Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot2 - STU 1 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 1.0.0-ballot2 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: EvidenceReport - Detailed Descriptions

Page standards status: Trial-use Maturity Level: 1

Definitions for the evidence-report resource profile.

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

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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

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
Definition

An Extension


May be used to represent additional information that is not part of the basic definition of the resource. 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.

ShortExtensionAdditional 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
Must Supportfalse
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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. 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
    Summaryfalse
    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: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
    Summaryfalse
    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: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
    Summaryfalse
    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: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
    Summaryfalse
    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: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
    Summaryfalse
    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: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
    Summaryfalse
    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:approvalDate
    Slice NameapprovalDate
    Definition

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

    ShortWhen the artifact was approved by publisher
    Comments

    The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.

    Control0..1
    TypeExtension(Artifact Approval Date) (Extension Type: date)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    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: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 artifact was approved by publisher
    Comments

    If specified, this date follows the original approval date.

    Control0..1
    TypeExtension(Artifact Last Review Date) (Extension Type: date)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    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:effectivePeriod
    Slice NameeffectivePeriod
    Definition

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

    ShortWhen the artifact is expected to be used
    Comments

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

    Control0..1
    TypeExtension(Artifact Effective Period) (Extension Type: Period)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    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:additionalLanguage
    Slice NameadditionalLanguage
    Definition

    The Resource contains content in a language additional to the one in the language element.

    ShortThe additional language
    Control0..*
    TypeExtension(Additional Language) (Extension Type: code)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    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:extendedContactDetail
    Slice NameextendedContactDetail
    Definition

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

    ShortContact details for the publisher
    Comments

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

    Control0..*
    TypeExtension(Artifact Extended Contact Detail) (Extension Type: ExtendedContactDetail)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    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:publicationDate
    Slice NamepublicationDate
    Definition

    Specifies the publication date of the Resource.

    ShortPublication date of Resource
    Control0..1
    TypeExtension(Publication Date) (Extension Type: date)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    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:publicationStatus
    Slice NamepublicationStatus
    Definition

    The status of the processing for making the artifact publicly available, not necessarily the same as artifact status (Resource.status).

    ShortPublication status
    Control0..1
    TypeExtension(ArtifactPublicationStatus) (Extension Type: CodeableConcept)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    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.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-ballot3
    (required to http://hl7.org/fhir/ValueSet/composition-status|6.0.0-ballot3)

    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()))
    38. 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()))
    40. 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 Citation Resource, ArtifactAssessment Resource (Classification Profile), Group Resource (EvidenceReportSubject Profile), ReserchStudy Resource, or any Resource to define a subject of this EvidenceReport.


    For clinical documents, this is usually the patient.

    Control0..*
    TypeReference(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()))
    42. 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()))
    44. 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, CareTeam, 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()))
    46. 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()))
    48. Composition.relatesTo
    Definition

    Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
      "targetReference": {
        "identifier": { 
          "system": "...", 
          "value": "..."
        }
      } 
    }]
    
    Control0..*
    TypeBackboneElement
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children or both (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 @ type
    • 50. Composition.relatesTo.extension
      Definition

      An Extension


      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.

      ShortExtensionAdditional 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
      • 52. Composition.relatesTo.extension:classifier
        Slice Nameclassifier
        Definition

        Provides additional classifiers of the related artifact.

        ShortAdditional classifiers for RelatedArtifacts
        Control0..1
        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        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())
        54. Composition.relatesTo.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()))
        56. Composition.relatesTo.type
        Definition

        The type of relationship to the related artifact.

        Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
        Control1..1
        BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

        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
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        58. Composition.relatesTo.target[x]
        Definition

        The artifact that is related to this Composition Resource.

        ShortThe artifact that is related to this Composition
        Control1..1
        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        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()))
        60. Composition.relatesTo:citeAs
        Slice NameciteAs
        Definition

        Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
          "targetReference": {
            "identifier": { 
              "system": "...", 
              "value": "..."
            }
          } 
        }]
        
        Control0..1*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        62. Composition.relatesTo:citeAs.extension:classifier
        Slice Nameclassifier
        Definition

        Provides additional classifiers of the related artifact.

        ShortAdditional classifiers for RelatedArtifacts
        Control0..1
        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        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())
        64. Composition.relatesTo:citeAs.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()))
        66. Composition.relatesTo:citeAs.type
        Definition

        The type of relationship to the related artifact.

        Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
        Control1..1
        BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

        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
        Must Supportfalse
        Summaryfalse
        Pattern Valuecite-as
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        68. Composition.relatesTo:citeAs.target[x]
        Definition

        The artifact that is related to this Composition Resource.

        ShortThe artifact that is related to this Composition
        Control1..1
        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        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()))
        70. Composition.relatesTo:partOf
        Slice NamepartOf
        Definition

        Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
          "targetReference": {
            "identifier": { 
              "system": "...", 
              "value": "..."
            }
          } 
        }]
        
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        72. Composition.relatesTo:partOf.extension:classifier
        Slice Nameclassifier
        Definition

        Provides additional classifiers of the related artifact.

        ShortAdditional classifiers for RelatedArtifacts
        Control0..1
        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        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())
        74. Composition.relatesTo:partOf.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()))
        76. Composition.relatesTo:partOf.type
        Definition

        The type of relationship to the related artifact.

        Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
        Control1..1
        BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

        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
        Must Supportfalse
        Summaryfalse
        Pattern Valuepart-of
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        78. Composition.relatesTo:partOf.target[x]
        Definition

        The artifact that is related to this Composition Resource.

        ShortThe artifact that is related to this Composition
        Control1..1
        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        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()))
        80. Composition.relatesTo:derivedFrom
        Slice NamederivedFrom
        Definition

        Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
          "targetReference": {
            "identifier": { 
              "system": "...", 
              "value": "..."
            }
          } 
        }]
        
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        82. Composition.relatesTo:derivedFrom.extension:classifier
        Slice Nameclassifier
        Definition

        Provides additional classifiers of the related artifact.

        ShortAdditional classifiers for RelatedArtifacts
        Control0..1
        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        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())
        84. Composition.relatesTo:derivedFrom.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()))
        86. Composition.relatesTo:derivedFrom.type
        Definition

        The type of relationship to the related artifact.

        Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
        Control1..1
        BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

        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
        Must Supportfalse
        Summaryfalse
        Pattern Valuederived-from
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        88. Composition.relatesTo:derivedFrom.target[x]
        Definition

        The artifact that is related to this Composition Resource.

        ShortThe artifact that is related to this Composition
        Control1..1
        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        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()))
        90. Composition.relatesTo:specificationOf
        Slice NamespecificationOf
        Definition

        Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
          "targetReference": {
            "identifier": { 
              "system": "...", 
              "value": "..."
            }
          } 
        }]
        
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        92. Composition.relatesTo:specificationOf.extension:classifier
        Slice Nameclassifier
        Definition

        Provides additional classifiers of the related artifact.

        ShortAdditional classifiers for RelatedArtifacts
        Control0..1
        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        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())
        94. Composition.relatesTo:specificationOf.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()))
        96. Composition.relatesTo:specificationOf.type
        Definition

        The type of relationship to the related artifact.

        Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
        Control1..1
        BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

        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
        Must Supportfalse
        Summaryfalse
        Pattern Valuespecification-of
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        98. Composition.relatesTo:specificationOf.target[x]
        Definition

        The artifact that is related to this Composition Resource.

        ShortThe artifact that is related to this Composition
        Control1..1
        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        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()))
        100. Composition.relatesTo:dependsOn
        Slice NamedependsOn
        Definition

        Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
          "targetReference": {
            "identifier": { 
              "system": "...", 
              "value": "..."
            }
          } 
        }]
        
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        102. Composition.relatesTo:dependsOn.extension:classifier
        Slice Nameclassifier
        Definition

        Provides additional classifiers of the related artifact.

        ShortAdditional classifiers for RelatedArtifacts
        Control0..1
        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        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())
        104. Composition.relatesTo:dependsOn.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()))
        106. Composition.relatesTo:dependsOn.type
        Definition

        The type of relationship to the related artifact.

        Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
        Control1..1
        BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

        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
        Must Supportfalse
        Summaryfalse
        Pattern Valuedepends-on
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        108. Composition.relatesTo:dependsOn.target[x]
        Definition

        The artifact that is related to this Composition Resource.

        ShortThe artifact that is related to this Composition
        Control1..1
        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        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()))
        110. Composition.relatesTo:supportedWith
        Slice NamesupportedWith
        Definition

        Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
          "targetReference": {
            "identifier": { 
              "system": "...", 
              "value": "..."
            }
          } 
        }]
        
        Control0..*
        TypeBackboneElement
        Is Modifierfalse
        Must Supportfalse
        Summaryfalse
        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
        112. Composition.relatesTo:supportedWith.extension:classifier
        Slice Nameclassifier
        Definition

        Provides additional classifiers of the related artifact.

        ShortAdditional classifiers for RelatedArtifacts
        Control0..1
        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
        Is Modifierfalse
        Summaryfalse
        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())
        114. Composition.relatesTo:supportedWith.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()))
        116. Composition.relatesTo:supportedWith.type
        Definition

        The type of relationship to the related artifact.

        Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
        Control1..1
        BindingThe codes SHALL be taken from ArtifactRelationshipTypehttp://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3
        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

        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
        Must Supportfalse
        Summaryfalse
        Pattern Valuesupported-with
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        118. Composition.relatesTo:supportedWith.target[x]
        Definition

        The artifact that is related to this Composition Resource.

        ShortThe artifact that is related to this Composition
        Control1..1
        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
        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()))

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

        0. Composition
        2. Composition.extension
        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
        • 4. Composition.extension:versionAlgorithm
          Slice NameversionAlgorithm
          Control0..1
          TypeExtension(Artifact Version Algorithm) (Extension Type: Choice of: string, Coding)
          6. Composition.extension:experimental
          Slice Nameexperimental
          Control0..1
          TypeExtension(Artifact Experimental) (Extension Type: boolean)
          8. Composition.extension:description
          Slice Namedescription
          Control0..1
          TypeExtension(Artifact Description) (Extension Type: markdown)
          10. Composition.extension:purpose
          Slice Namepurpose
          Control0..1
          TypeExtension(Artifact Purpose) (Extension Type: markdown)
          12. Composition.extension:copyright
          Slice Namecopyright
          Control0..1
          TypeExtension(Artifact Copyright) (Extension Type: markdown)
          14. Composition.extension:copyrightLabel
          Slice NamecopyrightLabel
          Control0..1
          TypeExtension(Artifact Copyright Label) (Extension Type: string)
          16. Composition.extension:approvalDate
          Slice NameapprovalDate
          Control0..1
          TypeExtension(Artifact Approval Date) (Extension Type: date)
          18. Composition.extension:lastReviewDate
          Slice NamelastReviewDate
          Control0..1
          TypeExtension(Artifact Last Review Date) (Extension Type: date)
          20. Composition.extension:effectivePeriod
          Slice NameeffectivePeriod
          Control0..1
          TypeExtension(Artifact Effective Period) (Extension Type: Period)
          22. Composition.extension:additionalLanguage
          Slice NameadditionalLanguage
          Control0..*
          TypeExtension(Additional Language) (Extension Type: code)
          24. Composition.extension:extendedContactDetail
          Slice NameextendedContactDetail
          Control0..*
          TypeExtension(Artifact Extended Contact Detail) (Extension Type: ExtendedContactDetail)
          26. Composition.extension:publicationDate
          Slice NamepublicationDate
          Control0..1
          TypeExtension(Publication Date) (Extension Type: date)
          28. Composition.extension:publicationStatus
          Slice NamepublicationStatus
          Control0..1
          TypeExtension(ArtifactPublicationStatus) (Extension Type: CodeableConcept)
          30. Composition.subject
          Comments

          Reference a Citation Resource, ArtifactAssessment Resource (Classification Profile), Group Resource (EvidenceReportSubject Profile), ReserchStudy Resource, or any Resource to define a subject of this EvidenceReport.

          32. Composition.attester
          34. Composition.attester.mode
          Shortreviewer | editor | endorser | informant | recorder
          BindingThe codes SHOULD be taken from Contributor Role
          (preferred to http://terminology.hl7.org/ValueSet/contributor-role)
          36. Composition.relatesTo
          SlicingThis element introduces a set of slices on Composition.relatesTo. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ type
          • 38. Composition.relatesTo.extension
            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
            • 40. Composition.relatesTo.extension:classifier
              Slice Nameclassifier
              Control0..1
              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
              42. Composition.relatesTo:citeAs
              Slice NameciteAs
              Control0..1
              44. Composition.relatesTo:citeAs.extension:classifier
              Slice Nameclassifier
              Control0..1
              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
              46. Composition.relatesTo:citeAs.type
              Pattern Valuecite-as
              48. Composition.relatesTo:partOf
              Slice NamepartOf
              Control0..*
              50. Composition.relatesTo:partOf.extension:classifier
              Slice Nameclassifier
              Control0..1
              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
              52. Composition.relatesTo:partOf.type
              Pattern Valuepart-of
              54. Composition.relatesTo:derivedFrom
              Slice NamederivedFrom
              Control0..*
              56. Composition.relatesTo:derivedFrom.extension:classifier
              Slice Nameclassifier
              Control0..1
              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
              58. Composition.relatesTo:derivedFrom.type
              Pattern Valuederived-from
              60. Composition.relatesTo:specificationOf
              Slice NamespecificationOf
              Control0..*
              62. Composition.relatesTo:specificationOf.extension:classifier
              Slice Nameclassifier
              Control0..1
              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
              64. Composition.relatesTo:specificationOf.type
              Pattern Valuespecification-of
              66. Composition.relatesTo:dependsOn
              Slice NamedependsOn
              Control0..*
              68. Composition.relatesTo:dependsOn.extension:classifier
              Slice Nameclassifier
              Control0..1
              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
              70. Composition.relatesTo:dependsOn.type
              Pattern Valuedepends-on
              72. Composition.relatesTo:supportedWith
              Slice NamesupportedWith
              Control0..*
              74. Composition.relatesTo:supportedWith.extension:classifier
              Slice Nameclassifier
              Control0..1
              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
              76. Composition.relatesTo:supportedWith.type
              Pattern Valuesupported-with
              78. Composition.section
              80. Composition.section.code
              BindingUnless not suitable, these codes SHALL be taken from EvidenceReportSectionCode Value Set
              (extensible to https://fevir.net/resources/ValueSet/179431)

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

              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.trace('id') in %resource.descendants().select(reference | as(uri))) or descendants().where(reference='#' | as(uri)='#').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-ballot3)

              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. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

              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
                Summaryfalse
                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
                Summaryfalse
                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
                Summaryfalse
                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
                Summaryfalse
                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
                Summaryfalse
                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
                Summaryfalse
                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 artifact content was approved by the publisher. Approval happens once when the content is officially approved for usage.

                ShortWhen the artifact was approved by publisher
                Comments

                The 'date' element may be more recent than the approval date because of minor changes or editorial corrections.

                Control0..1
                TypeExtension(Artifact Approval Date) (Extension Type: date)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                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 artifact was approved by publisher
                Comments

                If specified, this date follows the original approval date.

                Control0..1
                TypeExtension(Artifact Last Review Date) (Extension Type: date)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                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 artifact content was or is planned to be in active use.

                ShortWhen the artifact is expected to be used
                Comments

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

                Control0..1
                TypeExtension(Artifact Effective Period) (Extension Type: Period)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                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.extension:additionalLanguage
                Slice NameadditionalLanguage
                Definition

                The Resource contains content in a language additional to the one in the language element.

                ShortThe additional language
                Control0..*
                TypeExtension(Additional Language) (Extension Type: code)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                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())
                36. Composition.extension:extendedContactDetail
                Slice NameextendedContactDetail
                Definition

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

                ShortContact details for the publisher
                Comments

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

                Control0..*
                TypeExtension(Artifact Extended Contact Detail) (Extension Type: ExtendedContactDetail)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                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())
                38. Composition.extension:publicationDate
                Slice NamepublicationDate
                Definition

                Specifies the publication date of the Resource.

                ShortPublication date of Resource
                Control0..1
                TypeExtension(Publication Date) (Extension Type: date)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                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())
                40. Composition.extension:publicationStatus
                Slice NamepublicationStatus
                Definition

                The status of the processing for making the artifact publicly available, not necessarily the same as artifact status (Resource.status).

                ShortPublication status
                Control0..1
                TypeExtension(ArtifactPublicationStatus) (Extension Type: CodeableConcept)
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                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())
                42. 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()))
                44. 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()))
                46. 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()))
                48. 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()))
                50. 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-ballot3)

                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()))
                52. 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()))
                54. 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()))
                56. 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 Citation Resource, ArtifactAssessment Resource (Classification Profile), Group Resource (EvidenceReportSubject Profile), ReserchStudy Resource, or any Resource to define a subject of this EvidenceReport.

                Control0..*
                TypeReference(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()))
                58. 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()))
                60. 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()))
                62. 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()))
                64. 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, CareTeam, 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()))
                66. 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()))
                68. 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()))
                70. 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()))
                72. 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 or both (hasValue() or (children().count() > id.count()))
                74. 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
                76. 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()))
                78. 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()))
                80. Composition.attester.mode
                Definition

                The type of attestation the authenticator offers.

                Shortreviewer | editor | endorser | informant | recorder
                Control1..1
                BindingThe codes SHOULD be taken from Contributor Role
                (preferred to http://terminology.hl7.org/ValueSet/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()))
                82. 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()))
                84. 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()))
                86. 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()))
                88. Composition.relatesTo
                Definition

                Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
                  "targetReference": {
                    "identifier": { 
                      "system": "...", 
                      "value": "..."
                    }
                  } 
                }]
                
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children or both (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 @ type
                • 90. Composition.relatesTo.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
                  92. Composition.relatesTo.extension
                  Definition

                  An Extension

                  ShortExtension
                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 94. Composition.relatesTo.extension:classifier
                    Slice Nameclassifier
                    Definition

                    Provides additional classifiers of the related artifact.

                    ShortAdditional classifiers for RelatedArtifacts
                    Control0..1
                    TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                    Is Modifierfalse
                    Summaryfalse
                    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())
                    96. Composition.relatesTo.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()))
                    98. Composition.relatesTo.type
                    Definition

                    The type of relationship to the related artifact.

                    Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
                    Control1..1
                    BindingThe codes SHALL be taken from ArtifactRelationshipType
                    (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                    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
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    100. Composition.relatesTo.target[x]
                    Definition

                    The artifact that is related to this Composition Resource.

                    ShortThe artifact that is related to this Composition
                    Control1..1
                    TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                    [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                    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()))
                    102. Composition.relatesTo:citeAs
                    Slice NameciteAs
                    Definition

                    Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
                      "targetReference": {
                        "identifier": { 
                          "system": "...", 
                          "value": "..."
                        }
                      } 
                    }]
                    
                    Control0..1
                    TypeBackboneElement
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                    104. 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
                    Typestring
                    Is Modifierfalse
                    XML FormatIn the XML format, this property is represented as an attribute.
                    Summaryfalse
                    106. Composition.relatesTo:citeAs.extension
                    Definition

                    An Extension

                    ShortExtension
                    Control0..*
                    TypeExtension
                    Is Modifierfalse
                    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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                    • value @ url
                    • 108. Composition.relatesTo:citeAs.extension:classifier
                      Slice Nameclassifier
                      Definition

                      Provides additional classifiers of the related artifact.

                      ShortAdditional classifiers for RelatedArtifacts
                      Control0..1
                      TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                      Is Modifierfalse
                      Summaryfalse
                      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())
                      110. Composition.relatesTo:citeAs.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()))
                      112. Composition.relatesTo:citeAs.type
                      Definition

                      The type of relationship to the related artifact.

                      Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
                      Control1..1
                      BindingThe codes SHALL be taken from ArtifactRelationshipType
                      (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                      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
                      Must Supportfalse
                      Summaryfalse
                      Pattern Valuecite-as
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      114. Composition.relatesTo:citeAs.target[x]
                      Definition

                      The artifact that is related to this Composition Resource.

                      ShortThe artifact that is related to this Composition
                      Control1..1
                      TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                      [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                      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()))
                      116. Composition.relatesTo:partOf
                      Slice NamepartOf
                      Definition

                      Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
                        "targetReference": {
                          "identifier": { 
                            "system": "...", 
                            "value": "..."
                          }
                        } 
                      }]
                      
                      Control0..*
                      TypeBackboneElement
                      Is Modifierfalse
                      Must Supportfalse
                      Summaryfalse
                      Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                      118. 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
                      Typestring
                      Is Modifierfalse
                      XML FormatIn the XML format, this property is represented as an attribute.
                      Summaryfalse
                      120. Composition.relatesTo:partOf.extension
                      Definition

                      An Extension

                      ShortExtension
                      Control0..*
                      TypeExtension
                      Is Modifierfalse
                      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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                      • value @ url
                      • 122. Composition.relatesTo:partOf.extension:classifier
                        Slice Nameclassifier
                        Definition

                        Provides additional classifiers of the related artifact.

                        ShortAdditional classifiers for RelatedArtifacts
                        Control0..1
                        TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                        Is Modifierfalse
                        Summaryfalse
                        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())
                        124. Composition.relatesTo:partOf.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()))
                        126. Composition.relatesTo:partOf.type
                        Definition

                        The type of relationship to the related artifact.

                        Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
                        Control1..1
                        BindingThe codes SHALL be taken from ArtifactRelationshipType
                        (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                        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
                        Must Supportfalse
                        Summaryfalse
                        Pattern Valuepart-of
                        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                        128. Composition.relatesTo:partOf.target[x]
                        Definition

                        The artifact that is related to this Composition Resource.

                        ShortThe artifact that is related to this Composition
                        Control1..1
                        TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                        [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                        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()))
                        130. Composition.relatesTo:derivedFrom
                        Slice NamederivedFrom
                        Definition

                        Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
                          "targetReference": {
                            "identifier": { 
                              "system": "...", 
                              "value": "..."
                            }
                          } 
                        }]
                        
                        Control0..*
                        TypeBackboneElement
                        Is Modifierfalse
                        Must Supportfalse
                        Summaryfalse
                        Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                        132. 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
                        Typestring
                        Is Modifierfalse
                        XML FormatIn the XML format, this property is represented as an attribute.
                        Summaryfalse
                        134. Composition.relatesTo:derivedFrom.extension
                        Definition

                        An Extension

                        ShortExtension
                        Control0..*
                        TypeExtension
                        Is Modifierfalse
                        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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 136. Composition.relatesTo:derivedFrom.extension:classifier
                          Slice Nameclassifier
                          Definition

                          Provides additional classifiers of the related artifact.

                          ShortAdditional classifiers for RelatedArtifacts
                          Control0..1
                          TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                          Is Modifierfalse
                          Summaryfalse
                          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())
                          138. Composition.relatesTo:derivedFrom.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()))
                          140. Composition.relatesTo:derivedFrom.type
                          Definition

                          The type of relationship to the related artifact.

                          Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
                          Control1..1
                          BindingThe codes SHALL be taken from ArtifactRelationshipType
                          (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                          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
                          Must Supportfalse
                          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.target[x]
                          Definition

                          The artifact that is related to this Composition Resource.

                          ShortThe artifact that is related to this Composition
                          Control1..1
                          TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                          [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                          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()))
                          144. Composition.relatesTo:specificationOf
                          Slice NamespecificationOf
                          Definition

                          Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
                            "targetReference": {
                              "identifier": { 
                                "system": "...", 
                                "value": "..."
                              }
                            } 
                          }]
                          
                          Control0..*
                          TypeBackboneElement
                          Is Modifierfalse
                          Must Supportfalse
                          Summaryfalse
                          Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                          146. Composition.relatesTo:specificationOf.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
                          148. Composition.relatesTo:specificationOf.extension
                          Definition

                          An Extension

                          ShortExtension
                          Control0..*
                          TypeExtension
                          Is Modifierfalse
                          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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ url
                          • 150. Composition.relatesTo:specificationOf.extension:classifier
                            Slice Nameclassifier
                            Definition

                            Provides additional classifiers of the related artifact.

                            ShortAdditional classifiers for RelatedArtifacts
                            Control0..1
                            TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                            Is Modifierfalse
                            Summaryfalse
                            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())
                            152. Composition.relatesTo:specificationOf.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()))
                            154. Composition.relatesTo:specificationOf.type
                            Definition

                            The type of relationship to the related artifact.

                            Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
                            Control1..1
                            BindingThe codes SHALL be taken from ArtifactRelationshipType
                            (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                            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
                            Must Supportfalse
                            Summaryfalse
                            Pattern Valuespecification-of
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            156. Composition.relatesTo:specificationOf.target[x]
                            Definition

                            The artifact that is related to this Composition Resource.

                            ShortThe artifact that is related to this Composition
                            Control1..1
                            TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                            [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                            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()))
                            158. Composition.relatesTo:dependsOn
                            Slice NamedependsOn
                            Definition

                            Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
                              "targetReference": {
                                "identifier": { 
                                  "system": "...", 
                                  "value": "..."
                                }
                              } 
                            }]
                            
                            Control0..*
                            TypeBackboneElement
                            Is Modifierfalse
                            Must Supportfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                            160. Composition.relatesTo:dependsOn.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
                            162. Composition.relatesTo:dependsOn.extension
                            Definition

                            An Extension

                            ShortExtension
                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 164. Composition.relatesTo:dependsOn.extension:classifier
                              Slice Nameclassifier
                              Definition

                              Provides additional classifiers of the related artifact.

                              ShortAdditional classifiers for RelatedArtifacts
                              Control0..1
                              TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                              Is Modifierfalse
                              Summaryfalse
                              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())
                              166. Composition.relatesTo:dependsOn.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()))
                              168. Composition.relatesTo:dependsOn.type
                              Definition

                              The type of relationship to the related artifact.

                              Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
                              Control1..1
                              BindingThe codes SHALL be taken from ArtifactRelationshipType
                              (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                              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
                              Must Supportfalse
                              Summaryfalse
                              Pattern Valuedepends-on
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              170. Composition.relatesTo:dependsOn.target[x]
                              Definition

                              The artifact that is related to this Composition Resource.

                              ShortThe artifact that is related to this Composition
                              Control1..1
                              TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                              [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                              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()))
                              172. Composition.relatesTo:supportedWith
                              Slice NamesupportedWith
                              Definition

                              Relationships that this composition has with other compositions or documents (FHIR or non-FHIR resources) 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 targetReference 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",
                                "targetReference": {
                                  "identifier": { 
                                    "system": "...", 
                                    "value": "..."
                                  }
                                } 
                              }]
                              
                              Control0..*
                              TypeBackboneElement
                              Is Modifierfalse
                              Must Supportfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                              174. Composition.relatesTo:supportedWith.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
                              176. Composition.relatesTo:supportedWith.extension
                              Definition

                              An Extension

                              ShortExtension
                              Control0..*
                              TypeExtension
                              Is Modifierfalse
                              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.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                              • value @ url
                              • 178. Composition.relatesTo:supportedWith.extension:classifier
                                Slice Nameclassifier
                                Definition

                                Provides additional classifiers of the related artifact.

                                ShortAdditional classifiers for RelatedArtifacts
                                Control0..1
                                TypeExtension(RelatesTo Classifier) (Extension Type: CodeableConcept)
                                Is Modifierfalse
                                Summaryfalse
                                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())
                                180. Composition.relatesTo:supportedWith.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()))
                                182. Composition.relatesTo:supportedWith.type
                                Definition

                                The type of relationship to the related artifact.

                                Shortdocumentation | justification | 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 | specification-of | created-with | cite-as | summarizes
                                Control1..1
                                BindingThe codes SHALL be taken from ArtifactRelationshipType
                                (required to http://hl7.org/fhir/ValueSet/artifact-relationship-type|6.0.0-ballot3)

                                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
                                Must Supportfalse
                                Summaryfalse
                                Pattern Valuesupported-with
                                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                                184. Composition.relatesTo:supportedWith.target[x]
                                Definition

                                The artifact that is related to this Composition Resource.

                                ShortThe artifact that is related to this Composition
                                Control1..1
                                TypeChoice of: uri, Attachment, canonical(Resource), Reference(Resource), markdown
                                [x] NoteSeeChoice of Data Typesfor further information about how to use [x]
                                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()))
                                186. 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 or both (hasValue() or (children().count() > id.count()))
                                188. 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
                                190. 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()))
                                192. 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()))
                                194. 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()))
                                196. 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()))
                                198. 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 no entries are included (emptyReason.empty() or entry.empty())
                                ele-1: All FHIR elements must have a @value or children or both (hasValue() or (children().count() > id.count()))
                                200. 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
                                202. 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()))
                                204. 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()))
                                206. 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()))
                                208. 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()))
                                210. Composition.section.author
                                Definition

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

                                The actual author of the section when it is not the author of the composition. If author is not specified, the author is assumed to be the author of the parent section or the author of the composition.

                                ShortWho and/or what authored the section, when the section is authored by someone other than the composition.author
                                Control0..*
                                TypeReference(Practitioner, PractitionerRole, CareTeam, 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()))
                                212. 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()))
                                214. 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()))
                                216. 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()))
                                218. 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()))
                                220. 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()))
                                222. 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()))