesTo:groupAssignment.resourceReference
    Definition

    The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

    ShortWhat artifact, if not a conformance resource
    Comments

    If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

    Control0..1
    TypeReference(GroupAssignment, Resource)
    Is Modifierfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

    Guidance on how to interpret the contents of this table can be found here

    0. Composition
    Definition

    A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.).

    ShortA set of resources composed into a single coherent clinical statement with clinical attestation
    Comments

    While the focus of this specification is on patient-specific clinical statements, this resource can also apply to other healthcare-related statements such as study protocol designs, healthcare invoices and other activities that are not necessarily patient-specific or clinical.

    Control0..*
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
    dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
    dom-4: 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: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
    dom-6: A resource should have narrative for robust management (text.`div`.exists())
    2. Composition.id
    Definition

    The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

    ShortLogical id of this artifact
    Comments

    Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

    Control0..1
    Typeid
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    4. Composition.meta
    Definition

    The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

    ShortMetadata about the resource
    Control0..1
    TypeMeta
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    6. Composition.implicitRules
    Definition

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

    ShortA set of rules under which this content was created
    Comments

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

    Control0..1
    Typeuri
    Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    8. Composition.language
    Definition

    The base language in which the resource is written.

    ShortLanguage of the resource content
    Comments

    Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

    Control0..1
    BindingThe codes SHALL be taken from AllLanguages
    (required to http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot2)

    IETF language tag for a human language

    Typecode
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    10. Composition.text
    Definition

    A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

    ShortText summary of the resource, for human interpretation
    Comments

    Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

    Control0..1
    This element is affected by the following invariants: dom-6
    TypeNarrative
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesnarrative, html, xhtml, display
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. Composition.contained
    Definition

    These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

    ShortContained, inline Resources
    Comments

    This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

    Control0..*
    This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
    TypeResource
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Alternate Namesinline resources, anonymous resources, contained resources
    14. Composition.extension
    Definition

    An Extension

    ShortExtension
    Control0..*
    TypeExtension
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on Composition.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • value @ url
    • 16. Composition.extension:versionAlgorithm
      Slice NameversionAlgorithm
      Definition

      Indicates the mechanism used to compare versions to determine which is more current.

      ShortHow to compare versions
      Comments

      If set as a string, this is a FHIRPath expression that has two additional context variables passed in - %version1 and %version2 and will return a negative number if version1 is newer, a positive number if version2 and a 0 if the version ordering can't be successfully be determined.

      Control0..1
      TypeExtension(Artifact Version Algorithm) (Extension Type: Choice of: string, Coding)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      18. Composition.extension:experimental
      Slice Nameexperimental
      Definition

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

      ShortFor testing purposes, not real usage
      Control0..1
      TypeExtension(Artifact Experimental) (Extension Type: boolean)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      20. Composition.extension:description
      Slice Namedescription
      Definition

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

      ShortNatural language description of the artifact
      Comments

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

      Control0..1
      TypeExtension(Artifact Description) (Extension Type: markdown)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      22. Composition.extension:purpose
      Slice Namepurpose
      Definition

      Explanation of why this artifact is needed and why it has been designed as it has.

      ShortWhy this artifact is defined
      Comments

      This element does not describe the usage of the artifact. Instead, it provides traceability of ''why'' the resource is either needed or ''why'' it is defined as it is. This may be used to point to source materials or specifications that drove the structure of this artifact.

      Control0..1
      TypeExtension(Artifact Purpose) (Extension Type: markdown)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      24. Composition.extension:copyright
      Slice Namecopyright
      Definition

      A copyright statement relating to the artifact and/or its contents. Copyright statements are generally legal restrictions on the use and publishing of the artifact.

      ShortUse and/or publishing restrictions
      Comments

      The short copyright declaration (e.g. (c) '2015+ xyz organization' should be sent in the copyrightLabel element.

      Control0..1
      TypeExtension(Artifact Copyright) (Extension Type: markdown)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      26. Composition.extension:copyrightLabel
      Slice NamecopyrightLabel
      Definition

      A short string (<50 characters), suitable for inclusion in a page footer that identifies the copyright holder, effective period, and optionally whether rights are resctricted. (e.g. 'All rights reserved', 'Some rights reserved').

      ShortCopyright holder and year(s)
      Comments

      Defines the content expected to be rendered in all representations of the artifact. The (c) symbol should NOT be included in this string. It is expected to be added by software when rendering the notation. Full details about licensing, restrictions, warrantees, etc. goes in the more general 'copyright' element.

      Control0..1
      TypeExtension(Artifact Copyright Label) (Extension Type: string)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      28. Composition.extension:approvalDate
      Slice NameapprovalDate
      Definition

      The date on which the resource content was approved by the publisher. Approval happens once when the content is officially approved for usage.

      ShortWhen the resource was approved by publisher
      Control0..1
      TypeExtension(ArtifactApprovalDate) (Extension Type: date)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      30. Composition.extension:lastReviewDate
      Slice NamelastReviewDate
      Definition

      The date on which the resource content was last reviewed. Review happens periodically after approval but does not change the original approval date.

      ShortWhen the resource was last reviewed by the publisher
      Control0..1
      TypeExtension(ArtifactLastReviewDate) (Extension Type: date)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      32. Composition.extension:effectivePeriod
      Slice NameeffectivePeriod
      Definition

      The period during which the resource content was or is planned to be in active use.

      ShortWhen the resource is expected to be used
      Control0..1
      TypeExtension(ArtifactEffectivePeriod) (Extension Type: Period)
      Is Modifierfalse
      Must Supportfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
      34. Composition.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored
      Comments

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

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
      Must Supportfalse
      Summarytrue
      Requirements

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

      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      36. Composition.url
      Definition

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

      ShortCanonical identifier for this Composition, represented as a URI (globally unique)
      Comments

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

      Control0..1
      Typeuri
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

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

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      38. Composition.identifier
      Definition

      A version-independent identifier for the Composition. This identifier stays constant as the composition is changed over time.

      ShortVersion-independent identifier for the Composition
      Comments

      Similar to ClinicalDocument/setId in CDA. See discussion in resource definition for how these relate.

      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control0..*
      TypeIdentifier
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      40. Composition.version
      Definition

      An explicitly assigned identifier of a variation of the content in the Composition.

      ShortAn explicitly assigned identifier of a variation of the content in the Composition
      Comments

      While each resource, including the composition itself, has its own version identifier, this is a formal identifier for the logical version of the Composition as a whole. It would remain constant if the resources were moved to a new server, and all got new individual resource versions, for example.

      NoteThis is a business version Id, not a resource version Id (see discussion)
      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      42. Composition.status
      Definition

      The workflow/clinical status of this composition. The status is a marker for the clinical standing of the document.

      Shortregistered | partial | preliminary | final | amended | corrected | appended | cancelled | entered-in-error | deprecated | unknown
      Comments

      If a composition is marked as withdrawn, the compositions/documents in the series, or data from the composition or document series, should never be displayed to a user without being clearly marked as untrustworthy. The flag "entered-in-error" is why this element is labeled as a modifier of other elements.

      Some reporting work flows require that the original narrative of a final document never be altered; instead, only new narrative can be added. The composition resource has no explicit status for explicitly noting whether this business rule is in effect. This would be handled by an extension if required.

      Control1..1
      BindingThe codes SHALL be taken from CompositionStatus
      (required to http://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot2)

      The workflow/clinical status of the composition.

      Typecode
      Is Modifiertrue because This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      Need to be able to mark interim, amended, or withdrawn compositions or documents.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      44. Composition.type
      Definition

      Specifies the particular kind of composition (e.g. History and Physical, Discharge Summary, Progress Note). This usually equates to the purpose of making the composition.

      ShortKind of composition (LOINC if possible)
      Comments

      For Composition type, LOINC is ubiquitous and strongly endorsed by HL7. Most implementation guides will require a specific LOINC code, or use LOINC as an extensible binding.

      Control1..1
      BindingThe codes SHOULD be taken from FHIRDocumentTypeCodes
      (preferred to http://hl7.org/fhir/ValueSet/doc-typecodes)

      Type of a composition.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Key metadata element describing the composition, used in searching/filtering.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      46. Composition.category
      Definition

      A categorization for the type of the composition - helps for indexing and searching. This may be implied by or derived from the code specified in the Composition Type.

      ShortCategorization of Composition
      Control0..*
      BindingFor example codes, see ReferencedItemCategoryValueSet
      (example to http://hl7.org/fhir/ValueSet/referenced-item-category)

      High-level kind of a clinical document at a macro level.

      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Helps humans to assess whether the composition is of interest when viewing an index of compositions or documents.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      48. Composition.subject
      Definition

      Who or what the composition is about. The composition can be about a person, (patient or healthcare practitioner), a device (e.g. a machine) or even a group of subjects (such as a document about a herd of livestock, or a set of patients that share a common exposure).

      ShortWho and/or what the composition is about
      Comments

      Reference a single Citation Resource, EvidenceVariable Resource (EvidenceReportSubject Profile), or ReserchStudy Resource to define the subject of this EvidenceReport.

      Control0..1
      TypeReference(Citation, Classification, EvidenceReportSubject, ResearchStudy)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Essential metadata for searching for the composition. Identifies who and/or what the composition/document is about.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      50. Composition.encounter
      Definition

      Describes the clinical encounter or type of care this documentation is associated with.

      ShortContext of the Composition
      Control0..1
      TypeReference(Encounter)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Provides context for the composition and supports searching.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      52. Composition.date
      Definition

      The composition editing time, when the composition was last logically changed by the author.

      ShortComposition editing time
      Comments

      The Last Modified Date on the composition may be after the date of the document was attested without being changed. This means that the date on an amended document is the date of the amendment, not the date of original authorship.

      Control1..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      dateTime is used for tracking, organizing versions and searching. Note that this is the time of authoring this version of the Composition. When packaged in a document, Bundle.timestamp is the date of packaging.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      54. Composition.useContext
      Definition

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

      ShortThe context that the content is intended to support
      Comments

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

      Control0..*
      TypeUsageContext
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Assist in searching for appropriate content.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      56. Composition.author
      Definition

      Identifies who is responsible for the information in the composition, not necessarily who typed it in.

      ShortWho and/or what authored the composition
      Control1..*
      TypeReference(Practitioner, PractitionerRole, Device, Patient, RelatedPerson, Organization)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Identifies who is responsible for the content.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      58. Composition.name
      Definition

      A natural language name identifying the {{title}}. This name should be usable as an identifier for the module by machine processing applications such as code generation.

      ShortName for this Composition (computer friendly)
      Comments

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

      Control0..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Requirements

      Support human navigation and code generation.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      60. Composition.title
      Definition

      Official human-readable label for the composition.

      ShortHuman Readable name/title
      Comments

      For many compositions, the title is the same as the text or a display name of Composition.type (e.g. a "consultation" or "progress note"). Note that CDA does not make title mandatory, but there are no known cases where it is useful for title to be omitted, so it is mandatory here. Feedback on this requirement is welcome during the trial use period.

      Control1..1
      Typestring
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summarytrue
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      62. Composition.note
      Definition

      For any additional notes.

      ShortFor any additional notes
      Comments

      A comment, general note or annotation not coded elsewhere.

      Control0..*
      TypeAnnotation
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      64. Composition.attester
      Definition

      A participant who has attested to the accuracy of the composition/document.

      ShortAttests to accuracy of composition
      Comments

      Only list each attester once.

      Control0..*
      TypeBackboneElement
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      Identifies responsibility for the accuracy of the composition content.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      66. Composition.attester.id
      Definition

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

      ShortUnique id for inter-element referencing
      Control0..1
      This element is affected by the following invariants: ele-1
      Typestring
      Is Modifierfalse
      XML FormatIn the XML format, this property is represented as an attribute.
      Summaryfalse
      68. Composition.attester.extension
      Definition

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

      ShortAdditional content defined by implementations
      Comments

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

      Control0..*
      TypeExtension
      Is Modifierfalse
      Summaryfalse
      Alternate Namesextensions, user content
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      70. Composition.attester.modifierExtension
      Definition

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

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

      ShortExtensions that cannot be ignored even if unrecognized
      Comments

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

      Control0..*
      TypeExtension
      Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
      Summarytrue
      Requirements

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

      Alternate Namesextensions, user content, modifiers
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      72. Composition.attester.mode
      Definition

      The type of attestation the authenticator offers.

      Shortreviewer | editor | endorser | informant | recorder
      Control1..1
      BindingThe codes SHOULD be taken from Evidence Report Contributor Role Value Set
      (preferred to http://hl7.org/fhir/uv/ebm/ValueSet/evidence-report-contributor-role)
      TypeCodeableConcept
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      Indicates the level of authority of the attestation.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      74. Composition.attester.time
      Definition

      When the composition was attested by the party.

      ShortWhen the composition was attested
      Control0..1
      TypedateTime
      Is Modifierfalse
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Must Supportfalse
      Summaryfalse
      Requirements

      Identifies when the information in the composition was deemed accurate. (Things may have changed since then.).

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      76. Composition.attester.party
      Definition

      Who attested the composition in the specified way.

      ShortWho attested the composition
      Control0..1
      TypeReference(Patient, RelatedPerson, Practitioner, PractitionerRole, Organization)
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Requirements

      Identifies who has taken on the responsibility for accuracy of the composition content.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      78. Composition.custodian
      Definition

      Identifies the organization or group who is responsible for ongoing maintenance of and access to the composition/document information.

      ShortOrganization which maintains the composition
      Comments

      This is useful when documents are derived from a composition - provides guidance for how to get the latest version of the document. This is optional because this is sometimes not known by the authoring system, and can be inferred by context. However, it is important that this information be known when working with a derived document, so providing a custodian is encouraged.

      Control0..1
      TypeReference(Organization)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      Identifies where to go to find the current version, where to report issues, etc.

      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      80. Composition.relatesTo
      Definition

      Relationships that this composition has with other compositions or documents that already exist.

      ShortRelationships to other compositions/documents
      Comments

      To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
      When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
      Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

      "relatesTo": [{
        "type": "replaces",
        "resourceReference": {
          "identifier": { 
            "system": "...", 
            "value": "..."
          }
        } 
      }]
      
      Control1..*
      TypeRelatedArtifact
      Is Modifierfalse
      Must Supportfalse
      Summaryfalse
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
      SlicingThis element introduces a set of slices on Composition.relatesTo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ label
      • 82. Composition.relatesTo:citeAs
        Slice NameciteAs
        Definition

        Relationships that this composition has with other compositions or documents that already exist.

        ShortRelationships to other compositions/documents
        Comments

        To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
        When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
        Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

        "relatesTo": [{
          "type": "replaces",
          "resourceReference": {
            "identifier": { 
              "system": "...", 
              "value": "..."
            }
          } 
        }]
        
        Control0..1
        TypeRelatedArtifact
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        84. Composition.relatesTo:citeAs.id
        Definition

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

        ShortUnique id for inter-element referencing
        Control0..1
        This element is affected by the following invariants: ele-1
        Typeid
        Is Modifierfalse
        XML FormatIn the XML format, this property is represented as an attribute.
        Summaryfalse
        86. Composition.relatesTo:citeAs.extension
        Definition

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

        ShortAdditional content defined by implementations
        Comments

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

        Control0..*
        TypeExtension
        Is Modifierfalse
        Summaryfalse
        Alternate Namesextensions, user content
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        SlicingThis element introduces a set of slices on Composition.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 88. Composition.relatesTo:citeAs.type
          Definition

          The type of relationship to the related artifact.

          Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
          Comments

          The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

          Control1..1
          BindingThe codes SHALL be taken from RelatedArtifactType
          (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

          The type of relationship to the related artifact.

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Pattern Valuecite-as
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          90. Composition.relatesTo:citeAs.classifier
          Definition

          Provides additional classifiers of the related artifact.

          ShortAdditional classifiers
          Control0..*
          BindingFor example codes, see CitationArtifactClassifier
          (example to http://hl7.org/fhir/ValueSet/citation-artifact-classifier)

          Additional classifiers for the related artifact.

          TypeCodeableConcept
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          92. Composition.relatesTo:citeAs.label
          Definition

          A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

          ShortShort label
          Control1..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Pattern ValueCite as
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          94. Composition.relatesTo:citeAs.display
          Definition

          A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

          ShortBrief description of the related artifact
          Control0..1
          Typestring
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          96. Composition.relatesTo:citeAs.citation
          Definition

          A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

          ShortBibliographic citation for the artifact
          Comments

          Additional structured information about citations should be captured as extensions.

          Control0..1
          Typemarkdown
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          98. Composition.relatesTo:citeAs.document
          Definition

          The document being referenced, represented as an attachment. This is exclusive with the resource element.

          ShortWhat document is being referenced
          Control0..1
          TypeAttachment
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          100. Composition.relatesTo:citeAs.resource
          Definition

          The related artifact, such as a library, value set, profile, or other knowledge resource.

          ShortWhat artifact is being referenced
          Comments

          If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

          Control0..1
          Typecanonical(Resource)
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          102. Composition.relatesTo:citeAs.resourceReference
          Definition

          The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

          ShortWhat artifact, if not a conformance resource
          Comments

          If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

          Control0..1
          TypeReference(Resource)
          Is Modifierfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          104. Composition.relatesTo:citeAs.publicationStatus
          Definition

          The publication status of the artifact being referred to.

          Shortdraft | active | retired | unknown
          Control0..1
          BindingThe codes SHALL be taken from PublicationStatus
          (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

          Publication status of an artifact being referred to.

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          106. Composition.relatesTo:citeAs.publicationDate
          Definition

          The date of publication of the artifact being referred to.

          ShortDate of publication of the artifact being referred to
          Control0..1
          Typedate
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          108. Composition.relatesTo:partOf
          Slice NamepartOf
          Definition

          Relationships that this composition has with other compositions or documents that already exist.

          ShortRelationships to other compositions/documents
          Comments

          To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
          When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
          Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

          "relatesTo": [{
            "type": "replaces",
            "resourceReference": {
              "identifier": { 
                "system": "...", 
                "value": "..."
              }
            } 
          }]
          
          Control0..*
          TypeRelatedArtifact
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          110. Composition.relatesTo:partOf.id
          Definition

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

          ShortUnique id for inter-element referencing
          Control0..1
          This element is affected by the following invariants: ele-1
          Typeid
          Is Modifierfalse
          XML FormatIn the XML format, this property is represented as an attribute.
          Summaryfalse
          112. Composition.relatesTo:partOf.extension
          Definition

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

          ShortAdditional content defined by implementations
          Comments

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

          Control0..*
          TypeExtension
          Is Modifierfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on Composition.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ url
          • 114. Composition.relatesTo:partOf.type
            Definition

            The type of relationship to the related artifact.

            Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
            Comments

            The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

            Control1..1
            BindingThe codes SHALL be taken from RelatedArtifactType
            (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

            The type of relationship to the related artifact.

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Pattern Valuepart-of
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            116. Composition.relatesTo:partOf.classifier
            Definition

            Provides additional classifiers of the related artifact.

            ShortAdditional classifiers
            Control0..*
            BindingFor example codes, see CitationArtifactClassifier
            (example to http://hl7.org/fhir/ValueSet/citation-artifact-classifier)

            Additional classifiers for the related artifact.

            TypeCodeableConcept
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            118. Composition.relatesTo:partOf.label
            Definition

            A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

            ShortShort label
            Control1..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Pattern ValuePart of
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            120. Composition.relatesTo:partOf.display
            Definition

            A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

            ShortBrief description of the related artifact
            Control0..1
            Typestring
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            122. Composition.relatesTo:partOf.citation
            Definition

            A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

            ShortBibliographic citation for the artifact
            Comments

            Additional structured information about citations should be captured as extensions.

            Control0..1
            Typemarkdown
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            124. Composition.relatesTo:partOf.document
            Definition

            The document being referenced, represented as an attachment. This is exclusive with the resource element.

            ShortWhat document is being referenced
            Control0..1
            TypeAttachment
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            126. Composition.relatesTo:partOf.resource
            Definition

            The related artifact, such as a library, value set, profile, or other knowledge resource.

            ShortWhat artifact is being referenced
            Comments

            If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

            Control0..1
            Typecanonical(Resource)
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            128. Composition.relatesTo:partOf.resourceReference
            Definition

            The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

            ShortWhat artifact, if not a conformance resource
            Comments

            If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

            Control0..1
            TypeReference(Resource)
            Is Modifierfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            130. Composition.relatesTo:partOf.publicationStatus
            Definition

            The publication status of the artifact being referred to.

            Shortdraft | active | retired | unknown
            Control0..1
            BindingThe codes SHALL be taken from PublicationStatus
            (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

            Publication status of an artifact being referred to.

            Typecode
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            132. Composition.relatesTo:partOf.publicationDate
            Definition

            The date of publication of the artifact being referred to.

            ShortDate of publication of the artifact being referred to
            Control0..1
            Typedate
            Is Modifierfalse
            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            134. Composition.relatesTo:derivedFrom
            Slice NamederivedFrom
            Definition

            Relationships that this composition has with other compositions or documents that already exist.

            ShortRelationships to other compositions/documents
            Comments

            To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
            When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
            Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

            "relatesTo": [{
              "type": "replaces",
              "resourceReference": {
                "identifier": { 
                  "system": "...", 
                  "value": "..."
                }
              } 
            }]
            
            Control0..*
            TypeRelatedArtifact
            Is Modifierfalse
            Must Supportfalse
            Summaryfalse
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            136. Composition.relatesTo:derivedFrom.id
            Definition

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

            ShortUnique id for inter-element referencing
            Control0..1
            This element is affected by the following invariants: ele-1
            Typeid
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            138. Composition.relatesTo:derivedFrom.extension
            Definition

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

            ShortAdditional content defined by implementations
            Comments

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

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on Composition.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 140. Composition.relatesTo:derivedFrom.type
              Definition

              The type of relationship to the related artifact.

              Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
              Comments

              The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

              Control1..1
              BindingThe codes SHALL be taken from RelatedArtifactType
              (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

              The type of relationship to the related artifact.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Pattern Valuederived-from
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              142. Composition.relatesTo:derivedFrom.classifier
              Definition

              Provides additional classifiers of the related artifact.

              ShortAdditional classifiers
              Control0..*
              BindingFor example codes, see CitationArtifactClassifier
              (example to http://hl7.org/fhir/ValueSet/citation-artifact-classifier)

              Additional classifiers for the related artifact.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              144. Composition.relatesTo:derivedFrom.label
              Definition

              A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

              ShortShort label
              Control1..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Pattern ValueDerived from
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              146. Composition.relatesTo:derivedFrom.display
              Definition

              A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

              ShortBrief description of the related artifact
              Control0..1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              148. Composition.relatesTo:derivedFrom.citation
              Definition

              A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

              ShortBibliographic citation for the artifact
              Comments

              Additional structured information about citations should be captured as extensions.

              Control0..1
              Typemarkdown
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              150. Composition.relatesTo:derivedFrom.document
              Definition

              The document being referenced, represented as an attachment. This is exclusive with the resource element.

              ShortWhat document is being referenced
              Control0..1
              TypeAttachment
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              152. Composition.relatesTo:derivedFrom.resource
              Definition

              The related artifact, such as a library, value set, profile, or other knowledge resource.

              ShortWhat artifact is being referenced
              Comments

              If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

              Control0..1
              Typecanonical(Resource)
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              154. Composition.relatesTo:derivedFrom.resourceReference
              Definition

              The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

              ShortWhat artifact, if not a conformance resource
              Comments

              If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

              Control0..1
              TypeReference(Resource)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              156. Composition.relatesTo:derivedFrom.publicationStatus
              Definition

              The publication status of the artifact being referred to.

              Shortdraft | active | retired | unknown
              Control0..1
              BindingThe codes SHALL be taken from PublicationStatus
              (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

              Publication status of an artifact being referred to.

              Typecode
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              158. Composition.relatesTo:derivedFrom.publicationDate
              Definition

              The date of publication of the artifact being referred to.

              ShortDate of publication of the artifact being referred to
              Control0..1
              Typedate
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              160. Composition.relatesTo:specificationOfOriginal
              Slice NamespecificationOfOriginal
              Definition

              Relationships that this composition has with other compositions or documents that already exist.

              ShortRelationships to other compositions/documents
              Comments

              To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
              When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
              Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

              "relatesTo": [{
                "type": "replaces",
                "resourceReference": {
                  "identifier": { 
                    "system": "...", 
                    "value": "..."
                  }
                } 
              }]
              
              Control0..*
              TypeRelatedArtifact
              Is Modifierfalse
              Must Supportfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              162. Composition.relatesTo:specificationOfOriginal.id
              Definition

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

              ShortUnique id for inter-element referencing
              Control0..1
              This element is affected by the following invariants: ele-1
              Typeid
              Is Modifierfalse
              XML FormatIn the XML format, this property is represented as an attribute.
              Summaryfalse
              164. Composition.relatesTo:specificationOfOriginal.extension
              Definition

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

              ShortAdditional content defined by implementations
              Comments

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

              Control0..*
              TypeExtension
              Is Modifierfalse
              Summaryfalse
              Alternate Namesextensions, user content
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on Composition.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ url
              • 166. Composition.relatesTo:specificationOfOriginal.type
                Definition

                The type of relationship to the related artifact.

                Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
                Comments

                The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

                Control1..1
                BindingThe codes SHALL be taken from RelatedArtifactType
                (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

                The type of relationship to the related artifact.

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Pattern Valuespecification-of
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                168. Composition.relatesTo:specificationOfOriginal.classifier
                Definition

                Provides additional classifiers of the related artifact.

                ShortAdditional classifiers
                Control0..*
                BindingFor example codes, see CitationArtifactClassifier
                (example to http://hl7.org/fhir/ValueSet/citation-artifact-classifier)

                Additional classifiers for the related artifact.

                TypeCodeableConcept
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                170. Composition.relatesTo:specificationOfOriginal.label
                Definition

                A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

                ShortShort label
                Control1..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Pattern ValueOriginal publication
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                172. Composition.relatesTo:specificationOfOriginal.display
                Definition

                A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

                ShortBrief description of the related artifact
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                174. Composition.relatesTo:specificationOfOriginal.citation
                Definition

                A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

                ShortBibliographic citation for the artifact
                Comments

                Additional structured information about citations should be captured as extensions.

                Control0..1
                Typemarkdown
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                176. Composition.relatesTo:specificationOfOriginal.document
                Definition

                The document being referenced, represented as an attachment. This is exclusive with the resource element.

                ShortWhat document is being referenced
                Control0..1
                TypeAttachment
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                178. Composition.relatesTo:specificationOfOriginal.resource
                Definition

                The related artifact, such as a library, value set, profile, or other knowledge resource.

                ShortWhat artifact is being referenced
                Comments

                If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

                Control0..1
                Typecanonical(Resource)
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                180. Composition.relatesTo:specificationOfOriginal.resourceReference
                Definition

                The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

                ShortWhat artifact, if not a conformance resource
                Comments

                If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

                Control0..1
                TypeReference(Resource)
                Is Modifierfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                182. Composition.relatesTo:specificationOfOriginal.publicationStatus
                Definition

                The publication status of the artifact being referred to.

                Shortdraft | active | retired | unknown
                Control0..1
                BindingThe codes SHALL be taken from PublicationStatus
                (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

                Publication status of an artifact being referred to.

                Typecode
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                184. Composition.relatesTo:specificationOfOriginal.publicationDate
                Definition

                The date of publication of the artifact being referred to.

                ShortDate of publication of the artifact being referred to
                Control0..1
                Typedate
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                186. Composition.relatesTo:interventionGroup
                Slice NameinterventionGroup
                Definition

                Relationships that this composition has with other compositions or documents that already exist.

                ShortRelationships to other compositions/documents
                Comments

                To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
                When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
                Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

                "relatesTo": [{
                  "type": "replaces",
                  "resourceReference": {
                    "identifier": { 
                      "system": "...", 
                      "value": "..."
                    }
                  } 
                }]
                
                Control0..*
                TypeRelatedArtifact
                Is Modifierfalse
                Must Supporttrue
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                188. Composition.relatesTo:interventionGroup.id
                Definition

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

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typeid
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                190. Composition.relatesTo:interventionGroup.extension
                Definition

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

                ShortAdditional content defined by implementations
                Comments

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

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                SlicingThis element introduces a set of slices on Composition.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 192. Composition.relatesTo:interventionGroup.type
                  Definition

                  The type of relationship to the related artifact.

                  Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
                  Comments

                  The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

                  Control1..1
                  BindingThe codes SHALL be taken from RelatedArtifactType
                  (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

                  The type of relationship to the related artifact.

                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Pattern Valuedepends-on
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  194. Composition.relatesTo:interventionGroup.classifier
                  Definition

                  Provides additional classifiers of the related artifact.

                  ShortAdditional classifiers
                  Control0..*
                  BindingFor example codes, see CitationArtifactClassifier
                  (example to http://hl7.org/fhir/ValueSet/citation-artifact-classifier)

                  Additional classifiers for the related artifact.

                  TypeCodeableConcept
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  196. Composition.relatesTo:interventionGroup.label
                  Definition

                  A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

                  ShortShort label
                  Control1..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Pattern ValueIntervention Group
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  198. Composition.relatesTo:interventionGroup.display
                  Definition

                  A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

                  ShortBrief description of the related artifact
                  Control0..1
                  Typestring
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  200. Composition.relatesTo:interventionGroup.citation
                  Definition

                  A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

                  ShortBibliographic citation for the artifact
                  Comments

                  Additional structured information about citations should be captured as extensions.

                  Control0..1
                  Typemarkdown
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  202. Composition.relatesTo:interventionGroup.document
                  Definition

                  The document being referenced, represented as an attachment. This is exclusive with the resource element.

                  ShortWhat document is being referenced
                  Control0..1
                  TypeAttachment
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  204. Composition.relatesTo:interventionGroup.resource
                  Definition

                  The related artifact, such as a library, value set, profile, or other knowledge resource.

                  ShortWhat artifact is being referenced
                  Comments

                  If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

                  Control0..1
                  Typecanonical(Resource)
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  206. Composition.relatesTo:interventionGroup.resourceReference
                  Definition

                  The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

                  ShortWhat artifact, if not a conformance resource
                  Comments

                  If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

                  Control0..1
                  TypeReference(ExposureGroup, ComparatorGroup)
                  Is Modifierfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  208. Composition.relatesTo:interventionGroup.publicationStatus
                  Definition

                  The publication status of the artifact being referred to.

                  Shortdraft | active | retired | unknown
                  Control0..1
                  BindingThe codes SHALL be taken from PublicationStatus
                  (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

                  Publication status of an artifact being referred to.

                  Typecode
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  210. Composition.relatesTo:interventionGroup.publicationDate
                  Definition

                  The date of publication of the artifact being referred to.

                  ShortDate of publication of the artifact being referred to
                  Control0..1
                  Typedate
                  Is Modifierfalse
                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  212. Composition.relatesTo:comparatorGroup
                  Slice NamecomparatorGroup
                  Definition

                  Relationships that this composition has with other compositions or documents that already exist.

                  ShortRelationships to other compositions/documents
                  Comments

                  To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
                  When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
                  Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

                  "relatesTo": [{
                    "type": "replaces",
                    "resourceReference": {
                      "identifier": { 
                        "system": "...", 
                        "value": "..."
                      }
                    } 
                  }]
                  
                  Control0..*
                  TypeRelatedArtifact
                  Is Modifierfalse
                  Must Supporttrue
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  214. Composition.relatesTo:comparatorGroup.id
                  Definition

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

                  ShortUnique id for inter-element referencing
                  Control0..1
                  This element is affected by the following invariants: ele-1
                  Typeid
                  Is Modifierfalse
                  XML FormatIn the XML format, this property is represented as an attribute.
                  Summaryfalse
                  216. Composition.relatesTo:comparatorGroup.extension
                  Definition

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

                  ShortAdditional content defined by implementations
                  Comments

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

                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Summaryfalse
                  Alternate Namesextensions, user content
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  SlicingThis element introduces a set of slices on Composition.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 218. Composition.relatesTo:comparatorGroup.type
                    Definition

                    The type of relationship to the related artifact.

                    Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
                    Comments

                    The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

                    Control1..1
                    BindingThe codes SHALL be taken from RelatedArtifactType
                    (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

                    The type of relationship to the related artifact.

                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Pattern Valuedepends-on
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    220. Composition.relatesTo:comparatorGroup.classifier
                    Definition

                    Provides additional classifiers of the related artifact.

                    ShortAdditional classifiers
                    Control0..*
                    BindingFor example codes, see CitationArtifactClassifier
                    (example to http://hl7.org/fhir/ValueSet/citation-artifact-classifier)

                    Additional classifiers for the related artifact.

                    TypeCodeableConcept
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    222. Composition.relatesTo:comparatorGroup.label
                    Definition

                    A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

                    ShortShort label
                    Control1..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Pattern ValueComparator Group
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    224. Composition.relatesTo:comparatorGroup.display
                    Definition

                    A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

                    ShortBrief description of the related artifact
                    Control0..1
                    Typestring
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    226. Composition.relatesTo:comparatorGroup.citation
                    Definition

                    A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

                    ShortBibliographic citation for the artifact
                    Comments

                    Additional structured information about citations should be captured as extensions.

                    Control0..1
                    Typemarkdown
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    228. Composition.relatesTo:comparatorGroup.document
                    Definition

                    The document being referenced, represented as an attachment. This is exclusive with the resource element.

                    ShortWhat document is being referenced
                    Control0..1
                    TypeAttachment
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    230. Composition.relatesTo:comparatorGroup.resource
                    Definition

                    The related artifact, such as a library, value set, profile, or other knowledge resource.

                    ShortWhat artifact is being referenced
                    Comments

                    If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

                    Control0..1
                    Typecanonical(Resource)
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    232. Composition.relatesTo:comparatorGroup.resourceReference
                    Definition

                    The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

                    ShortWhat artifact, if not a conformance resource
                    Comments

                    If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

                    Control0..1
                    TypeReference(ExposureGroup, ComparatorGroup)
                    Is Modifierfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    234. Composition.relatesTo:comparatorGroup.publicationStatus
                    Definition

                    The publication status of the artifact being referred to.

                    Shortdraft | active | retired | unknown
                    Control0..1
                    BindingThe codes SHALL be taken from PublicationStatus
                    (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

                    Publication status of an artifact being referred to.

                    Typecode
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    236. Composition.relatesTo:comparatorGroup.publicationDate
                    Definition

                    The date of publication of the artifact being referred to.

                    ShortDate of publication of the artifact being referred to
                    Control0..1
                    Typedate
                    Is Modifierfalse
                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    238. Composition.relatesTo:totalGroup
                    Slice NametotalGroup
                    Definition

                    Relationships that this composition has with other compositions or documents that already exist.

                    ShortRelationships to other compositions/documents
                    Comments

                    To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
                    When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
                    Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

                    "relatesTo": [{
                      "type": "replaces",
                      "resourceReference": {
                        "identifier": { 
                          "system": "...", 
                          "value": "..."
                        }
                      } 
                    }]
                    
                    Control0..1
                    TypeRelatedArtifact
                    Is Modifierfalse
                    Must Supporttrue
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    240. Composition.relatesTo:totalGroup.id
                    Definition

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

                    ShortUnique id for inter-element referencing
                    Control0..1
                    This element is affected by the following invariants: ele-1
                    Typeid
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    242. Composition.relatesTo:totalGroup.extension
                    Definition

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

                    ShortAdditional content defined by implementations
                    Comments

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

                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    Summaryfalse
                    Alternate Namesextensions, user content
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    SlicingThis element introduces a set of slices on Composition.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 244. Composition.relatesTo:totalGroup.type
                      Definition

                      The type of relationship to the related artifact.

                      Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
                      Comments

                      The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

                      Control1..1
                      BindingThe codes SHALL be taken from RelatedArtifactType
                      (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

                      The type of relationship to the related artifact.

                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Pattern Valuedepends-on
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      246. Composition.relatesTo:totalGroup.classifier
                      Definition

                      Provides additional classifiers of the related artifact.

                      ShortAdditional classifiers
                      Control0..*
                      BindingFor example codes, see CitationArtifactClassifier
                      (example to http://hl7.org/fhir/ValueSet/citation-artifact-classifier)

                      Additional classifiers for the related artifact.

                      TypeCodeableConcept
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      248. Composition.relatesTo:totalGroup.label
                      Definition

                      A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

                      ShortShort label
                      Control1..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Pattern ValueTotal Group
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      250. Composition.relatesTo:totalGroup.display
                      Definition

                      A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

                      ShortBrief description of the related artifact
                      Control0..1
                      Typestring
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      252. Composition.relatesTo:totalGroup.citation
                      Definition

                      A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

                      ShortBibliographic citation for the artifact
                      Comments

                      Additional structured information about citations should be captured as extensions.

                      Control0..1
                      Typemarkdown
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      254. Composition.relatesTo:totalGroup.document
                      Definition

                      The document being referenced, represented as an attachment. This is exclusive with the resource element.

                      ShortWhat document is being referenced
                      Control0..1
                      TypeAttachment
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      256. Composition.relatesTo:totalGroup.resource
                      Definition

                      The related artifact, such as a library, value set, profile, or other knowledge resource.

                      ShortWhat artifact is being referenced
                      Comments

                      If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

                      Control0..1
                      Typecanonical(Resource)
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      258. Composition.relatesTo:totalGroup.resourceReference
                      Definition

                      The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

                      ShortWhat artifact, if not a conformance resource
                      Comments

                      If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

                      Control0..1
                      TypeReference(StudyGroup)
                      Is Modifierfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      260. Composition.relatesTo:totalGroup.publicationStatus
                      Definition

                      The publication status of the artifact being referred to.

                      Shortdraft | active | retired | unknown
                      Control0..1
                      BindingThe codes SHALL be taken from PublicationStatus
                      (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

                      Publication status of an artifact being referred to.

                      Typecode
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      262. Composition.relatesTo:totalGroup.publicationDate
                      Definition

                      The date of publication of the artifact being referred to.

                      ShortDate of publication of the artifact being referred to
                      Control0..1
                      Typedate
                      Is Modifierfalse
                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      264. Composition.relatesTo:groupAssignment
                      Slice NamegroupAssignment
                      Definition

                      Relationships that this composition has with other compositions or documents that already exist.

                      ShortRelationships to other compositions/documents
                      Comments

                      To reference (using relatesTo) a Bundle of type "document" or another Composition where you only have the identifier, use a resourceReference with an identifier.
                      When a Composition is an alternate representation of another type of document e.g. CDA, the other document could be referenced in a DocumentReference resource.
                      Here is an example of using relatesTo to reference another Bundle of type "document" or Composition where you only have the identifier:

                      "relatesTo": [{
                        "type": "replaces",
                        "resourceReference": {
                          "identifier": { 
                            "system": "...", 
                            "value": "..."
                          }
                        } 
                      }]
                      
                      Control0..*
                      TypeRelatedArtifact
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      266. Composition.relatesTo:groupAssignment.id
                      Definition

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

                      ShortUnique id for inter-element referencing
                      Control0..1
                      This element is affected by the following invariants: ele-1
                      Typeid
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      268. Composition.relatesTo:groupAssignment.extension
                      Definition

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

                      ShortAdditional content defined by implementations
                      Comments

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

                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      Summaryfalse
                      Alternate Namesextensions, user content
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      SlicingThis element introduces a set of slices on Composition.relatesTo.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 270. Composition.relatesTo:groupAssignment.type
                        Definition

                        The type of relationship to the related artifact.

                        Shortdocumentation | justification | citation | predecessor | successor | derived-from | depends-on | composed-of | part-of | amends | amended-with | appends | appended-with | cites | cited-by | comments-on | comment-in | contains | contained-in | corrects | correction-in | replaces | replaced-with | retracts | retracted-by | signs | similar-to | supports | supported-with | transforms | transformed-into | transformed-with | documents | specification-of | created-with | cite-as
                        Comments

                        The presence of both sides of a relationship type (e.g. successor and predecessor) is required to support use cases where one side of a relationship is not represented in FHIR. However, this feature SHALL NOT be used to create bi-directional resource links in FHIR instances. Specifically, following the methodology of "new points to old" and "many points to one", when using related artifact elements to describe and reference FHIR resources, the type element SHALL be drawn from the fhir-related-artifact-type ValueSet.

                        Control1..1
                        BindingThe codes SHALL be taken from RelatedArtifactType
                        (required to http://hl7.org/fhir/ValueSet/related-artifact-type|6.0.0-ballot2)

                        The type of relationship to the related artifact.

                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Pattern Valuecomposed-of
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        272. Composition.relatesTo:groupAssignment.classifier
                        Definition

                        Provides additional classifiers of the related artifact.

                        ShortAdditional classifiers
                        Control0..*
                        BindingFor example codes, see CitationArtifactClassifier
                        (example to http://hl7.org/fhir/ValueSet/citation-artifact-classifier)

                        Additional classifiers for the related artifact.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        274. Composition.relatesTo:groupAssignment.label
                        Definition

                        A short label that can be used to reference the citation from elsewhere in the containing artifact, such as a footnote index.

                        ShortShort label
                        Control1..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Pattern ValueGroup Assignment
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        276. Composition.relatesTo:groupAssignment.display
                        Definition

                        A brief description of the document or knowledge resource being referenced, suitable for display to a consumer.

                        ShortBrief description of the related artifact
                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        278. Composition.relatesTo:groupAssignment.citation
                        Definition

                        A bibliographic citation for the related artifact. This text SHOULD be formatted according to an accepted citation format.

                        ShortBibliographic citation for the artifact
                        Comments

                        Additional structured information about citations should be captured as extensions.

                        Control0..1
                        Typemarkdown
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        280. Composition.relatesTo:groupAssignment.document
                        Definition

                        The document being referenced, represented as an attachment. This is exclusive with the resource element.

                        ShortWhat document is being referenced
                        Control0..1
                        TypeAttachment
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        282. Composition.relatesTo:groupAssignment.resource
                        Definition

                        The related artifact, such as a library, value set, profile, or other knowledge resource.

                        ShortWhat artifact is being referenced
                        Comments

                        If the type is predecessor, this is a reference to the succeeding knowledge resource. If the type is successor, this is a reference to the prior knowledge resource.

                        Control0..1
                        Typecanonical(Resource)
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        284. Composition.relatesTo:groupAssignment.resourceReference
                        Definition

                        The related artifact, if the artifact is not a canonical resource, or a resource reference to a canonical resource.

                        ShortWhat artifact, if not a conformance resource
                        Comments

                        If both resource and resourceReference are present, they SHOULD be consistent and reference the same resource. Although relatedArtifact is intended to support references to definitional resources, there are cases where non-definitional resources can be definitional (such as Location where the kind is mode). Related artifacts SHOULD be used to reference definitional resources, and profiles SHOULD be used to make that explicit for particular use cases.

                        Control0..1
                        TypeReference(GroupAssignment)
                        Is Modifierfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        286. Composition.relatesTo:groupAssignment.publicationStatus
                        Definition

                        The publication status of the artifact being referred to.

                        Shortdraft | active | retired | unknown
                        Control0..1
                        BindingThe codes SHALL be taken from PublicationStatus
                        (required to http://hl7.org/fhir/ValueSet/publication-status|6.0.0-ballot2)

                        Publication status of an artifact being referred to.

                        Typecode
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        288. Composition.relatesTo:groupAssignment.publicationDate
                        Definition

                        The date of publication of the artifact being referred to.

                        ShortDate of publication of the artifact being referred to
                        Control0..1
                        Typedate
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        290. Composition.event
                        Definition

                        The clinical service, such as a colonoscopy or an appendectomy, being documented.

                        ShortThe clinical service(s) being documented
                        Comments

                        The event needs to be consistent with the type element, though can provide further information if desired.

                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supportfalse
                        Summarytrue
                        Requirements

                        Provides context for the composition and creates a linkage between a resource describing an event and the composition created describing the event.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        292. Composition.event.id
                        Definition

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

                        ShortUnique id for inter-element referencing
                        Control0..1
                        This element is affected by the following invariants: ele-1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        294. Composition.event.extension
                        Definition

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

                        ShortAdditional content defined by implementations
                        Comments

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

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        296. Composition.event.modifierExtension
                        Definition

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

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

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

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

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

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

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        298. Composition.event.period
                        Definition

                        The period of time covered by the documentation. There is no assertion that the documentation is a complete representation for this period, only that it documents events during this time.

                        ShortThe period covered by the documentation
                        Control0..1
                        TypePeriod
                        Is Modifierfalse
                        Must Supportfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        300. Composition.event.detail
                        Definition

                        Represents the main clinical acts, such as a colonoscopy or an appendectomy, being documented. In some cases, the event is inherent in the typeCode, such as a "History and Physical Report" in which case the procedure being documented is necessarily a "History and Physical" act. The events may be included as a code or as a reference to an other resource.

                        ShortThe event(s) being documented, as code(s), reference(s), or both
                        Comments

                        An event can further specialize the act inherent in the typeCode, such as where it is simply "Procedure Report" and the procedure was a "colonoscopy". If one or more events are included, they SHALL NOT conflict with the values inherent in the classCode, practiceSettingCode or typeCode, as such a conflict would create an ambiguous situation. This short list of codes is provided to be used as key words for certain types of queries.

                        Control0..*
                        BindingFor example codes, see v3 Code System ActCode
                        (example to http://terminology.hl7.org/ValueSet/v3-ActCode)

                        This list of codes represents the main clinical acts being documented.

                        TypeCodeableReference(Resource)
                        Is Modifierfalse
                        Must Supportfalse
                        Summarytrue
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        302. Composition.section
                        Definition

                        The root of the sections that make up the composition.

                        ShortComposition is broken into sections
                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantscmp-1: A section must contain at least one of text, entries, or sub-sections (text.exists() or entry.exists() or section.exists())
                        cmp-2: A section can only have an emptyReason if it is empty (emptyReason.empty() or entry.empty())
                        ele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        304. Composition.section.id
                        Definition

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

                        ShortUnique id for inter-element referencing
                        Control0..1
                        This element is affected by the following invariants: ele-1
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        306. Composition.section.extension
                        Definition

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

                        ShortAdditional content defined by implementations
                        Comments

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

                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        Summaryfalse
                        Alternate Namesextensions, user content
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        308. Composition.section.modifierExtension
                        Definition

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

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

                        ShortExtensions that cannot be ignored even if unrecognized
                        Comments

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

                        Control0..*
                        TypeExtension
                        Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                        Summarytrue
                        Requirements

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

                        Alternate Namesextensions, user content, modifiers
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        310. Composition.section.title
                        Definition

                        The label for this particular section. This will be part of the rendered content for the document, and is often used to build a table of contents.

                        ShortLabel for section (e.g. for ToC)
                        Comments

                        The title identifies the section for a human reader. The title must be consistent with the narrative of the resource that is the target of the section.content reference. Generally, sections SHOULD have titles, but in some documents, it is unnecessary or inappropriate. Typically, this is where a section has subsections that have their own adequately distinguishing title, or documents that only have a single section. Most Implementation Guides will make section title to be a required element.

                        Control0..1
                        Typestring
                        Is Modifierfalse
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Section headings are often standardized for different types of documents. They give guidance to humans on how the document is organized.

                        Alternate Namesheader, label, caption
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        312. Composition.section.code
                        Definition

                        A code identifying the kind of content contained within the section. This must be consistent with the section title.

                        ShortClassification of section (recommended)
                        Comments

                        The code identifies the section for an automated processor of the document. This is particularly relevant when using profiles to control the structure of the document.

                        If the section has content (instead of sub-sections), the section.code does not change the meaning or interpretation of the resource that is the content of the section in the comments for the section.code.

                        Control0..1
                        BindingUnless not suitable, these codes SHALL be taken from EvidenceReportSectionCode Value Set
                        (extensible to https://fevir.net/resources/ValueSet/179431)
                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Provides computable standardized labels to topics within the document.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        314. Composition.section.author
                        Definition

                        Identifies who is responsible for the information in this section, not necessarily who typed it in.

                        ShortWho and/or what authored the section
                        Control0..*
                        TypeReference(Practitioner, PractitionerRole, Device, Patient, RelatedPerson, Organization)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Identifies who is responsible for the content.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        316. Composition.section.focus
                        Definition

                        The actual focus of the section when it is not the subject of the composition, but instead represents something or someone associated with the subject such as (for a patient subject) a spouse, parent, fetus, or donor. If not focus is specified, the focus is assumed to be focus of the parent section, or, for a section in the Composition itself, the subject of the composition. Sections with a focus SHALL only include resources where the logical subject (patient, subject, focus, etc.) matches the section focus, or the resources have no logical subject (few resources).

                        ShortWho/what the section is about, when it is not about the subject of composition
                        Comments

                        Typically, sections in a doument are about the subject of the document, whether that is a patient, or group of patients, location, or device, or whatever. For some kind of documents, some sections actually contain data about related entities. Typical examples are a section in a newborn discharge summary concerning the mother, or family history documents, with a section about each family member, though there are many other examples.

                        Control0..1
                        TypeReference(Resource)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        318. Composition.section.text
                        Definition

                        A human-readable narrative that contains the attested content of the section, used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative.

                        ShortText summary of the section, for human interpretation
                        Comments

                        Document profiles may define what content should be represented in the narrative to ensure clinical safety.

                        Control0..1
                        This element is affected by the following invariants: cmp-1
                        TypeNarrative
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        320. Composition.section.orderedBy
                        Definition

                        Specifies the order applied to the items in the section entries.

                        ShortOrder of section entries
                        Comments

                        Applications SHOULD render ordered lists in the order provided, but MAY allow users to re-order based on their own preferences as well. If there is no order specified, the order is unknown, though there may still be some order.

                        Control0..1
                        BindingThe codes SHOULD be taken from ListOrderCodes
                        (preferred to http://hl7.org/fhir/ValueSet/list-order)

                        What order applies to the items in the entry.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Important for presentation and rendering. Lists may be sorted to place more important information first or to group related entries.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        322. Composition.section.entry
                        Definition

                        A reference to the actual resource from which the narrative in the section is derived.

                        ShortA reference to data that supports this section
                        Comments

                        If there are no entries in the list, an emptyReason SHOULD be provided.

                        Control0..*
                        This element is affected by the following invariants: cmp-1, cmp-2
                        TypeReference(Resource)
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        324. Composition.section.emptyReason
                        Definition

                        If the section is empty, why the list is empty. An empty section typically has some text explaining the empty reason.

                        ShortWhy the section is empty
                        Comments

                        The various reasons for an empty section make a significant interpretation to its interpretation. Note that this code is for use when the entire section content has been suppressed, and not for when individual items are omitted - implementers may consider using a text note or a flag on an entry in these cases.

                        Control0..1
                        This element is affected by the following invariants: cmp-2
                        BindingThe codes SHOULD be taken from ListEmptyReasons
                        (preferred to http://hl7.org/fhir/ValueSet/list-empty-reason)

                        If a section is empty, why it is empty.

                        TypeCodeableConcept
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Requirements

                        Allows capturing things like "none exist" or "not asked" which can be important for most lists.

                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        326. Composition.section.section
                        Definition

                        A nested sub-section within this section.

                        ShortNested Section
                        Comments

                        Nested sections are primarily used to help human readers navigate to particular portions of the document.

                        Control0..*
                        TypeSeettp://hl7.org/fhir/StructureDefinition/Composition#Composition.section
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))